This past weekend, I had the wonderful experience of assisting at Herman & Wallace’s Level 1 Pelvic Floor Course, held here in Atlanta. I have been assisting at these courses for the past 4 years now, and I absolutely love it. There’s nothing better than helping clinicians who are new to the field of pelvic health learn and grow in this fantastic specialty. I love the excitement, the slight fear (I mean, many of these folks are doing their first vaginal exams at these courses), and the growing passion for helping men and women with pelvic floor problems. And the most exciting thing is knowing that they are going out in their communities to begin offering this service to people who really need it. And, now you know how much that really means to me.
The initial level 1 course covers an introduction to pelvic floor dysfunction (all diagnoses), and covers bladder dysfunction in more detail. One of the prerequisites of the course is for all participants to complete a bladder diary which is then evaluated in the class. So, why keep a bladder or bowel diary?
First, let’s be honest, we are all horrible historians. Many of us can barely remember what we ate for breakfast, let alone remember all the details of our bathroom habits! Let me ask you this:
- How many times did you urinate yesterday?
- How much fluid did you drink? What exactly did you drink?
- What did your poop look like? When did you poop?
If you’re like me, it’s probably tricky to recall these exact details. (Well, you may be slightly better at recalling than I am, now that my pregnancy brain is in full effect!). And, if you are having any problems with your bowels or bladder, these details really do matter. Here are a few examples:
Patient #1: Mary (obviously not her name) was a lovely 65 year old retired nurse experiencing urinary leakage on her way to the restroom several times each day. She had tried exercises, dietary changes, and medications, and her problem kept persisting. Her bladder diary was eye opening for both of us! We learned that she only leaked urine when she would hold her bladder for over 6 hours! After years of holding her bladder for entire shifts, she got into some pretty bad habits. Once we changed this, her leakage went away completely!
Patient #2: Sara(also, not her name) was a 10 year old girl having bowel accidents daily. Once we did a diary, we found out the problem! Her mother was a hair stylist who saw clients out of her home. Sara was afraid to have a bowel movement while her mom’s clients were there, and had started having accidents from getting too constipated! The three of us quickly determined a “code word” for Sara to tell her mom when she needed to go, and within 2 weeks, the problem was solved!
So, as you can see… these little diaries can be oh so powerful! So, let’s get into the details!
Who should do a bowel or bladder diary? Well, in my mind, everyone should try it at some point! It’s so cool to see what your patterns really are… but for sure, anyone who is having problems like urinary urgency or frequency, urinary leakage, constipation or bowel leakage.
How long should you keep one? Typically, I like people to track for at least 3 days. Preferably, two of those days should be “regular” and one can be “different.” For example, if you are working, you may choose two days to be work days, and one to be over the weekend.
What should you look for? The best thing to do if you are having problems is to bring your diary to your health care provider. He or she will be able to analyze it completely, and give you insight into what may be happening. However, I do think there is some benefit in doing a little sleuthing yourself. Here are a few things to identify:
- How often are you going? Normal bladder frequency is typically around 5-8 times each day, and less than 1 time each night. Normal bowel frequency varies quite a bit from 1 time over 3 days to 3 times each day.
- How strong are your urges when you go? Generally, I recommend grading urges on a 0-3 scale (from no urge –> gotta go right now!). Were most of your urges very small? Were you running to the bathroom all day?
- How much did you urinate? The best way to track this is to actually measure your output (usually a cheap plastic cup or a dollar tree measuring cup works well). Normal output of urine is 400-600 mL per void. You can also try just counting the seconds of your stream, however, this does tend to be less accurate. We generally tell people that each stream should be at least 8 seconds.
- What did your poop look like? Was your stool soft and formed? Little rabbit pellets? Did you have to push hard to empty your bowels or did they come out easily? Did you have any discomfort or pain?
- What was your diet like? Do you notice any trends in what you eat or drink? Were you drinking some well-known bladder offenders (like caffeinated drinks, soda, coffee, artificial sweeteners or sugary drinks)? Did you eat at really regular intervals? (You know I love my bowel routines!)
- Did you notice any trends? Did you always go to the bathroom when you had the littlest urge? Was most of your leaking with coughing or sneezing? Does running water send you running to the bathroom? Did you always have a bowel movement after your morning coffee?
As you can see, so much wonderful information can be gleaned from these diaries, so if you’re having problems, get started today! Knowledge is power, and once we become aware and identify trends in our habits, we can make the changes needed to really help us get the most out of our bodies!
If you want to get started today, try using one of these free templates available online (John Hopkins’ Bladder Diary, Continence Foundation Diary, or Movicol’s “Choose your Poo!” Diary) There are also wonderful apps available now for tracking bowel/bladder function! This is a sample of a diary I frequently use in the clinic (see below).
So, get tracking! And, on a serious note– don’t forget that these diaries can also help to determine if you are having a more serious problem, so please, please please, see your health care provider for an evaluation if you are having the types of problems we discussed today!