1 Bladder Diary Does Not Fit All
For almost a decade I gave my patients copies of a bladder diary I googled on-line, but I realized that one bladder diary wouldn't suit all of my patients (in fact I needed multiple versions), so...I re-invented the wheel a little bit. These are descriptions of the 3 bladder diaries I use in my practice and the resources are linked to the bottom of this page:
BLADDER DIARY A: 'Type A'
This is the most specific. Fluid intake and output is recorded in mL across a span of 3 days. Due to its quantitative ability, this diary would be preferable for someone who has a history of cardiac or renal dysfunction. If a therapist suspects a medication interaction, a medication consultation form is provided in ‘The Bladder Book.’
BLADDER DIARY B: Basic
This bladder diary is more basic and convenient. Output is measured in “Mississippi’s” (seconds) and the patient is asked to describe their urine flow. It is easier to do, but more qualitative in nature.
BLADDER DIARY C: Caregiver
This is optimal for the caregiver. Urinary incontinence is one of the biggest reasons for nursing home admissions. Bladder diary C enhances communication between caregivers and provides the therapist with the necessary information to set-up a plan of action for improving bladder health and hygiene.
WHAT WAS MISSING IN THE FREE RESOURCES?
BOWEL FUNCTION
Most bladder diaries didn’t take into consideration bowel issues! For example, if I was assessing bladder urgency didn’t I need to know if my client was constipated? The bladder diaries that I created all have columns for voluntary & involuntary evacuation of stool that they complete across a 3-day time-frame. Usually I have the patient complete it before their 1st visit; it sends a message that we are going to be comprehensive in our assessment & suddenly asking about stool consistency becomes more conversational! Most of my patients don’t even know I can help them with bowel function, but now they do and early in the game!
FLUID INTAKE VERSUS FLUID OUTPUT
A significant portion of the general population has heart and/or kidney dysfunction; monitoring fluid intake and output in this population is crucial! Relying on descriptions of fluid intake with cups, cans and oz., and fluid output with “small, medium or large” isn’t going to cut it with this population. Quantifying fluid intake and output gives credible insight and useful information you can provide the doctor. Furthermore, a substantial number of people with urinary incontinence restrict fluid intake! Calculating fluid intake and output as well as looking at the ratio of dehydrating to hydrating fluids and bladder irritants is helpful.
INSTRUCTION
Most bladder diaries came with no instruction. I realized if someone sent me the old bladder diary I used prior to my initial evaluation I would be frustrated taking the time to do it and not really understand what I was doing. Adding instructions benefits the patient and practitioner. Details like how to clean a measuring cup and convert milliliters to ounces (just to name a couple) removes barriers to completing the diary.
PROVIDE CLARITY WITH OBJECTIVE DATA
Clarity can come to the patient simply by doing the bladder diary. It’s a useful baseline tool and occasionally worthwhile repeating during treatment. I rely on bladder diaries to determine treatment interventions and goals and I select the best bladder diary to use based on the patient.
- Article written by Susannah Haarmann, PT, WCS, CLT
Susannah is a board-certified Women's Clinical Specialist by the American Physical Therapy Association. She is a private practice owner in Asheville, North Carolina, teaches nationally in pelvic health and internationally in breast oncology rehabilitation. Susannah is an advocate of conservative treatment for pelvic health conditions and writes handouts for practitioners to improve patient literacy.