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Toilet

Inkontinensdiagram

This form is to: 1) Record the times you pass urine, 2) Record the amount of urine you pass on each occasion and 3) Record the times you leak urine (are incontinent).

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  • Tick (to the nearest hour) each time you go to the toilet to pass urine.

  • If your doctor or nurse asks, when possible, also record the amount (volume) of urine you pass each time. You can use a household measuring jug to do this. If you are away from home and it is inconvenient to measure the amount then just record the time with a tick.

  • If you leak urine unintentionally, record the times it happens (to the nearest hour). Put one, two or three + signs in the box. + = damp. ++ = wet. +++ = soaking.

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Explore bladder control treatments

Get expert healthcare advice from the comfort of home. Complete a quick online consultation, available 24/7, with your request reviewed by a UK-registered clinician. Next day delivery available on eligible treatments.

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Ansvarsfriskrivning: The views expressed in the community do not represent medical advice. For any health concerns, consult your GP or healthcare provider.

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