Printable Bladder Diary: Free 3-Day Bladder Diary (PDF)

All four files have the same six pages. Pick the paper size you use: US Letter in the US and Canada, A4 almost everywhere else.

• Bladder Diary, color, US Letter (PDF, 6 pages)
• Bladder Diary, black and white, US Letter (PDF, 6 pages)
• Bladder Diary, color, A4 (PDF, 6 pages)
• Bladder Diary, black and white, A4 (PDF, 6 pages)

A bladder diary is a written record, usually over three days and nights, of what you drink, when you pass urine, how urgent it felt, and when you leak. The NIH’s bladder diary says it will help you and your health care team figure out the causes of your bladder control trouble.

The pattern matters. Leaks that happen when coughing, sneezing or lifting point one way; leaks that come with a sudden, strong urge point another; many trips with small amounts, or a lot of trips at night, tell the doctor something else again. A diary shows that pattern in a way memory usually cannot.

• Page 1 — How to keep the diary: the four things to write down, the urgency scale from 0 to 4, and leak sizes.
• Pages 2 to 4 — Day 1, Day 2 and Day 3: the date, when you woke and went to bed, and a line for each drink, toilet trip or leak, with the amount, the urgency, the leak size, what you were doing, and a box to tick for a pad change. Day totals at the bottom.
• Page 5 — 3-day summary: copy each day’s totals and work out the average, then note what most leaks were linked to and your questions.
• Page 6 — When to see a doctor: the warning signs, and questions you might ask at the appointment.

These steps follow the NHS three-day bladder diary and the NIH bladder diary. If your clinic gives you its own diary or asks for different details, follow theirs.

1. 1

   Keep it for three days and nights in a row

   and, if you can, include a busy day and a quiet day, because habits can change.

2. 2

   Start when you get up on Day 1

   and count anything during the night toward the day before, until you get up the next morning.

3. 3

   Write down every drink

   with its type and how much. If you always use the same cup or glass, measure it once and use that amount every time.

4. 4

   Write down every time you pass urine

   and, if your doctor or nurse asks you to, how much. If you forget to measure, still write the time and put an x.

5. 5

   Give each trip an urgency score

   from 0 to 4, using the scale below.

6. 6

   Mark every leak at the time it happened

   however small, with its size and what you were doing.

This 0 to 4 scale is based on the one in the NHS three-day bladder diary.

The NIH bladder diary records each leak as small, medium or large, whether you felt a strong urge to go, and what you were doing at the time. This diary uses the same idea:

• S, small: a few drops.
• M, medium: wet underwear or pad.
• L, large: soaked through, or wet clothes.

Write what you were doing in a few words: coughing, lifting, getting up from a chair, running water, putting the key in the door. Those notes are often the most useful part of the diary.

The NIDDK also advises seeing a health care professional for trouble urinating, loss of bladder control, waking at night to urinate, pelvic pain or leaking urine.

Your doctor or nurse will use the diary to work out the type of leakage and the next step. The NIDDK lists bladder training, where you go to the toilet on a schedule and slowly lengthen the time between trips, and pelvic floor muscle exercises among the treatments. A physical therapist trained in pelvic floor therapy can help with the exercises.

• How to talk to a doctor about incontinence
• Pelvic floor exercises for seniors
• Managing incontinence at home
• Nighttime incontinence solutions

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