Bladder diary analysis

A three day bladder diary is an essential part of a continence assessment. It is best if it is completed prior to the assessment to enable the information to be analysed in conjunction with the rest of the assessment. The three day bladder diary is a tool to support the diagnosis and can be repeated during treatment to enable evaluation of progress.

What needs to be recorded?

• Record each day the time you get up and the time you go to bed
• Measurements of each void in ml recorded on the chart to nearest hour (some individuals may void more than once per hour)
• Record of degree of urgency for each void (0 = no urgency, 1, 2, 3 = very urgent)
• Record of all wet episodes and degree of wetness. The degree of wetness could be subjective (dry, damp/dribble, wet/stream, soaked/flood) or by pad weighing
• What you were doing when you leak – you may want some individuals to record this information
• Record of pad/underwear changes

Fluid intake and voiding

The following information is required about fluid intake:

• Volume of drink (measure how much the drinking mug/cup/glass holds)
• Type of drink
• Time taken to nearest hour

Clinical practice points. Measurement of the voided volumes are important, if there is only a tick on the chart how do you know if 50ml or 500ml was voided^[1]?

Support from relatives and carers will be needed to collect this information for some individuals.

If it is not possible to measure during the night, a commode can be used and the total volume voided measured, this will enable clinical judgements to be made.

Urgency score is important when the diagnosis is overactive bladder. The chart can be repeated during treatment and the scores compared as part of the evaluation.

Pad weighing

24 hour pad weighing is a method to obtain this information and it can be undertaken in care homes or hospital wards and in individual’s homes.Pad weighing can be undertaken as part of the diary as 1g weight is equivalent to 1ml urine.Pad weighs are usually done using a 24 hour pad collection where all pads used in a 24 hour period are collected in a sealable bag and then weighed. Voided volume (ml) = weight of wet pad (g) – weight of dry pad (g).

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Your task

Use the example bladder diary (available in PDF format) to analyse:

• Total fluid intake volume
• Total urine output
• Number of daytime voids
• Number of episodes nocturia
• Maximum functional bladder capacity
• Average voided volume
• Average urgency score

Did you find this information easy to identify and calculate?Share your thought with fellow learners about the information you gained from the bladder diary.

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References

_{1. Colley W. Use of frequency volume charts and voiding diaries. Nursing Times. 2015 January;111:5;12-15. [Cited 24 August 2018] Available from: https://www.nursingtimes.net/clinical-archive/continence/use-of-frequency-volume-charts-and-voiding-diaries/5081466.article2. Gilbert R. Fluid intake and bladder and bowel function. Nursing Times. 2006 March;102;12;55. [Cited 24 August 2018] Available from: https://www.nursingtimes.net/fluid-intake-and-bladder-and-bowel-function/201368.article}