Importance of a Bladder Diary

Urologists utilize a bladder diary to better understand patients’ urinary symptoms. If your urologist asks you to keep a bladder diary, you can record fluid intake, urination, urgency, accidents, etc. as instructed on paper the old fashioned way. The Urology Care Foundation of the American Urological Association provides the following example of a bladdery diary.
or you may find it helpful to use the following app. UroBladderDiary in the App Store of your smartphone. It costs only $1.99 and makes recording your intake and voiding details a snap. The app can also email a report to your physician.

Adult Intermittent Self-Catheterization

The bladder is a hollow muscular organ shaped like a small balloon that is located in the lower abdomen. The kidneys, (bean-shaped organs near the middle of the back), normally remove excess water and waste products from the bloodstream and store it as urine in the bladder. The rate at which urine is produced depends on fluid intake, activity, and environmental temperature.
As the bladder fills with urine over several hours, a normal bladder will send signals to the brain that the bladder is full and needs to empty. Most people empty their bladders by voluntarily going to the bathroom four or five times a day. This is called urinating or voiding. When the bladder is not emptied of all urine, problems can occur.
Intermittent Self-Catheterization (ISC) is a safe and effective alternative method to empty the bladder. ISC involves inserting a catheter (a flexible hollow tube) into the urethra (the urine channel that drains urine from the bladder) several times a day. ISC is used to help protect the kidneys, prevent incontinence (urine leakage) and lessen the number of infections by promoting good drainage of the bladder while lowering pressure inside the bladder. It has been used successfully for individuals with injury to the nerves of the bladder, spinal cord and brain as well as in persons with diabetes, multiple sclerosis, spina bifida, myelodysplasia, enlarged prostate and continent urinary diversion. It can be done on a short or long term basis, depending on the bladder’s ability or inability to return to normal function.

How to perform ISC:

ISC is performed by intermittently inserting a catheter into the urethral opening (meatus) and advancing it into the bladder to allow the bladder to empty. Only persons who know the correct technique of proper insertion and care of the catheter should perform catheterization.
It is recommended that ISC be performed at regular intervals throughout the day depending on the person’s fluid intake and as directed by the healthcare provider. The ability to perform catheterization and adhere to a schedule is essential to success of the ISC program. You may need to catheterize every four to six hours to keep the amount of urine in your bladder less than 400-500 milliliters (13 to 15 ounces). If you are urinating but continue with high residual urine volumes (the amount left in your bladder after urinating) your healthcare provider may ask you to increase the number of times per day you catheterize.

Many persons will catheterize using a “clean” method, which means you do not need to wear gloves, just wash your hands with soap and water before catheterizing. It is recommended that you use a new catheter each time you catheterize. For alternatives to using each catheter only once, discuss this with your healthcare provider who prescribed the ISC for you.

Materials needed to prepare:

• Soap and water to wash hands and the urethral opening. If soap and water are not readily available, waterless alcohol-based hand rub or towelettes may be used.
• Urethral catheter (male or female). The size of the catheter should be the smallest size (called a “French” size) to pass easily into the bladder and allow adequate drainage.
• The correct type and size of the catheter to be used will be determined by the healthcare provider.
• Lubricant (water-soluble jelly) packet or tube.
• Urinal or appropriate container to collect drained urine (if not emptying into a toilet).
• Mirror (for women to locate the opening of the urethra).

Set up:

• Gather all the necessary products before beginning the procedure.
• Males and females must be instructed on the locations of basic structures in the area of the genital anatomy and urinary opening with proper procedure before they do the procedure on their own.


• Wash hands thoroughly with soap and water or use a waterless alcohol-based hand rub or towelette.
• Find a comfortable position.
• Spread the labia apart using the hand you will not be using to hold the catheter.
• Clean the entire urethral opening (meatus) area from front to back with warm, soapy water and a clean washcloth or towelette (when away from home).
• Use a mirror initially to aid in the location of the meatal opening if needed. It is located below the clitoris and just above the vagina in most females, visually seen as “^”.
• Lubricate the tip of the catheter with the water-soluble jelly.
• Rotate the tip to spread the lubricant along the entire length of the catheter.
• With a collection container ready, slowly and gently insert the catheter (2-4 inches) into the meatus until urine begins to flow.
• If resistance is felt at the internal sphincter, hold firm, gentle, steady pressure and the muscles should relax allowing the catheter to pass. You can also cough or take a few slow, deep breaths to relax your sphincter.
• Allow the urine to empty into the collection container or into the toilet.
• When the urine flow stops, slowly withdraw the catheter allowing the lower parts of the bladder to drain. When there is no further flow of urine, remove the catheter.
• If requested by the healthcare provider prescribing the catheterization, record the amount of urine.
• Wipe yourself with tissue from front to back and discard the used catheter.
• Wash hands thoroughly with soap and water.


• Wash hands thoroughly with soap and water or use a waterless alcohol-based hand rub or towelette.
• Find a comfortable position. Some men prefer to stand for the procedure but it can be done just as easily in the sitting position.
• Hold the penis in an upright position (pointing towards the belly button) and wash the urethral opening (meatus) with soapy water and a clean washcloth or towelette (when away from home). For uncircumcised men, pull back the foreskin first and clean the meatus in the same way.
• Lubricate the tip of the catheter with the water-soluble jelly.
• Rotate the tip to spread the lubricant along the entire length of the catheter.
• With a collection container ready, slowly and gently insert the catheter into the meatus, approximately 6-8 inches or until urine begins to flow. Often the entire length of the catheter must be inserted (to the hub or end of the catheter) for urine flow to occur.
• There may be some resistance to the passage of the catheter halfway through the urethra, at the part of the urethra where the sphincter (valve) and the prostate gland is found. If this happens, hold firm, gentle, steady pressure and the sphincter will open. Muscle relaxation will be felt and the catheter will advance through this part of the urethra. You can also cough or take a few slow, deep breaths to relax your sphincter.
• There may also be resistance at the bottom of the bladder (called the “bladder neck”) which has another sphincter. Using firm, gentle, steady pressure should cause this part of the bladder to open and allow the catheter to pass into the bladder. If not, bearing down or pushing down or a strong cough may also relax this muscle so you can pass the catheter.
• Once inside the bladder, keep the catheter in place until the flow of urine stops. As soon as urine starts to flow, point your penis downwards over the collection container or toilet. Slowly and gently withdraw the catheter allowing for any pockets of urine at the base of the bladder to drain. When there is no further flow of urine, remove the catheter.
• If requested by your healthcare provider, record the amount of urine drained from your bladder.
• Discard the used catheter.
• Wash hands thoroughly with soap and water.

Intermittent Self-Catheterization Tips:

• Never force the catheter. Difficulty inserting a straight catheter or being unable to catheterize may require you to see a urologist. Coudé tipped catheters often are able to successfully pass into the bladder when catheterization with a straight catheter is difficult. Coudé catheters have a special curve at the tip that makes passage through the urethra easier.
• If you are at home and unable to pass the catheter and feel that your bladder is full, you will need to go to your nearest Urgent Care Center/Emergency Room for appropriate evaluation.
• It is not uncommon to have an abnormal urinalysis (urine test). You should only be treated for a urinary tract infection if you have signs and symptoms of an infection such as tenderness in your lower abdomen or pelvic area, back pain, malaise, confusion, cloudy or foul-smelling urine, urgency (pressing need to urinate), frequency (urinating more often than usual), pain with urination, fever higher than 100.4 F, and/or chills, nausea and vomiting. Contact your healthcare provider if these symptoms occur.
• For patients who have Multiple Sclerosis or other conditions that may compromise their immune system, ISC may need to be performed using sterile technique which is when you use sterile gloves, antiseptic to wipe the area where the catheter is inserted and a sterile catheter each time you catheterize. Contact your Urologist for guidance.

Points to remember:

• Do not remove the catheter from the package until ready to use.
• Check the catheter for defects such as cracks or color changes before use.
• Avoid touching the tip of the catheter and avoid letting it touch other surfaces.
• A prescription or order from a healthcare provider is needed to state the number of times an individual catheterizes each day. Check with your individual insurance carrier to see which benefits are available to you.
• This fact sheet focuses on the adult patient. Children require special assessment and teaching to be successful. Contact your Pediatric Urologist for guidance.
• If you perform ISC and encounter any problems, call your healthcare provider for timely advice.

Katy Bortel, MS, RN, CCRP
Debbie L. Hensley, BSN, RN, CURN
Evelyn M. Kliever, MA, RN, CURN
Theresa A. Lesher, BSN, CURN
Diane Newman, MSN, RNC, CRNP, FAAN


Overactive Bladder Bladder Diary instructions

What is a Bladder Diary?

A bladder diary is a tool used by you and your health care provider to better understand your bladder symptoms. It helps you track a number of things: when and how much fluid you drink, when and how much you urinate, how often you have that “gotta go” urgency feeling, and when
and how much urine you may leak. When is a Bladder Diary used? You can use a Bladder Diary before or after visiting with your health care provider. Having a Bladder Diary during your first visit can be helpful because it describes your daily habits, your urinary symptoms and demonstrates how they are affecting your life. Your doctor will use this information to help treat you.

How do you use the Bladder Diary?

  1. Begin writing in your diary when you wake up each day. Take notes throughout the day, and continue until you complete 24 hours. For example, if you wake up at 7 a.m. on the first day of your diary, take notes until 7 a.m. the next day.
  2. Write down what you drink (i.e, water, juice, coffee, wine) and how much. Measuring the amount is helpful.
    If you are unable to measure your drinks, then it’s important to take a good guess about the number of ounces every time you drink something. Most containers will list the number of ounces they contain. Use these listings to help you make an estimate—for example, an 8 oz. cup of juice, 12 oz. can of soda, or 20 oz. bottle of water.
  3. Write down when and how much you urinate, both during the day and night. Doctors often provide a special measuring collection device to use. It sits under your toilet seat and is marked with measurements to let you know how much you urinated.
    If you are keeping the diary on your own before visiting a health care provider, then you may want to collect your urine in a paper cup. Choose a cup that you know holds a certain amount of liquid, such as 8 oz. Rinse the urine collection device with water after each use. Keep the device close to your toilet until you’ve finished your diary.
  4. It’s best to keep a diary for at least three days. A one day diary may not provide enough information to give a true picture of your bladder condition. Also, the three days you keep your diary don’t have to be three days in a row. Any three days you chose will be fine, as long as they represent three “typical days” for you. Print as many pages of the Bladder Diary you need to complete the three days.
  5. Don’t forget to bring your completed diary with you to your office visit. Urology Care Foundation You may download this Bladder Diary and print it at
    For copies of printed materials about other urologic conditions, visit or call 1-800-828-7866.
    get started Use the attached bladder diary to start tracking!



My brother had wheels. I can still hear the way the tires sounded as he slowed to a stop; rubber on cement, creating a smooth whirring as his hands glided against the worn material, bringing himself to a stop. My legs were made of flesh, and functioned as normal legs do. I understood that his legs were wheels, and functioned as wheels normally do. From Bike Rodeos where Joey deftly maneuvered around orange traffic cones set up in school parking lots, to “marching” in parades as he played his clarinet, he trucked on as anyone would, just with a little extra help. If he could do anything, so could I. Growing up with my older brother having Spina Bifida melded all impossibilities together, and threw them to the curb. Accomplishments were always obtainable, trophies and awards within reach. I looked up to him as someone who was capable of anything thrown at him, and in turn, I’ve become the same way. As an adult, I now recognize how difficult life must have been for him. How every curb may as well have been a  mountain, and how exhausting it must have been to just exist at times, but onward and upwards, he persevered. My brother taught me perseverance, determination, and resolution. It is because of him that I know how to roll with the punches, and when to go down swinging. He went down swinging. Every day I feel his strength within me, passed onto me through some astral vein, shooting down from the heavens, beyond galaxies, and straight into my heart. These daily lessons give me the strength I need in my life to keep going, and to understand that even if that curb seems like a mountain, we can always find a way around.

A love letter

What I didn’t realize when you were born was the label that would be put on you – “Special Needs”.  It’s a label that no one wants to have. I didn’t realize that this journey would be both powerful and exhausting. I would tell the me before you that I would become a stronger person. That I had strength I didn’t know existed.  The quiet meager mouse would learn to speak up, stand strong, and fight.

I would say this journey has been hard and that you will cry for doors that shut and for moments that are a breakthrough. That labels like “Special Needs” won’t define us. That people don’t know the power of “Special Needs”. That it doesn’t mean limitations. It means finding how to break through the norm. That it doesn’t mean sadness that the world was built for “normal life”. It’s joy that you can show the world a new normal.  When other mothers tell me “I don’t know how you do it,” I know that this for me isn’t a choice. As a “Special Needs Mother” I do what I do because I know no other way. This is what unconditional love is about. 

I would tell the me before you that people truly don’t understand what “Special Needs” is. Others think that it describes a person with disabilities and/or physical/learning difficulties. What they don’t understand is that we all have “Special Needs” and that you just happen to wear your needs externally. Inside all of us is a person that needs something special. So many of us hide our deficiencies so well and walk around feeling sorry for others.  I would tell me to prepare for this journey because as your mother it would be up to me to break down doors for you, so that as you get older you don’t have to worry about them.  I would tell me to prepare you for those doors that still remain shut. Maybe they aren’t meant to be open.  You (we) will find another way. A shut door is not the end of the story – it’s the start of one.

I would tell me that this journey will be long and beautiful. It will be filled with the smartest doctors, the best educators, and the know-it- all’s of everything. BUT- I will be your expert and I will raise you to be your own expert. I would say to the me before you that you are worth every obstacle we come across and find a way around. I would tell me to know that we will always be learning but the one thing we will know for sure is that we will not let labels like “Special Needs” define us. It will be us that define it!

Intermittent Catheterization

Clean intermittent catheterization is now the standard of care for individuals who experience urinary retention or incontinence. With intermittent catheterization to drain the bladder, there is lower risk of urinary tract infections (UTIs) and bladder atrophy than with indwelling Foley catheters. Still, some individuals are unable to perform self-catheterization or have a caregiver catheterize them. In these cases, an indwelling Foley may be necessary. With the introduction of a catheter through the urethra to drain the bladder, there comes a greater risk of urinary tract infection from bacteria entering the urinary tract. Urinary tract infections can be severe and serious, not to mention painful and uncomfortable. Precautions are definitely warranted to avoid or reduce the incidence of UTI’s. Following are some general rules of thumb to follow when performing intermittent catheterization in order to reduce the risk of experiencing a urinary tract infection.

  1. Drink adequate amounts of water–6 to 8 glasses of water a day.
  2. Catheterize as prescribed by your doctor: don’t skip catheterizations.
  3. Wash your hands thoroughly with soap and water every time before you self-cath.
  4. Use a new catheter each time you catheterize: don’t wash and reuse catheters.
  5. Use sterile insertion supplies if you experience UTIs while cathing.

Closed System Catheters, Catheter Kits, or Sterile Insertion Supplies are clinically proven to reduce urinary tract infections (UTIs). These kits contain an attachable drainage bag, underdrape, BZK wipes or povidone iodine swab sticks, lubricant and gloves. If you are a catheter user, who continues to experience urinary tract infections while on a program of clean intermittent catheterization, be sure to visit your doctor and request a urinalysis with culture if you think you have a UTI. You may also consider using sterile insertion supplies to reduce the risk of getting a UTI if you have vesicoureteral reflux, are immunosuppressed, or experience recurrent urinary tract infections even while performing intermittent catheterization with a clean technique and using a new catheter each time.

My Magical Journey

“Your quad screen results came back abnormal.”  Who know that seven words would dictate and shape the future for my husband and me.

My husband and I married in December 2010. Excited to start a family, I visited my OB/GYN, soon after, and started a regimen of daily prenatal vitamins. After all, we’d read many journals and articles about the importance of maintaining my health for pregnancy. We knew it might not happen, right away, but even when it approached six months, we refused to give up.

When I began to experience daily nausea, in September of 2011, I couldn’t help but grow excited. When a test confirmed pregnancy, we were overjoyed! The next few months were filled with brainstorming names, managing nausea, and well, just enjoying pregnancy.

Things changed a few weeks into my second trimester. While at work, one day in December, I began to feel tightness in my stomach, which eventually turned into cramps. When I went home that night, I decided to stay at my parents to rest. Unfortunately, what I thought was cramps turned out to be what an ER doctor describes as a threatened miscarriage. I was put on bed rest for a week and told that a large blood clot had formed in my placenta; miraculously, despite bleeding for over a week, our baby was determined to stay strong.

It was at that point, during a follow up, the next week, I decided to take an optional quad screen test. I figured, after the scare we had, I may as well take it. Then, our lives changed.

It was three days before Christmas. We were slated to fly out the next morning to California, to stay with my immediate family for the holidays. Instead. I got a call from my OB’s nurse saying we had abnormal test results. “Don’t worry,” she said. “These tests can have false positives.” Yet, she wouldn’t answer me when I asked what a positive meant. Instead she referred me to a perinatologist for an extensive ultrasound.

I called, telling the office about the results and our travel plans, so we were thrilled when they asked if they could see us in less than an hour. My husband and I quickly accepted and arrived in less than 30 minutes.

After waiting less than five minutes, we were seen by the specialist. They took us into a room where several people began doing an ultrasound. All I kept hearing between them were words like “lemon shaped” “definitely positive.” They kept giving us quiet, somber looks, except for one nurse who said, “Would you like to know the baby’s sex?” When we said yes, she said, “That’s your daughter.” She then began to comment on how wiggly she was, and how she wouldn’t cooperate with their machines. I thought, “Everything must be okay, right? Look at her! She can’t stop moving.”

About half an hour later, the perinatologist grabbed my hand and said, “Well, the ultrasound confirms my suspicion.” I asked, “Is she okay?” He then proceeded to tell us that our daughter, the miracle who survived a threatened miscarriage has Spina Bifida with hydrocephalus. But I’d been taking prenatal vitamins, I said. I eat healthy. He kept telling us, “You did absolutely nothing wrong” and “This is NOT your fault.” He continued, “You just happened to be that 1 in 30,000 that this happens to.”

After that, all I remember were words like, “worse case scenario,” “vegetable, “die soon after birth.” He offered abortion, as well. But then something else happened. I asked him, “What’s best case scenario?” After a pause, the doctor said, “Well, she may end up wheelchair bound for the rest of her life” with possible intellectual or learning disabilities. At that point, I didn’t know what to say. But after watching my daughter refused to let them scan her, I refused to give up on her. My husband… well, I wasn’t so sure.

We drove home in silence, and being the pragmatic person I am, I immediately began researching Spina Bifida. Knowing how scary Google can get (I’m a librarian, in case you might not know), so I began reading up on SB in medical journals and support groups. Into the late hours of the night, while my husband slept, I read story after story of adults and children thriving with SB, and am forever grateful for the now defunct Spina Bifida Connection website (I believe it’s now on Facebook). In less than two hours, I had people from all over the world reassuring me that my daughter was going to be okay. I finally fell asleep believing them.

The next morning, my husband solidified my thoughts. With tears, he said, “This is our baby. God chose us for a reason. I can’t give up on her.”

With that, we returned to our perinatologist, and told him, “We’re keeping our daughter. We believe, in our hearts, that she’s going to be okay.” Surprisingly, he nodded and said, “Okay. Then, let’s make sure she’s delivered as safely as possible.” For the next five months, he and my extremely supportive OB ensured that our daughter stayed safe, as I was still recovering from the threatened miscarriage and in danger due to the blood clot.

My daughter is turning seven and a half, this month. If anyone were to meet her, they would never guess that she spent her first year of life in and out of the hospital with surgeries and other complications. Today, she’s a brilliant, witty, precocious girl who loves to play sports and sing along to her favorite songs.

Looking back, I wished I had enjoyed more of my pregnancy. Instead I spent the entire second and third trimester waiting for the other shoe to drop, kept second guessing what I could have done to prevent her SB, and refused to tell anyone in my extended family what was going on. As a result, I spent those last months scared, stressed, and fearful. And for what? It didn’t change anything.

Now, if I meet any families or moms pregnant with a child with SB, I beg them to enjoy the pregnancy. Enjoy everything. I’ll never get those moments back, and I wish I had embraced those moments more.

As for your child? Let him or her surprise you. Let him or her tell you what she or he can do. Treat him or her like you would any other child. They can do all the same things—just differently and on their own timeline.

Christopher Reeve once said, “A hero is an ordinary individual who finds the strength to persevere and endure in spite of overwhelming obstacles.” Yes, it’s not easy, and yes, it’s going to be challenging and yes, definitely exhausting, but your child WILL astound you. Only he or she can dictate what he or she can achieve, not a doctor or a statistic.