Abstract
A bladder diary provides an objective evaluation of the severity of urinary storage symptoms and associated urinary incontinence. Bladder diaries are not used to diagnose detrusor overactivity or urodynamic stress incontinence; however, they help to guide conservative management and to provide lifestyle advice, and keeping a bladder diary is the only method available to diagnose nocturnal polyuria.
A bladder diary provides an objective evaluation of the severity of urinary storage symptoms and associated urinary incontinence. Bladder diaries are not used to diagnose detrusor overactivity or urodynamic stress incontinence; however, they help to guide conservative management and to provide lifestyle advice, and keeping a bladder diary is the only method available to diagnose nocturnal polyuria.
2.1 Types
Frequency-volume chart (FVC) – records the volumes voided and the times of each micturition during day and night, over at least 24 hours.
Bladder diary (BD) or voiding diary – records micturition times, voided volumes, incontinence episodes, pad usage and other information such as fluid intake, the degree of urgency and the degree of incontinence [1].
2.2 Features
Bladder diaries should be completed as a mandatory part of the basic assessment of urinary incontinence, prior to treatment as recommended by NICE [2].
They are more accurate than recall when recording urinary symptoms and are cheap and easy to use.
They can guide many aspects of conservative treatment, and inform timing and type of fluid intake.
Non-completion of a diary does not exclude urinary symptoms.
Reduction in bladder capacity and 24-hour voided volume is associated with aging.
Ideally, a bladder diary should include a minimum of 3 days, covering variations in usual activities, such as both working and leisure days [3,4].
They are especially useful in identifying the following:
disorders associated with compulsive/excessive fluid intake, e.g., diabetes insipidus/mellitus, habitual excessive intake;
inappropriate normal fluid consumption (e.g., at bedtime causing nocturia);
excessive intake of alcohol or caffeine causing exacerbation of symptoms.
Learned or habitual frequency may only be semi-objectively assessed.
2.3 Information Provided by a Bladder Diary
Functional bladder capacity.
24-hour diurnal and nocturnal frequency of micturitions.
Daytime micturitions defined as voiding during waking hours and includes the last void before sleep and the first void after waking.
Nocturia is the number of voids recorded during a night sleep: each void is preceded and followed by sleep.
Voided volumes during the daytime and during the night (which assumes voiding immediately after rising in the morning, and before going to bed).
Duration of day and night, to allow calculation of production rates including nocturnal polyuria which includes the morning void in the nighttime production.
2.4 Formats for Diaries
2.4.1 Paper
This is the most common format (see Figure 2.1).
Advantages
Easily posted or handed directly to the patient.
Easy to produce.
Inexpensive to post.
Easily and safely stored.
Disadvantages
24-hour and nocturnal total volumes are manually calculated which is time-consuming and inaccuracies may occur.
Strong positive relationship between bladder capacity and 24-hour voided volume is not accounted for (unlike an electronic diary).
Strong negative relationship with age, in normality and detrusor overactivity, is not accounted for [5,6].
‘Eye-balling’ charts may therefore lead to inaccuracy.
