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Walking?
Which of the following in NOT a direct benefit of a regular walking regimen?
Reduce Stress
Improved immune function
Achieving ideal weight.
Improved sugar metabolism
Medical Self - Care: Sample Bladder Record
Share
Agency for Health Care Policy and Research
©
NAME: ____________________________________________
DATE: ____________________________________________
INSTRUCTIONS: Place a check in the appropriate column next to the time you urinated in the toilet or when an incontinence episode occurred. Note the reason for the incontinence and describe your liquid intake (for example, coffee, water) and estimate the amount (for example, one cup).
Time interval
Urinated in toilet
Had a small incontinence episode
Had a large incontinence episode
Reason for incontinence episode
Type/amount of liquid intake
6-8 a.m.
____________
________________
________________
________________
____________
8-10 a.m.
____________
________________
________________
________________
____________
10-noon
____________
________________
________________
________________
____________
Noon-2 p.m.
____________
________________
________________
________________
____________
2-4 p.m.
____________
________________
________________
________________
____________
4-6 p.m.
____________
________________
________________
________________
____________
6-8 p.m.
____________
________________
________________
________________
____________
8-10 p.m.
____________
________________
________________
________________
____________
10-midnight
____________
________________
________________
________________
____________
Overnight
____________
________________
________________
________________
____________
No. of pads used today:
No. of episodes:
Comments:
_______________________________________
About Incontinence
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