Healthy Urinary System in Adults

What is enuresis?

Enuresis is emptying the bladder (urinary incontinence) during sleep. Many people are aware that enuresis, or bedwetting, is a common issue in childhood. However, it can continue from childhood into adulthood, or start at any point in adulthood, including in people who did not have bedwetting as children.

It can happen whenever the affected person goes to sleep, including at night or during daytime naps, or may just happen occasionally.

If there have never been six months of dry nights every night, urinary incontinence during sleep is known as primary enuresis. Primary enuresis is thought to affect 1 – 2% of all adults. Wetting that has started after at least six months of dry nights is called secondary enuresis. Secondary enuresis is more likely to be a symptom of another underlying health condition.

Enuresis is more common in women with other bladder problems, in older adults and in some others, including people with Down syndrome.

What is the difference between enuresis (wetting the bed) and nocturia?

Enuresis will only happen if the affected person is unable to wake to the bladder signalling that it needs to empty. If the person is able to wake up, they would get up and go to the toilet. Waking to go to the toilet is called nocturia. It is usually not considered to be a medical problem, unless it is happening two or more times a night.

Enuresis and nocturia can both cause embarrassment, frustration, disturbed sleep and relationship issues. There is information about nocturia in the Bladder & Bowel UK leaflet here.

What causes enuresis in adults?

Most people do not need to pass urine more than once a night and can wake if they need to do this. Not being able to wake up in response to the bladder signals causes enuresis. However, there are a number of reasons why someone may need to pass urine at night.

These include:

1. The kidneys not being able to reduce the amount of urine they produce at night in the way that they usually would. Arginine vasopressin is a hormone that tells the kidneys to make less urine. The body should produce more arginine vasopressin at night. If someone is not making enough arginine vasopressin, urine production at night will be closer to daytime levels.
   
   
2. If the bladder is not storing urine as well as it should be. This may be because the bladder is smaller than it should be, or because the muscles in the bladder wall are less stretchy than usual or are tightening when they should be relaxed. Extra tightening of the bladder wall muscles is called bladder overactivity. Many people with this problem will need the toilet more frequently in the day than usual, may get very little or no notice of needing to pass urine and may get some daytime urinary incontinence (bladder leakage).
   
   
3. Urinary tract infection can cause wetting due to an increased need to pass urine or due to scarring if there have been repeat infections.
   
   
4. Enuresis can be a symptom of type I and type II diabetes (both types of sugar diabetes) as well as a rare condition called diabetes insipidus. Diabetes insipidus is an inability to reduce urine production.
   
   
5. Enuresis can be caused by an obstruction somewhere in the urinary tract (the bladder or the urethra – the tube that urine flows down when going to the toilet). Blockages can be caused by stones in the bladder or urethra, or an enlarged prostate in men.
   
   
6. Constipation. This can be severe enough to partially block the urethra. Also, when there is constipation the full lower bowel can put pressure on the bladder and result in it being able to hold less than usual, which can result in enuresis.
   
   
7. Fizzy drinks and caffeine (tea, coffee, cola, many energy drinks and hot chocolate contain caffeine) may irritate the bladder and cause urinary problems.
   
   
8. Alcohol has a diuretic effect (it encourages the kidneys to make more urine) and affects sleep, so may make it more difficult for the person to wake to bladder signals.
   
   
9. Some medications including some used for mental health conditions, diuretics (medications that increase urine production) and medications to improve sleep, are linked with enuresis. If you think that enuresis is being caused by a medication that you are taking speak to your healthcare professional before stopping the medication.
   
   
10. Sleep apnoea (stopping breathing while asleep) and snoring have also been linked to enuresis.
    
    
11. Some neurological disorders or damage to the nerves controlling the bladder muscles may result in enuresis.
    
    
12. Smoking, being overweight, not taking much physical activity and high blood pressure are associated with enuresis in women.

Psychological problems including anxiety, depression, feeling tired all the time have been linked to enuresis. However, it is not clear if they happen because of the enuresis or make the enuresis worse.

For many adults with enuresis there may be more than one issue that is causing or contributing to the bedwetting.

Should I speak to my healthcare professional about enuresis? What will they do?

Enuresis should be investigated to make sure that a significant underlying health problem is not being missed. Your GP or other healthcare professional will ask you questions about any other bladder problems, any medications you are taking, and what other illnesses you have or have had in the past and whether you have had any surgery or injuries.

They will check a urine specimen to make sure you do not have a urine infection or type I or II diabetes (sugar diabetes) and may ask you to complete a bladder diary. The bladder diary is usually a three day record of your drinks and visits to the toilet to pass urine and any other symptoms, such as bladder leakage and how strong the urge to visit the toilet was.

Your GP or healthcare professional should explain the outcome of the assessment to you and outline what they think is causing the enuresis and the options for treatment. They may refer you for further investigations or to a specialist service for support.

What treatment is there for enuresis in adults?

Recommended treatment will depend on what the assessment suggests is causing the wetting. Sometimes simple lifestyle adjustments can be helpful, regardless of the cause.

These include:

1. Drink plenty of water-based drinks during the day, but avoid all drink in the last two hours before bed. Good daytime fluid intake can help to improve the amount of urine the bladder can hold.
   
   
2. Avoid caffeinated, fizzy and alcoholic drinks, particularly in the evening. This is because these can irritate the bladder lining and caffeine and alcohol may have diuretic effects (cause the kidneys to make more urine.)
   
   
3. Discuss the use of sedatives (medication for sleeping) with your healthcare professional. They change sleep and can make it more difficult to wake to bladder signals.
   
   
4. Weight reduction, if you are overweight, may help by improving snoring and sleep apnoea, which can cause or be linked to enuresis.

If the above lifestyle options do not help, then treatments that target the cause of bedwetting may be an option.

Inability to reduce overnight urine production 

If the kidneys are making too much urine at night then medication to help reduce this may help. Medication called Desmopressin may be suitable for some adults who are under 65 years old. Noqdirna may be a suitable alternative for some older adults.

Both Desmopressin and Noqdirna must be prescribed by a healthcare professional and are usually taken up to an hour before bedtime. They are not suitable for everyone and people over 65 years old may need blood tests to make sure that the treatment is suitable both before starting it and after four to eight days of taking it and again after a month of treatment.

If you are taking either Desmopressin or Noqdirna, you must not drink for an hour before having them and for eight hours afterwards.

Problems with bladder storage

If the bedwetting is caused by a problem with the way the bladder is storing urine, then medication to help this may be an option. Anticholinergic medications help the bladder wall muscle to stay relaxed during bladder filling and therefore may increase the amount of urine that the bladder can hold overnight. 

Enuresis due to diabetes

If enuresis is associated with diabetes, good management of blood sugar levels and fluid intake may be helpful. Discuss your diabetic treatment and enuresis with your specialist nurse or other healthcare professional.

Obstruction in the urniary tract

You may need to have scans or other investigations if an obstruction is suspected. This would then be treated. Options might include prostatectomy (having all or part of the prostate removed if it is enlarged), having the urethra dilated (stretched) if it is narrow, or having stones removed, if they are present.

Problems with constipation 

Constipation is usually treated with increased water-based drinks, dietary changes, including eating more fruit and vegetables and other high fibre foods and using laxatives (medications to help bowel emptying). Good management of constipation may help to resolve enuresis.

Enuresis as a side-effect of some medications

If the enuresis starts when you are on medicines for mental health problems or diuretics (water pills, usually used to treat heart problems), then speak to the person who prescribed the medicines. It may be possible for you to change to different treatments that do not cause enuresis. Do not stop taking prescribed medication without talking to your healthcare professional.

Sleep apnoea and snoring 

You may be referred to a respiratory (breathing) clinic to discuss options to treat problems with breathing during sleep. This can help to reduce or make enuresis better for some people.

Neurological disorders

Some neurological conditions or injuries can affect the nerves or part of the brain that helps to control the bladder. There may be appropriate treatments to help with this. Your healthcare professional should be able to advise you.

What other information is there?

If the enuresis is caused by more than one problem, it may need more than one treatment to help.

It is important that you talk to your healthcare professional about any changes to your bladder or bowel health and any new bladder and/or bowel symptoms, as they may indicate a different underlying condition that can and should be treated.

For further advice, help and signposting to NHS services contact Bladder & Bowel UK here or on telephone 0161 214 4591.

Download this information as a leaflet (PDF).

Nocturia

What is nocturnal polyuria (NP)?

NP is when somebody passes a normal amount of urine during the day, with larger volumes being passed at night. More urine is produced during sleep than would normally be expected, which is more than the bladder is able to hold. This results in getting up more than once in the night to pass urine, or in wetting of the bed (also known as nocturnal enuresis) during sleep.

There are a number of possible reasons why you might need to get up more than once during the night:

• Poor sleep
• Prostate / bladder issues
• Producing too much urine at night (nocturnal polyuria)
• A combination of these causes

What causes nocturnal polyuria?

Usually, the body produces a chemical (known as antidiuretic hormone or ADH), which tells the kidneys to cut down the amount of urine produced during sleep. If this process is disrupted for any reason, it can cause NP. We should be producing less than a third of our total urine output during the night, even with increased age (including over age 65). If we produce too much urine during the night, which is measured as more than a third of the daily total, this is described as nocturnal polyurea.

Potential causes may include:

• Your body is not producing enough ADH
• Drinking too much in the evening or eating food with a high-water content
• Excretion of excess water from the body . Some people develop swelling or puffiness in their feet or ankles as the day progresses. On lying down, the excess water which causes the swelling then passes back into the bloodstream and is converted into urine by the kidneys, causing you to wake during the night with a full bladder.

How is nocturnal polyuria treated?

The first step is that NP is identified. Any recommended treatment will be based on the underlying reason for the increased urine production at night, so varies from person to person.

What can I do myself to help with nocturnal polyuria?

It is important that you don’t suffer in silence, and speak to your doctor or nurse. They will begin by asking questions about your diet and fluid intake, and check for any ankle swelling.

You can also:

• Check your eating and drinking patterns in the evening to see if these need adjusting. You could consider reducing evening fluid intake (though avoid becoming dehydrated).
• Try eating most water-based foods, such as tomatoes, cucumbers, melons, jellies etc, during the daytime rather than in the evening.
• Try to incorporate some leg elevation rest time during the day to help your body eliminate excess water.
• Consider trying to increase exercise such as walking, as this will help with excess fluid going back into the circulatory system

What else might help with nocturnal polyuria?

Consider completing a bladder diary over three days and nights. Bladder & Bowel UK have one you can download. This will help you doctor or nurse to assess your symptoms and to direct correct treatment.

Ask your doctor to assess if you can be prescribed a diuretic (water tablet). This treatment works to help your body produce more urine during the day, rather than at night. If you are already prescribed these, speak to your doctor about taking it in the afternoon rather than other times. Diuretics are used with caution in older people, because it may precipitate water retention which can put strain upon the heart.

If you have any questions or concerns, always speak to a healthcare professional.

Download this information as a leaflet (PDF)

What is overactive bladder syndrome (OAB)?

An overactive bladder is where a person regularly experiences a sudden and compelling urge or desire to pass urine. It is not uncommon and can affect people of all ages, including children, adults and the elderly.

This sensation is often quite difficult to ignore. It can happen at any time during the day or night, often without any warning.

OAB syndrome is sometimes called detrusor instability or overactivity. Detrusor is the medical name for the bladder muscle. It can also be known as an irritable bladder. The cause of OAB syndrome is not fully understood. The bladder muscle (detrusor) seems to become overactive and squeeze (contract) when you don’t want it to.

It is characterised by several symptoms, including:

• Urgency: having to rush to the toilet to pass urine.

• Frequency: need to pass urine frequently by day.

• Nocturia: waking up to pass urine.

• Urge incontinence: leakage of urine because of not making it to the toilet on time

This condition can cause considerable distress for people and significantly affect quality of life. People with OAB might be anxious about needing to go to the toilet quickly and worry about toilet access. They might limit activities, possibly leading to withdrawal and isolation. Waking up several times at night to pass urine can lead to disturbed sleep not only for the individual but may also impact also on others in the house.

It is important to know that there are a number of things can often be done to improve OAB in someone experiencing the symptoms.

How do I know if I have got an overactive bladder?

The number of times people usually have to pass urine each day is very varied, but people with an overactive bladder tend to pass urine more often than they would expect during the daytime and several times in the night.

If your bladder squeezes without any warning, it can give you an urgent need to pass urine. This means that ‘when you have to go, you simply have to go’ – there’s no hanging about or delay. Often people with OAB have little or no time to reach the toilet and this is referred to as urinary urgency.

If the need to pass urine is so strong that you are unable to hold it, it can lead to involuntary leakage of urine.

If you have urinary urgency, this means that you might need to pass urine more often and more frequently than usual and in smaller volumes.

Your need to pass urine may be triggered by a sudden change of position, or even by the sound of running water. You may also pass urine during sex, particularly when you reach orgasm.

What causes OAB?

In OAB, the need to urinate is triggered by sensitivity from even from small amounts of urine in the bladder. This may be, but is not always, accompanied with unwanted bladder contractions.

Going to the toilet ‘just in case’ and frequent passing of urine for fear of leakage can lead to overactive bladder as this increases bladder sensitivity to small amounts of urine.

Excessive fluid intake, especially of caffeinated drinks, like coffee and tea, and fizzy drinks can irritate the bladder enough to cause or worsen the condition. Alcohol, a diuretic which increases the need to urinate, and smoking can also aggravate the bladder.

OAB may co-exist with stress urinary incontinence (leakage of small drops of urine on coughing and sneezing), which is known as mixed incontinence.

Overactive bladder can sometimes be a manifestation of other diseases or conditions, such as:

• Diabetes mellitus.

• Urinary tract infection.

• Pressure on the bladder from an enlarged uterus or ovarian cyst.

• Local disease in the bladder, such as ulcer or mass.

• Neurological disease. Conditions such as Parkinson’s Disease, Multiple Sclerosis or those who have suffered a stroke may also develop overactive bladder.

• Some medications may be associated with overactive bladder.

For this reason, it is important to seek medical help if you are experiencing symptoms of OAB syndrome.

How do I seek help?

We would encourage you to speak to your doctor or health care professional, who will ask some questions about your bladder symptoms and general health. They may also perform a physical examination.

A urine test to check for infection will usually be done, and you may be asked to attend an ultrasound bladder scan to check whether your bladder is emptying properly.

You might be asked to complete a diary for three of four days, logging how much you drink and how much, and how often, you need to urinate. Bladder & Bowel UK have one of these diaries in this section that you can download and use.

If your condition does not improve after initial treatment, you might be invited to further tests to investigate.

How can I help improve OAB syndrome myself?

Diet and fluids

Being thirsty is often a guide that your body needs water. Drinking less does result in a reduction the amount of urine produced, but the urine can then become highly concentrated which can further aggravate symptoms, needing more frequent visits to the toilet. Not drinking enough water can also cause constipation. Remember that food also contains water, particularly fruits and vegetables. It is also worth bearing in mind that some foods may further irritate symptoms, including highly spiced foods, citrus fruits and artificial sweeteners.

Aim to drink about 1.5 litres of fluid a day, adjusting the amount you drink according to your need, and spreading drinks throughout the day.

There are a number of drinks that can irritate the bladder, such as caffeinated drinks, carbonated drinks, drinks containing aspartame (an artificial sweetener found in diet drinks), hot chocolate, green tea, alcohol, blackcurrant juice and citrus fruit juice.

Drinks which are believed not to irritate the bladder include water, non-caffeinated herbal and fruit teas, milk and diluted fruit juice. Avoid caffeine and alcohol before going to bed. If you feel thirsty or need to take medications before bed, then try having small sips of water.

If you suffer from constipation, this can increase pressure on the bladder and be an irritant. Increased dietary fibre can help with constipation. Eating healthily can help with maintaining a healthy weight, which helps reduce symptoms of OAB and incontinence. It has been demonstrated that a 5-10% weight loss can help.

Toilet access

If you have an overactive bladder and have mobility problems, consider special adaptations, like a handrail or a raised seat in your toilet. Sometimes a commode in the bedroom makes life much easier.

Bladder & Bowel UK also have a Just Can’t Wait card, which helps give access to toilets not normally accessible by the public.

Bladder training and diary keeping

A technique known as bladder training might help you regain control of your overactive bladder. This is done by gradually increasing the amount of time between toilet visits, so that your bladder will slowly stretch and suppress its contractions over time. Suggestions of how to train your bladder include:

Instead of rushing to the toilet as soon as you get the urge to pass urine, try to hold on. You may find this difficult initially but try to distract yourself. The aim here is to gradually to increase both the capacity of your bladder, and the time between toilet visits to pass urine. Try to suppress the urgency feeling, for example when getting up from a sitting position, when hearing running water or putting the key in the door. Your health professional will be able to further guide on an individual bladder training plan.

Keep a diary, making a note of the number of times you pass urine, and the amount (volume) that you pass each time. Also record any times that you have a leak. Have a jug handy to measure the volume passed each time you go to pass urine.

Complete your diary for the first couple of days as you would normally go to the toilet, to give a baseline. Record each visit in the diary, including when and how much you urinate.

The aim is then to increase the time between toilet visits, holding on for as long as you can when you get the initial urge feeling. This will probably seem difficult at first. Don’t worry and try to keep calm and relaxed. If you usually go to the toilet every hour, try to hold on a few minutes longer. It can help to try distracting yourself by counting backwards from 100 or doing a crossword puzzle. Practicing this may take several weeks or longer but stick with it. For most people it will become easier over time. Eventually, the aim would be to pass urine only 5-6 times in 24 hours (about every 3-4 hours). After several months you may find that you just get the normal feelings of needing the toilet, which you can easily put off for a reasonable time until it is convenient to go. Your health care professional will be able to further guide and individually instruct a treatment plan.

Pelvic floor exercises

Doing exercises to strengthen your pelvic floor, also known as Kegel exercises, might help you with bladder training and reducing the time between visits to the toilet. See our section on pelvic floor exercises for more information.

Medicines

In some cases, medicines are appropriate for people experiencing symptoms of OAB. These medicines are often referred to as antimuscarinics or anticholinergics. They work by blocking certain nerve impulses to the bladder, which stops it contracting when it should not contract. Medication can improve symptoms in some cases, but not in all, and the amount of improvement varies from person to person. Side-effects are not uncommon and can include a dry mouth and constipation. Some carry a higher risk of confusion or drowsiness than others. Your doctor or healthcare professional will guide you. If your healthcare professional feels medicine is appropriate for you, after taking them you should notice less trips to the toilet, fewer bladder leakage episodes and less urgency or dashing to the toilet. However, it is uncommon for symptoms to go completely with medication alone, and your doctor or nurse may recommend more than one approaches so that symptoms do not return.

If these approaches do not help with your symptoms of OAB, it may be that further specialist tests are required, and other measures might be recommended. More advanced treatments can include botulinum toxin (botox) injection; percutaneous tibial nerve stimulation (where a fine needle is inserted into a nerve in the ankle, and a mild electric current is passed through the needle and carried to the nerves that control bladder); sacral neuromodulation (a procedure which targets the sacral nerve to restore normal communication between the brain and bladder/bowels), and surgery. Your healthcare professional will guide you on which further treatments are right for you.

More information

Download this information as a leaflet (PDF)

What is stress incontinence?

Stress urinary incontinence is when the pelvic floor muscles around your bladder and anus (back passage) become weak or stretched. Leakage from your bladder can happen when you cough, sneeze, laugh, run, or jump. Usually only a small amount of urine is passed.

Research suggests that women who complete pelvic floor muscle training experience fewer leaking episodes and report a better quality of life.

In men, some studies have shown that pelvic floor muscle training can reduce urinary incontinence – particularly after surgery to remove the prostate gland

What causes stress incontinence?

Stress urinary incontinence can happen at any age. Pelvic floor muscles may become weakened by pregnancy, childbirth, and delivery, straining to empty the bowel, repeated heavy lifting, menopausal changes, long term coughing, constipation and being overweight, lack of general fitness and high impact sports.

It is caused by a weak sphincter (a muscle at the bladder outlet), or by poor support to the bladder outlet from the pelvic floor muscles and ligaments. This usually happens because the muscles of the pelvic floor are weak or damaged.

Things that can weaken these muscles include pregnancy, childbirth, menopause, and some medication. People who are overweight, have a cough or who have been constipated for a long time may also be prone to stress incontinence.

What are the pelvic floor muscles?

The pelvic floor is made up of layers of muscles, stretching like a hammock from your pubic bone to the bottom of your backbone. These muscles help to hold your bladder and bowel in position, as well as the uterus (womb) in women. They prevent leakage from your bladder and bowel, only relaxing when your bladder or bowel is emptying.

What can I do myself to help with stress urinary incontinence?

You can help yourself by making some lifestyle changes in order to reduce pressure on your bladder and pelvic floor muscles.

• Exercise regularly, including pelvic floor muscle exercises. Avoid exercises that increase the pressure on your abdomen such as high impact aerobics, jogging/running.
• Avoid smoking, which can aggravate bladder weakness through coughing.
• Avoid gaining excess weight. If you are overweight, a weight loss diet might help your incontinence.
• Drinking plenty of fluid each day, typically 1.5-2 litres (6 – 8 large cups or glasses, unless otherwise medically directed ). Drinks containing alcohol or caffeine, for example tea, coffee, or sugary fizzy and energy drinks may irritate your bladder and should be avoided. You can have drinks that do not contain caffeine, such as decaffeinated tea or coffee.
• Limit the amount of caffeine and alcohol you drink to prevent bladder irritation and avoid increased urine production.
• Trying not to become constipated by eating a healthy diet with plenty of fruit and vegetables
• Doing pelvic floor exercises. These can improve your muscle tone (strength), your continence and quality of life. Your health care professional will explain these exercises.
• Seeking medical advice if you have a long-term cough

All of these can also be discussed when you attend your consultation with the doctor, physiotherapist or nurse specialist. They will be able to advise and support you make these changes.

When should I seek further treatment for stress incontinence?

Although you may feel embarrassed talking to someone about your symptoms, we would encourage you to have a chat with your GP if you have any type of urinary incontinence. They are used to having these conversations and you should be encouraged to know that this can be the first step towards finding a way to effectively manage the problem.

Many people wrongly think that incontinence is a normal part of ageing, or that it cannot be treated. We would recommend seeking further advice who can assess and guide on treatment and management.

Will I need any tests?

These are some initial tests that you may have as part of your assessment:

• Urinalysis: This test usesa sample of urine to find out if there is any infection or any blood in the urine.
• Bladder diary: You will be given a chart (bladder diary) so that you can keep a record of the amount of fluid you drink and the amount of urine you pass, for a 3 day period. You can also record other information on the chart such as incontinence. ( link to our diary )
• Bladder scan: This is to find out if there is any urine left in your bladder after you have passed urine. The nurse will check the residual urine using an ultrasound machine to scan the bladder.
•  Physical examination: Your health care professional may need to undertake a physical examination to make a further assessment, for example a pelvic/vaginal, rectal or prostate examination.

Some further tests may be required if the cause of your urinary incontinence is not clear. Your health care professional will usually start treating you first and may suggest these tests if treatment is not effective.

Pelvic floor exercises

These are exercises that improve and strengthen the pelvic floor muscles. It is important that you are shown how to do these correctly and you will be referred to the physiotherapist or specialist nurse for this treatment. They will assess your pelvic floor muscle strength and then advise an individual programme of exercises for you to follow.

Are there any other treatments?

If pelvic floor exercises and conservative options do not help, your health care professional will discuss further treatments, for example, you may benefit from a referral to a Bladder and Bowel specialist nurse, physiotherapist or a doctor who specialises in urinary incontinence.

Further treatments can include medication (tablets), nerve stimulation, physiotherapy or surgery.

More information

Download this information as a leaflet (PDF)

What is a UTI? (Urinary tract infection)

What is a bladder diary?

A bladder diary is a useful tool that can be used to record the number of trips to the toilet to pass urine (wee), to measure the volume of urine passed and any episodes of wetness or leakage. You will also be asked to record what you are drinking, how much, and when you are having your drinks.

Why is completing a bladder diary helpful?

A bladder diary can help your healthcare professional, as part of an assessment, to better understand how your bladder is working. It provides information on the amount you drink, the amount of urine your bladder can hold, how often you pass urine, and any wetting or episodes of leakage. It may also help identify if there are any patterns or links which contribute to your symptoms. It is recommended to keep a diary of your bladder habits for at least 3 days, so you can give your healthcare professional as much information as possible, about your condition. A one-day diary may not provide enough information to give a true picture of how your bladder is working.

Top Tips: What to record whilst keeping your diary

• Record when you go to bed and when you get up in the morning to start your day
• How often you need to pass urine Keep a record of toilet visits to pass urine throughout the day and night
• Have a measuring jug handy by the toilet, to record the amount of urine you pass at each toilet visit; this should be recorded both day and night
• It is important to record if you are getting up frequently in the night to pass urine
• If you pass urine but couldn’t measure it eg at work, away from home, put a tick/s in the column to indicate that you have passed urine
• Record any episodes of bladder leaks and any additional information you think may be important about when this occurs, eg: coughing, sneezing, during exercise etc
• You could measure the mug / glass that is frequently used, so as not to have to measure every drink if the same are used.

It may be helpful to complete the diary, choosing a time when you will be mostly at home, or over a weekend and near a time when you are due to see your nurse or doctor. You may also want to consider recording on a day when you are at work or away from home as your drinking patters may be different eg: Friday, Saturday, Sunday.

Recording in your diary

The Bladder & Bowel UK Bladder 3-day diary is free to download – don’t forget to take your completed diary to your health care professional appointment.

• Record if damp, wet, or soaking
• Make a note if you experience urgency or need to get to the toilet quickly
• Record as 1 if you could hold on for a short period of time without worry
• Record as 2 if you had to rush to the toilet, otherwise you would have experienced leakage
• Record as 3 if you leaked or were wet before you reached the toilet Record if you changed your pad
• Keep a record of your fluid intake – write down what you drink (i.e, water, juice, coffee, alcohol etc) and how much. It is helpful to measure the amount of fluid you drink, or if you can further describe for example, small glass, mug, teacup etc
• Record activities eg out for a walk, exercising, at home.

Download this information and the Bladder & Bowel UK Bladder 3-day diary   as a document (PDF)

SCR Nocturnal Polyurea

Diet, fibre and healthy bowels in adults

Bowel incontinence

Swimming with incontinence

Toileting Aids and Urinals
Urinals on prescription (PDF)

Travelling with a bladder and or bowel condition

Introduction to pelvic organ prolapse what is a prolapse?

Pelvic floor exercises for men

The Prostate and BPH- Benign prostatic hyperplasia (Enlarged prostate)