Assess your Pelvic Floor

Urinary Diary


Firstly fill out your name and then print out the Diary. Print out as many as you might need.

How to use the Diary

Each morning when you get up, start the Urine Diary and continue throughout that day and night. This 24 hour period is One day and should be recorded in the same column. Continue for Two full days.

  • Time. In this column carefully note the time that you go to the toilet
  • Volume. Measure the amount of urine you pass every time you go to the toilet and write it in this column. Any ordinary measuring jug is suitable for this.
  • Wet. If you wet yourself at any time, record the time and tick this column.
  • Comment. Use this column to write down anything you think may have influenced your bladder, e.g. cold weather, lauging, coughing, sneezing, running water, etc.
  • Record how much you drink in a day (mls)
  • If you are unable to measure your urine (e.g. while out shopping, visiting, or at work) then just record the time.



Time Volume Voided Wet Comment

Daily Fluid Intake (MLS)

Pelvic Floor Questionnaire