Urination Log

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Average Ratings

INSTRUCTIONS

This chart helps track your urinary patterns and accidents over a 24-hour period. It's important for your doctor to know what is going on with your body so you can get the best treatment.

  • Make copies of the chart and fill in for three or four days in a row.
  • Bring all completed charts as well as a list of drugs (including over-the-counter medications) you are taking when you see your doctor.
EXAMPLES
  • Under "What Happened," you might write, Couldn't make it to the bathroom in time, Wet bed when sleeping or Leaked urine right after using the toilet and flushing.
  • "Type and Amount of Most Recent Fluid Intake" might include 2 cups of caffeinated coffee, 12-ounce bottle of water or 1 glass of wine.
DATE:
About What Time Did You Urinate or Have a Leak Did You Urinate in the Toilet? Did You Have a Leak or Wet Yourself? What Happened? What and How Much Did You Drink During the Day?
a.m. / p.m. Yes / No Yes / No
a.m. / p.m. Yes / No Yes / No
a.m. / p.m. Yes / No Yes / No
a.m. / p.m. Yes / No Yes / No
a.m. / p.m. Yes / No Yes / No
a.m. / p.m. Yes / No Yes / No
a.m. / p.m. Yes / No Yes / No
a.m. / p.m. Yes / No Yes / No
a.m. / p.m. Yes / No Yes / No
a.m. / p.m. Yes / No Yes / No
External Source

Adapted from Health A to Z. Accessed July, 2008. Available at: http://www.healthatoz.com/healthatoz/Atoz/common/standard/transform.jsp?requestURI=/healthatoz/Atoz/dc/caz/kidn/uinc/incontlog.jsp

Author: Geri Metzger

Disclaimer: The information about educational or therapeutic approaches is provided for educational purposes only. Certain treatments may or may not be covered through your benefit plan. Coverage typically depends on your plan specifications and relevant guidelines maintained in relation to your benefit plan.

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