A bladder diary is a log of how much a person drinks in a day, how much they urinate and if they experience any leaking. This information can give us great insight into a person’s daily routine and habits and be used as an assessment tool. I typically have patients with “overactive bladder” or increased frequency of urination as well as those with leaking fill out this worksheet. We can find out a lot of valuable information, including how many times a day one goes to the bathroom and how much is being voided. We can look at if the person actually needed to go or if they were peeing “just in case.” We can also see if they have potential bladder irritants and what the most common causes of their leaking may be. I do like to make a caveat to that and remind us all that correlation does not imply causation and we need to take a look at the picture (and person) as a whole and not in isolated situations.
After we have identified patterns in voiding habits, overall intake and timing of fluids we can begin to address any habitual changes that may improve urinary frequency and urgency symptoms based on the results.
As mentioned above, if there seems to be a trend with a certain intake (whether it be food or drink) and increased leaking or urgency/ frequency we can do one of 2 things.
The first thing that we could do is potentially begin a trial of elimination of certain known bladder irritants, or ones that stand out the most in your bladder diary. Some common bladder irritants include alcohol, citrus/acidic fruit, coffee (even decaf) and tea, carbonated beverages, chocolate, vinegar, spicy food and tomato-based products to name a few. And as mentioned above, these irritants can lead to urinary frequency, urgency and incontinence. Most people are not sensitive to all of the mentioned irritants, so it is important to find out which ones irritate your symptoms.
The second thing that we have the option of doing – is just having an awareness of the information and not necessarily doing anything about it. If we do see a correlation between something consumed and output, whether that be leaking or increased frequency, we can acknowledge that and keep it in the back of our minds. It is powerful to have the knowledge and be able to make certain choices with that information if need be. For example, coffee is a bladder irritant to me personally however I love coffee and it makes me happy, so I continue to drink it. I do however increase the amount of water I drink with my coffee (not in my coffee, but one sip coffee, one sip water and repeat) to help decrease its irritating effects on my bladder. I also selectively choose when I will and will not drink it. If I am at home I will definitely have a cup of coffee, even with the increased likelihood that it may cause me to leak. On the other hand, if I were to give a presentation in front of a bunch of people and I was wearing white pants, I would most certainly decrease my coffee consumption that day, or not drink it at all, to minimize my chances of leaking. So ultimately, I have the knowledge of what causes my symptoms, and depending on the day and situation I change my behavior accordingly.
Here is an example of a bladder diary and a “sample” of an hour in this person’s life.
In the above example we can see that this person had coffee, and in the same hour they voided twice and leaked with running. There are a couple of takeaways from this. Firstly, we know that the normal time between voids is 2-5 hours so to pee twice in 1 hour would be “abnormal.” Secondly, not only did this person pee twice in 1 hour but then also leaked with exercise in the same hour. This is only one day (and one hour) in this person’s life so I would want to be careful about making assumptions and I would want to compare it to other days, but with coffee being a known bladder irritant and the amount of voiding and leaking this person experienced after drinking it, it makes me more susceptible to believing that this may very well be a bladder for this person. So where do we go from here? Well as mentioned above, I take the person’s goals, likes/ dislikes and motivation into account. They could either try eliminating coffee, decreasing coffee intake, increasing water intake around coffee intake or do nothing and just be aware that coffee may be a triggering factor for their symptoms.
When educating my patients on this log, the most ideal would be daily for a week, but often this is unrealistic for most people to remember to do this, so at a minimum I have my patients fill one out during a working day and one on a non-working day.
This is only one (very helpful) piece of the puzzle and there are other factors to consider when treating overactive bladder and leaking. Come visit us at Up and Running Physical Therapy in Fort Collins so that we can start putting all of the pieces together to decrease your symptoms and improve your quality of life.
Dr. Sam Greig.
This blog was written by our very own Pelvic/Women’s Specialist, Dr. Sam Greig.