Instructions for your child’s voiding diary

Monitoring and recording the amount of fluid your child drinks and voids for 2-4 days is important information to help us decide how to treat the bladder problem.


Tools needed to do this are the voiding diary worksheet and a urine collection device called a urinal or a collection “hat” depending if the child sits or stands to void. Sometimes a small cup to measure volumes less than 100 ml will also be helpful. These containers are available in the office of your pediatric urologist or primary care physician or at your local drug store. You can also buy them online for just a few dollars.


This data is best collected on a weekend day when you expect to be home with your child. If you are out of the house for part of the day, just mark the time the child went to the restroom without recording the volume, and please note whether there was any urine leaking.


Now let us look at the worksheet in detail:


Write the actual time in the second column next to the hourly slots. The reason the times are from 5:00 am to midnight is because some of our patients are teenagers and may be up very early or very late. The amount voided goes in the second column using ounces or milliliters (whatever you prefer). Next, please check off if the child was dry, damp or wet at the time they voided. We define damp as moisture just in the underwear and wetness involves some urine leaking to the outer clothes. Of course we would also want you to mark if there is some wetting when your child was not in the bathroom planning to void.


The next column is trying to keep track of how urgently the child had to void. Children, who know their numbers from 1-10, may be able to relate to this. An urge of 1 may mean that the person is not sure if they even could pee. An urge of 10 means he or she is very close to leaking. You may be surprised how the urge number does not always seem to relate to the volume of urine voided. Certain fluids can irritate the bladder and cause more urgency and leaking even at smaller volumes.


The last two columns have to do with what and how much your child is drinking. Maybe it will work well for them to use a cup or water bottle during the diary days where you can easily see how much fluid your child is drinking.


This is a good place to mention those fluids, which could irritate the bladder: I like to call them culprits, which helps me remember them because they all start with the letter “C”. The list includes carbonation, caffeine, citrus, chocolate and highly concentrated urine, which happens when the child does not drink enough. It often comes as a great surprise to the children when they follow our advice to drink more water and they notice themselves leaking less.


One way you can help your child monitor that they are drinking enough is by asking them to void into the hat or urinal one random afternoon per week. (I call this the “pop quiz”). If they see lemonade colored, light yellow, urine it means they are well hydrated. If the color is more like apple juice, motor oil or honey they need to drink more water.


If you think your child is old enough to read the amount of fluid in the container you can ask them to report the amount without you having to look at their urine. You could also practice with them for a while how to read the scale on the container by filling it with different amounts of water. Independence and privacy are actually very good goals when it comes to helping your child take care of their bladder. And children maybe as young as 6 years old could certainly tell what color the urine is.


Lastly, I would like to give you some suggestions on how to use the four different days of the voiding diary worksheet. We can vary the circumstances and routines for your child’s bladder and see dramatically different outcomes:


  1. On the first day of the diary let your child decide when they want to void and what they want to drink.
  2. Second day give them a timed voiding schedule to empty the bladder every 2 hours (or 90 minutes if there is a lot of leaking). Many children do this very well by using a vibrating watch. Even shorter than 90 minute intervals are usually not helpful because the bladder needs a chance to fill up.
  3. If your child is constipated (see the other handout about how to check on your child’s bowel habits) you may want to treat that first and do day 3 and 4 of the voiding diary a couple weeks later. We have seen many patients whose bladder was no longer leaking when their bowel movements became regular. You will notice the child’s bladder capacity increase when the poop is no longer pushing on the bladder.
  4. If your child likes to drink one of the bladder-irritating fluids instead of water you can test how the bladder likes that by having them drink their favorite bladder irritant for a whole day. Very likely the bladder capacity will be decreased, there will be more urgency and frequency and maybe even more leaking.
  5. If your doctor or nurse practitioner prescribe a medication to help the bladder relax it could also be useful to repeat the voiding diary while your child is on the medication to see the bladder capacity increase.


Lastly, I would like to show you what I do when I evaluate a voiding diary. On the video we hope to post on our website I go over an example diary. I check how many times the child voided during the day (in the case of this 6 year old girl it is about 7 times a day). Then I want to know what the largest voided volume is and how that relates to the child’s age expected capacity. Using our standard formula of taking the child’s age and adding 1 to arrived at the number of ounces we expected her to hold she should be able to void 7 ounces without leaking. It looks like she never held even close to 7 ounces. At 5 ounces her bladder is already leaking. I also look at what the longest and the shortest voiding interval is. It seems that at 2 hours she is sometimes leaking already. But the day she did timed voiding was clearly drier. Of course I also look at the fluid intake, which could be increased a bit in this case. Our suggestion is 6-8 ounces per year of age up to 64 oz.


Please have the completed diary with you at the appointment or upload it to the patient portal.


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