How to Keep a Bladder Diary

Overactive bladder (OAB) is an umbrella term for several urinary symptoms. The most common symptom is a sudden urge to urinate that you can’t control. Other symptoms include leaking urine, frequent urination, and waking up at night to urinate. 

OAB is a common condition, affecting as many as 40% of women and 30% of men in the United States. It can usually be managed with lifestyle changes, prescription medications, botulinum toxin (Botox) treatments, nerve stimulation, and, in severe cases, surgery. 

Whether you’ve already been diagnosed with OAB or you suspect you have it, you may want to consider keeping a bladder diary. This can give you clues about what’s behind your OAB symptoms and even help you manage them. 

“The bottom line is, these are very easy to do,” says Howard Goldman, MD, a urologist at Cleveland Clinic. “They don’t cost anything, there’s no risk, and many of the guidelines on how to treat overactive bladder suggest that a keeping a diary before starting treatment can be very helpful.”

There are several reasons you may want to start a bladder diary.

To gather data for yourself: “If you think something might be going on, keeping a bladder diary could be really helpful just to see how often you’re really going to the bathroom and when you leak urine,” says Margaret Mueller, MD, a urogynecologist at Northwestern Medicine in Chicago. 

That said, Mueller notes that women in particular tend to think that they urinate too frequently because “their bladder is interfering with their being able to do 100 million things in a day.” In reality, she says they’re often within the range of normal. A bladder diary can show this and give you reassurance.

To take to your health care provider: If you decide to see your health care provider about your symptoms, it’s helpful to have a bladder diary completed. For instance, keeping track of how much you’re urinating can give your provider a much better sense of how much your bladder can hold and how much you’re actually going to the bathroom. “We have patients who think they’re going all the time, but you see their diary and they’re only going five times,” says Goldman. “It’s a big difference if someone’s holding just 6 ounces in their bladder versus 15 ounces.”

To pinpoint behaviors that you can change: Maybe you’re having bothersome symptoms like having to go to the bathroom too often or needing to run to get to the bathroom in time. Goldman says a bladder diary may show you some behaviors that you can change on your own before you even go to the doctor. 

For example, you might see that you’re drinking a lot right before you go to bed or consuming more Diet Cokes a day than you thought. “Sometimes, part of the OAB problem is that someone may be taking in too much fluid or too much caffeine, which may be an underlying contributing factor,” Goldman says.

When your health care provider requests it: Goldman has his patients keep a bladder diary when he first sees them. “It’s most important right at the start to get some idea of what’s going on,” he says.

Both Mueller and Goldman also sometimes have their patients keep a bladder diary when they start a new treatment or to measure their response to treatment. “There are some therapies where we may do a trial. In those cases, we may do a diary beforehand and then during the therapy to get a sense of how much it’s helping,” Goldman says.

When you get up multiple times during the night: A bladder diary is important for people who urinate often at night “because we can see if they’re putting out more urine at night than they should,” says Goldman. Typically, you should urinate less than a third of your total volume of urine at night, he explains. If you’re voiding more than that, this could indicate other medical problems that are causing your body to put out more fluid in the evening.

One of the more common causes of making too much urine at night, known as nocturnal polyuria, is obstructive sleep apnea. “When you have obstructive sleep apnea, you make less antidiuretic hormone because the body thinks it’s daytime and makes urine like normal,” says Mueller. If someone has risk factors for sleep apnea such as snoring, overweight, or obesity, “we’ll typically have them referred for a sleep study to see if that might be part of the picture,” she says. “The benefit is that sleep apnea is reversible and getting treated for it can really reduce those bladder symptoms.”

Pick your tracking method. You can write your bladder diary in a notebook, download a template and print it out (Goldman recommends this one), or find an app for your phone. There are even companies that sell cups that measure your urine and automatically upload your volume to an app, according to Goldman. “Your average person probably doesn’t need to be that fancy though,” he says.

Keep the diary for 3 days. One day isn’t enough because things can change too much from day to day, Goldman says. “There have been studies that show that a 3-day diary isn’t much different than longer diaries, so 3 days is short enough to get a sense of what’s going on but long enough to give you an accurate idea,” he explains. 

Use 24-hour periods. Start tracking when you wake up in the morning. You don’t have to track for 3 days in a row, but you should do 24 hours at a time. For example, if you get up at 7 a.m. the first day, fill out your diary until 7 a.m. the next day.

Measure your urine. You’ll need a cup unless you have a collection device from your health care provider. A measuring cup is a good choice so you can see exactly how much you’ve passed. You’ll need to rinse the cup or collection device with water after every use. Be sure to measure and keep track of how much urine you pass both during the day and at night.

Use a bladder diary to track information and symptoms such as:

• How much fluid you drink
• How often you drink
• How often you urinate
• How much you urinate
• How often you feel an urgent need to urinate
• When and how much urine you leak, if applicable

Goldman stresses that it’s important to have your health care provider check everything out if you have OAB symptoms. “There’s everything now, from certain exercises to plenty of medications to Botox injections and pacemakers,” he says. “We can do all kinds of things, so OAB is not something people should have to live with.”