How to keep a urination diary?

Author: Lou Wenjia, MD, Peking Union Medical College Hospital

Reviewer: Zhu Lan, Professor, Doctoral Supervisor, Chief Physician, Peking Union Medical College Hospital

If you go to the doctor because of "urinary leakage" or "wetting your pants", the doctor recommends that you try to record your urination (i.e. "urination diary"). What will be your first reaction?

I believe that when most people hear the word "diary", they will subconsciously think that it is time-consuming and laborious, and that it is troublesome and incomprehensible.

So, why should patients with urinary incontinence (commonly known as "urinary leakage" or "wetting pants") keep a urination diary? How to keep a urination diary?

1. What are the symptoms of urinary incontinence?

In simple terms, urinary incontinence is the involuntary leakage of urine through the urethra in adults. Both men and women may experience this disease.

Many female friends think that this is not a disease, but a manifestation of declining body functions due to aging, or that it is an inevitable phenomenon after childbirth, so they do not take urinary incontinence seriously.

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Urinary incontinence is a common urinary dysfunction disease, which brings embarrassment and pain to the patient's life and increases the economic burden of sanitary products. If the condition is not intervened, it will gradually worsen and increase the risk of urinary tract infection. Therefore, we need to seek medical attention and treatment in time.

Symptoms of urinary incontinence include the following 5 situations.

Stress urinary incontinence : The symptoms described by these friends are as follows.

“I pee my pants when I sneeze or cough”

"I leak urine when I do housework, such as mopping the floor"

"I will leak urine involuntarily when I walk fast or jump rope at night"

"I leak urine whenever I carry my child up and down the stairs at home"

“I have uncontrollable urine leakage during sex, which is very embarrassing”

Their common feature is that urine involuntarily leaks out when the abdominal pressure increases due to sneezing, coughing, labor, exercise, etc. Gynecological examination of such patients found that the abdominal pressure of the patients increased and urine involuntarily leaked from the urethra.

Urgent urinary incontinence : It means that the patient has a strong urge to urinate, but the urine cannot be controlled by the will and leaks through the urethra. The symptoms often described by this type of friends are as follows.

“I can’t hold my urine”

"When I feel the urge to pee, I wet my pants before I even get to the bathroom."

In addition to the symptoms of urinary urgency, patients often also have frequent urination, increased nocturia, and frequent urination at night, which can easily lead to lack of sleep. In severe cases, they may develop anxiety and depression.

Mixed incontinence : Symptoms of stress incontinence plus symptoms of urgency or urge incontinence.

Overflow incontinence : caused by a large amount of residual urine in the bladder, more common in chronic lower urinary tract obstruction.

Others : urinary fistula caused by birth trauma, etc.

Do you have a deeper understanding of urinary incontinence now? Do patients have a clearer understanding of it based on their own symptoms? In order to solve the problem of urinary incontinence as soon as possible, we must follow the doctor's advice and start by recording a urination diary.

What is a urination diary?

A urination diary is a record of daily urination by the doctor. Most doctors will provide a corresponding record form. The patient only needs to record the corresponding situation in detail according to the form. The recording time is generally at least 3 days, and it records in detail how much water (including soup) you drink every day, what kind of water you drink (coffee, beverages, tea water or boiled water), whether you have urinary incontinence, that is, involuntary wetting of the pants, whether you have urinary urgency, if you have urinary urgency, to what extent, and whether you use a urine pad, etc. There are 3 commonly used record forms.

1. Urination diary : record the number of urinations, specific urination time, waking time and bedtime in 24 hours a day.

2. Frequency and volume chart : records the number of urinations during the day and at night and the amount of urine each time.

3. Bladder diary : record urination habits for 72 hours, and continuously record the amount of fluid intake, urination time, urine volume per time, number of urinary incontinence and amount of incontinence. Although this record is cumbersome, it can reflect the true situation of urinary incontinence.

3. Why should you keep a urination diary?

Unlike symptoms such as tumors and stones, urinary incontinence cannot be diagnosed through imaging examinations such as color ultrasound and CT, so the urination diary is an important tool and one of the main examination methods for evaluating the daily condition of patients with urinary incontinence.

So what exactly is the purpose of a urination diary?

1. Effectively assist doctors in making correct diagnoses : For example, when a patient comes for a follow-up visit, the doctor can quickly give a correct diagnosis based on the relevant data in the urination diary. It also makes it easier for the doctor to explain to the patient the meaning of the recorded data and the difference between the recorded data and normal data.

2. Correct patients' misconceptions about urinary incontinence : In fact, most patients are not clear about what normal urination is, but they believe that they have urinary incontinence, which is wrong. Therefore, in order to let patients have a correct understanding of urinary incontinence, they can understand normal urination data and specific situations of urinary incontinence through observation and recording of urination diaries. For example, the amount of urination of each person is related to the amount of water consumed. Generally, the number of urination times per day for normal people is less than or equal to 8 times, and the total amount of urine discharged is 1000-1500 ml.

3. Determine whether there is a problem with the bladder : The bladder is a urogenital organ that stores urine. Generally, the initial capacity of the bladder is 100-150 ml, and the normal capacity is 200-300 ml. If the patient finds through recording a urination diary that the actual data recorded is less than the initial capacity, it will help the doctor determine whether the patient has a bladder problem, which will facilitate the doctor's further diagnosis and treatment.

4. Facilitate communication between doctors and patients : After a series of interviews, physical examinations and tests in the outpatient clinic, highly professional doctors can generally determine whether the patient has bladder functional abnormalities. However, some patients do not agree and insist that they are "sick" or even think that the doctor is irresponsible. At this time, the doctor combines the data from the urination diary and explains the physiological characteristics of urination to help patients understand and accept the doctor's judgment.

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4. How to keep a good urination diary

First of all, in order to ensure the accuracy of filling in the form and to record the urination diary more accurately, you must be clear about the following 4 terms.

1. Urinary urgency : A strong feeling of wanting to urinate (same as the feeling of holding urine).

2. Nocturia : After falling asleep, you feel a strong urge to urinate in the middle of the night. If it happens once, it is recorded as once. Generally, if it happens more than once, it is considered as increased nocturia.

3. Frequent urination : The number of urinations during the day is very frequent, such as urinating more than 8 times or more during the day.

4. Urinary incontinence : refers to the situation where urine cannot be controlled and leaks out of the urethra[1].

In addition, in order to accurately reflect the actual urination status, avoid errors and provide the best reference for doctors, we should record this special diary for 3 consecutive days or more.

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In real life, many female friends who have urinary incontinence will not go to the hospital for treatment because they are embarrassed. In fact, it is unnecessary. You should know that long-term urinary incontinence affects our social life, destroys our self-confidence, and destroys our good mood. If it is delayed for a long time, not only will the symptoms worsen, but it may also cause urinary tract infection.

Therefore, if urinary incontinence occurs, it is recommended to go to a regular hospital for treatment as soon as possible, cooperate with the doctor to record a urination diary, pay attention to a scientific diet, and resume a quality life as soon as possible.

References

Zhu Lan, Lang Jinghe. Female Pelvic Floor. 3rd edition. Beijing: People's Medical Publishing House, 2021.