24 HOUR VOIDING DIARY - Healing, Teaching …（24小时排尿日记u2014u2014治疗、教学u2026）.pdfVIP

24 HOUR VOIDING DIARY Please complete this chart prior to your visit. Choose a 24-hour period when it is convenient for you to measure and record the following: 1. The amount of fluid you drink and type of beverage. 2. The amount of fluid you void (urinate). Use an old measuring cup or mark off ounces on an old jar or can and use that to measure. 2 tablespoons = 1 ounce. There are also “hats” for the toilet available at the Center for Women’s Health. 3. The time when leakage occurred and whether or not you have an urge to void just prior to any leakage episodes. 4. The activity you are doing when you leak or feel the need to void. 5. Your awakening and bedtimes during that 24-hour period. Below is a sample diary for your review. Time Fluid Intake Void Leaks or Strong urge Activity when Amount (oz) Amount (oz) Accidents? to urinate? you leaked or had an urge. 6:20 am 8 oz awakening 7:00 am 8 oz coffee 7:20 am 6 oz yes yes washing 7:30 am 8 oz coffee 8:00 am 8 oz 8:45 am yes no coughing 1 24 Hour Voiding Diary Date: __________________ Awakening time: _____________ Bedtime: ____________ Estimate how much fluid you consume in a day:_________________________________ Time Fluid Intake Void Leaks or Strong urge Activity when Amount (oz) Amount (oz) Accidents? to urinate? you leaked or