Keeping a Bladder Diary

Complete the information for two consecutive 24-hour periods. Record both day and night.

• Begin with first urination upon arising.

• Record intake amount in ounces and type of fluid (for example, coffee, juice, water, etc.).

• Record approximate urine output and time of urination.

Fluid intake

Fluid output

Time of intake (a.m./p.m.)

Amount and type of fluid (oz)

Time of void (a.m./p.m.)

Amount voided (oz)

Leakage (time, place, quantity)

Day 1

Day 2