Overactive bladder (OAB) is an umbrella term for various urinary tract complaints. The most common symptom is a sudden urge to urinate that you cannot control. Other symptoms include urine leakage, frequent urination, and waking up during the night to urinate.
OAB is a common condition, affecting as many as 40% of women and 30% of men in the United States. It can usually be managed with lifestyle changes, prescription medications, botulinum toxin (Botox) treatments, nerve stimulation, and, in severe cases, surgery.
Whether you have already been diagnosed with OAB or suspect you may have it, you may want to consider keeping a bladder diary. This can give you clues as to what’s behind your OAB symptoms and even help you manage them.
“The bottom line is that these are very easy to do,” says Howard Goldman, MD, a urologist at Cleveland Clinic. “They cost nothing, there is no risk, and many of the guidelines on treating overactive bladder suggest that keeping a diary before starting treatment can be very helpful.”
There are several reasons why you may want to start a bladder diary.
Collecting data for yourself: “If you think something is going on, keeping a bladder diary can be very helpful just to see how often you actually go to the toilet and when you leak urine,” says Margaret Mueller, MD, urogynecologist at Northwestern Medicine in Chicago.
That said, Mueller notes that women in particular tend to think they urinate too often because “their bladder prevents them from doing 100 million things in a day.” In reality, she says they are often within the normal range. A bladder diary can demonstrate this and reassure you.
To take with you to your healthcare provider: If you decide to consult your doctor about your symptoms, it is helpful to keep a bladder diary. For example, keeping track of how much you pee can give your healthcare provider a much better idea of how much your bladder can hold and how much you actually go to the toilet. “We have patients who think they go all the time, but when you see their diary, they only go five times,” says Goldman. “It’s a big difference if someone is only holding 6 ounces in their bladder, versus 15 ounces.”
To identify behavior you can change: You may have unpleasant symptoms, such as having to go to the toilet too often or having to run to get to the toilet on time. Goldman says a bladder diary can show you certain behaviors you can change on your own before you even go to the doctor.
For example, you may notice that you drink a lot just before going to bed or consume more Diet Coke per day than you thought. “Sometimes part of the OAB problem is that someone is consuming too much fluid or too much caffeine, which may be an underlying factor,” says Goldman.
When your healthcare provider asks: Goldman has his patients keep a bladder diary when he first sees them. “It’s paramount to get an idea of what’s going on from the start,” he says.
Both Mueller and Goldman also sometimes have their patients keep a bladder diary when starting a new treatment or to measure their response to treatment. “There are some therapies that we can do a trial for. In those cases, we can keep a diary before and during therapy to get an idea of how much it helps,” says Goldman.
Mueller uses a bladder diary to see how often her patients pass urine when they have a strong urge to go to the toilet and how often they pass urine when coughing, sneezing, etc. She also wants to see how often they urinate. This combination helps her determine what treatment may be needed.
“Let’s say there’s no leakage, but they’re going to the toilet every 30 minutes,” says Mueller. “You may be able to do an intervention called timed voiding, which is basically retraining the bladder. This has proven to be effective.” In this example, you would try to take an hour to go to the toilet instead of 30 minutes. Gradually you should add another 30 minutes until you are urinating every 2 hours.
When you get up several times a night: A bladder diary is important for people who urinate frequently at night “because we can see if they are passing more urine than they should during the night,” says Goldman. Normally, you should urinate less than a third of your total urine volume at night, he explains. If you are urinating more, it may indicate other medical problems that are causing your body to excrete more fluid in the evening.
One of the most common causes of making too much urine at night, known as nocturnal polyuria, is obstructive sleep apnea. “If you have obstructive sleep apnea, you produce less antidiuretic hormone because the body thinks it’s daytime and makes urine normally,” says Mueller. If someone has risk factors for sleep apnea, such as snoring, being overweight or obese, “we typically refer them for a sleep study to see if that might be playing a role,” she says. “The advantage is that sleep apnea is reversible and treatment for it can really reduce bladder symptoms.”
Choose your tracking method. You can write your bladder diary in a notebook, download a template and print it out (Goldman recommends this), or find an app for your phone. There are even companies that sell cups that measure your urine and automatically upload your volume to an app, Goldman said. “The average person probably doesn’t need to be that fancy,” he says.
Keep the diary for 3 days. One day isn’t enough because things can change too much from day to day, Goldman says. “There have been studies showing that a three-day diary is not much different from longer diaries. So three days is short enough to get an idea of what’s going on, but long enough to give you an accurate idea” , he explains.
Use periods of 24 hours. Start tracking when you wake up in the morning. You do not have to follow 3 days in a row, but you do have to follow 24 hours in a row. For example, if you get up at 7 a.m. the first day, fill your calendar until 7 a.m. the next day.
Measure your urine. You will need a cup unless you have a collection device from your health insurer. A measuring cup is a good choice so you can see exactly how much you’ve passed. After each use, rinse the cup or collection system with water. Make sure you measure and keep track of how much urine you pass both during the day and at night.
Use a bladder diary to track information and symptoms, such as:
- How much fluid you drink
- How often you drink
- How often you urinate
- How much you pee
- How often you feel an urgent need to urinate
- When and how much urine you lose, if applicable
Goldman emphasizes that it’s important to have your healthcare provider monitor everything if you have OAB symptoms. “There’s everything now, from certain exercises to a lot of medications, Botox injections and pacemakers,” he says. “We can do anything, so OAB is not something people have to live with.”