Printable 3-Day Bladder Diary Template
Print this sheet, keep it on the bathroom counter, and fill it in over three days. Bring it to your next appointment, or type your numbers into the free in-browser diary to get the calculations automatically.
Urge levels: 0 No urge, 1 Mild, 2 Moderate, 3 Strong, 4 Leaked. Scale adapted from the PPIUS (Patient Perception of Intensity of Urgency Scale).
Day 1
| Time | Trips to the bathroom and amount | What you drank and amount | Urge level (0-4) | Leaks |
|---|---|---|---|---|
| Morning wake | ||||
| Bedtime |
Day 2
| Time | Trips to the bathroom and amount | What you drank and amount | Urge level (0-4) | Leaks |
|---|---|---|---|---|
| Morning wake | ||||
| Bedtime |
Day 3
| Time | Trips to the bathroom and amount | What you drank and amount | Urge level (0-4) | Leaks |
|---|---|---|---|---|
| Morning wake | ||||
| Bedtime |