All for 1 & 1 for all! – Doesn’t Work for Bladder Diaries

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As a women’s health physiotherapist, I created 3 different bladder diaries to give my patients. It’s not that I wanted to re-invent the wheel…I felt that I had to! These 3 bladder diaries and the collection of bladder diaries I use in my practice are available in ‘The Bladder Book.’

For almost a decade I gave patients bladder diaries I googled on-line. I appreciated these free resources, but they didn’t include all the information I needed. I also realized that one bladder diary doesn’t suit everyone.

The 3 bladder diary options I created for different patient populations are:

  1. Bladder Diary A – for ‘Type A’ analysis
  2. Bladder Diary B – Basic
  3. Bladder Diary C – for the caregiver of someone with cognitive deficits.

What was missing in the free resources?

Bowel Function

Most bladder diaries didn’t take into consideration bowel issues! For example, if I am assessing bladder urgency don’t I need to know if my client is constipated? The bladder diaries that I created all have columns for voluntary & involuntary evacuation of stool. This information & the task of doing a 3-day bladder diary is very useful. When the patient completes the diary before their evaluation, it sends a message that we are going to be comprehensive in our assessment & suddenly asking about stool consistency becomes more conversational! If completed after the first assessment, I often see inconsistencies between patient report and the diary…enough to change my plan of care! 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 large 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 go to the doctor with. 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.


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 benefit the patient and practitioner. Details like how to clean a measuring cup and convert milliliters to ounces or encouragement to track volume in a consistent manner and draw a line at the time they wake and go to bed may seem insignificant, but streamline and simplify the task and interpretations!

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. I select the best bladder diary to use based on the patient.

Bladder diary 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

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

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 help set-up a plan of action to improve bladder health and hygiene.

Get 'The Bladder Book'

All three bladder diaries complete with instruction, a notes section and summary page are available in ‘The Bladder Book’ for less than $2 per page; this will save a lot of time and improve patient outcomes for the medical practitioner. A bladder diary analysis page is also provided.

Take advantage of launch month and get ‘The Bladder Book’ for 20% off until the end of November 2018!


Susannah Haarmann, PT, WCS, CLT wrote 'The Bladder Book' for pelvic health specialists. As a private practice owner and instructor of continuing education in pelvic health, she saw the value of specific handouts to assist with patient education for improved therapeutic outcomes and continued empowerment in self-practice.