Bladder diary / frequency volume chart

Editors: Beth ShellyPT, DPT, WCS, BCB PMD and Tomoe Inoue-Hirakawa, PT, PhD.
July 2017

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Bladder diary or voiding diary BethShelly BethShelly 0 32 Jul 16, 2017 by BethShelly BethShelly

Current definition
Frequency–volume chart (FVC) - records the time of each micturition and the volume voided for at least 24 h, although 2 or 3 days of recording (not necessarily consecutive) generally provide more useful clinical data (1).

Bladder diary: In addition to the FVC, a bladder diary will include fluid intake, pad usage, incontinence episodes and the degree of incontinence. Episodes of urgency and sensation might also be recorded, as might be the activities performed during or immediately preceding the involuntary loss of urine. Additional information obtained from the bladder diary involves severity of incontinence in terms of leakage episodes and pad usage (1).
Subsequent ICS standard terms documents have used the same definitions. (2)

Old definition(s)
The first ICS standard terminology of lower urinary tract function was published in 1976. (3). In this report only the frequency volume chart was defined.
The frequency volume chart is a specific urodynamic investigation recording fluid intake and urine output per 24-h period. The chart gives objective information on the number of voiding, the distribution of voiding between day- time and night-time and each voided volume. The chart can also be used to record episodes of urgency and leakage and the number of incontinence pads used. (3).
This is a combination of the current frequency volume chart and bladder dairy definitions and lacks clarity.

In 1992 Andersen et al listed frequency volume voiding chart or voiding diary but did not define them. (4) Later standardized terms for lower urinary tract dysfunction in children were published with the following definition
Frequency volume diary - intake, volume voided over several 24 hr periods. may include urgency and leakage. (5) Still the terms are unclear.

One of the earliest ICS standard documents was published in 2002 and included these definitions. (6)
Micturition Time Chart records only the time of each micturition.
Frequency Volume Chart records the volumes recorded and time of each micturition, Bladder Diary which adds relevant symptoms and events such as urgency, pain, incontinence episodes, and pad usage. Recording for a minimum of 2 days is recommended. From the recordings, the average voided volume, voiding frequency, and if, the patient’s time in bed is recorded, day/night urine production and nocturia can be determined.

Perspective and controversies
Definitions for bladder dairy and FVC have changed little since 2002. The ICS Standards on Chronic Pelvic Pain syndromes uses the term voiding diary instead of bladder dairy and encourages recording of sensations associated with those voids. (7) Continued debate is needed to decide if "voiding diary" or "bladder dairy" is the proper term.

Pathophysiology or therapy
The bladder dairy is often undertaken as part of a bladder training process. Bladder training has been advocated for treatment of overactive bladder (OAB) symptoms since the late 1960s. It also has been recommended as a treatment for mixed urinary incontinence and stress urinary incontinence. Recommended duration of a bladder dairy is 3 days ( 8) and a Three day diary showed highly reliable (CCC 0.86) for number of UI episodes. (9) In addition it has been shown that patients unable to complete a 3-day diary have less success with treatment. (10)

  1. 1. Haylen BT, de Ridder D, Freeman RM, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn 29: 4–20, 2010.
  2. 2. Bo K, et al. An International Urogynecological Association (IUGA)/ International Continence Society (ICS) joint report on the terminology for the conservative and nonpharmacological management of female pelvic floor dysfunction. 2016 Neurourol and Urodynam. DOI 10.1002/nau.23107
  3. 3. Bates P, Bradley WE, Glen E, et al.: The standardization of terminology of lower urinary tract function. Eur Urol 2: 274-276, 1976.
  4. 4. Andersen JT, et al. Lower Urinary Tract Rehabilitation Techniques: Seventh Report on the Standardization of Terminology of Lower Urinary Tract Function. Neurourology and Urodynamics 11593403 (1992).
  5. 5. Norgaard, et al. Standardization and definitions in lower urinary tract dysfunction in children, British Journal of Urology (1998), 81, Suppl. 3, 1–16
  6. 6. Abrams P et al. The standardization of terminology of the lower urinary tract function: Report from Standardization sub-committee of International Continence Society. Neurourol and Urodynam 21:167-178(2002).
  7. 7. Doggweiler, R. et al. A Standard for Terminology in Chronic Pelvic Pain Syndromes: A Report From the Chronic Pelvic Pain Working Group of the International Continence Society. Neurourology and Urodynamics 2016, DOI 10.1002/nau.23072.
  8. 8. Tincello DG, Williams KS, et al. Urinary diaries- a comparison of data collected for three days versus seven days. Obstet Gynecol, 2007; 109: 277-280.
  9. 9. Groutz A, Blaivas JG, Chaikin DC, et al. Noninvasive outcome measure of urinary incontinence and lower urinary tract symptoms: a multicenter study of micturition diary and pad test. J Urol 2000;164(3 pt 1):698-701.
  10. 10. Kincade JE, Peckous BK, Busby-Whitehead J. A pilot study to determine predictors of behavioral treatment completion for urinary incontinence. Urol Nurs. 2001;21:39-44.