Hi there. Today, I'm going to be talking to you about voiding diaries. Avoiding diary is a tool to help you document your leaking and your bladder symptoms. And in essence, it's really journaling your symptoms and what is going on with you. But I was recently talking to someone who's followed me for a long time and she said to me, you know, I sat down to do avoiding diary and I realized that I did not have the right Enough detail to really do it correctly.
And I had a lot of questions about what I should be writing down, how long I should be tracking my symptoms, and that was really great feedback for me, and I realized that I need to go into this into a little bit more detail for you. So avoiding Diary is a tool that you can use on your journey to dryness.
It's something that I use all of the time in the office and you can use it in a similar fashion. When you are doing a voiding diary, you are essentially journaling the liquid that you put into your body and you are journaling the liquid that comes out of your body as well. When we do this in the office, we have you measure how much you are emptying.
But if you're looking at your habits and your symptoms, I think that you can just document how often you're leaking and you don't actually need to measure. So when I look at avoiding diary in the office, I'm looking at your habits. I'm looking at how much you're drinking, what types of things you're drinking, if there are any triggers that could be causing your, your leaking or your symptoms.
There are, there are lots of different, uh, foods and liquids that are bladder irritants that can cause bladder symptoms. And. Knowing these bladder irritants and eliminating them from your diet can help a lot of people get better as well. I'm going to talk about the voiding diary first, and then I'll talk about a trigger diary where you're looking at foods and also, um, what the different bladder irritants are as well.
So we look at your habits. It's important to look at your habits because most of us don't realize what we're eating and drinking during the day or the amounts until we actually write it down. And that's something that we see with weight loss. Uh, when women write down what they're eating, They are much more aware of what they're eating.
They tend to eat less because of that. And that leads to better habits. And we see this with the bladder as well. So looking at the habits is really the first thing that we want to do. And then. When I have someone do avoiding diarrhea, I can easily see their symptoms and the severity of their symptoms, and that gives me baseline information, meaning that I know how bad your symptoms are at this point in time.
Bladder symptoms tend to get better slowly over time, and sometimes it's really hard to tell if you're getting better. And so if you're doing avoiding diarrhea, if you're tracking your symptoms over time, Then you can monitor your improvement. And I think that feedback is really important so that you can press on.
It's hard to keep doing something if you're not getting that feedback. So let's say you've been doing public floor exercises. You do a. at the beginning of your program. And then you do one, let's say four weeks later, you might be feeling frustrated because you're not as much better as you want to be.
But in doing avoiding diary, you might be able to realize that you are more than 50 percent improved, right? And, and you may not be able to tell that just in your day to day life, because you're frustrated with The remaining leakage that you have. So avoiding diary also helps us measure your progress, which is very important, um, for the, you know, mindset piece of all of this.
There are different recommendations for avoiding diaries. You can do it. Some people will recommend to do it for three days. Some people will recommend to do it for seven days. I usually recommend three days, but it's important that those days are normal days for you. Meaning that, um, you're not doing, you're not on vacation, you're not doing anything different.
They're not the best days that you've ever had. You're not getting to a point where you're not leaking at all. You want the voiding diary to really show what's going on in your life. So if for whatever reason you have the three best days ever, then you need to repeat it because the days really need to represent what's going on in your day to day life and the problem that you're trying to fix.
Avoiding Diarrhea tells me about your symptoms, it tells me about the severity of your symptoms, it can help me track your progress, it can tell me what things we might be able to change, what behaviors we might be able to change so that you could progress more quickly, um, and it can also help me with your diagnosis.
So if you look at avoiding diarrhea and you're leaking with exercise or coughing, that's stress urinary incontinence. If you're having urgency and you can't get there, then that is urgency incontinence. And sometimes writing it all down makes this diagnosis really clear. Okay, so let's talk about the details of the voiding diary.
So there is a voiding diary that I've created that's attached to this episode, so you can look at that while we're talking about this, or you could get it later if that is helpful to you. There's also the same one on my website at thewomensbladderdoctor. com, so you could find it there as well. So, I want you to do your voiding diary for three days, and again, these have to be typical days for you.
Okay, so let's talk about the details of a voiding diary. So, I would tell you to do the voiding diary for three days, and if you're really focusing on symptoms and triggers and severity, you do not have to measure how much you're emptying. Okay? Um, you need to write the date at the top of the piece of paper and you can make your own voiding diary or you can use the one that I've created that's attached to this episode and is also on my website at thewomensbladderdoctor.
com. So there are two. main columns. One is titled in, one is titled out. And the in, you're looking at what you're, what liquids you're putting into your body, and the out, you're looking at how often you're going to the bathroom and how often you're leaking. So, for the ins, what you would write down is you would write down the time.
And then you're writing down the type of fluid and the amount of fluid. So there are three columns that are here. Um, and it's important for you to measure what you're drinking. You want to keep track of what you're drinking. So you would write down, I had eight ounces of orange juice in the morning or two cups of coffee.
I think it is easiest if you use the same units, right? So you always use ounces or you always use cups. Um, But not everybody does it that way, but it makes it a little bit easier to compare. And so that's what you're writing down for the in portion. Time, type of fluid, and then amount of fluid. For out, there is Five columns.
The first is time. I think it's easiest to have a time on this side as well. It just makes it a little bit easier to scan the document. The next column is void. And a void just means that you're emptying your bladder. So you're just writing down how often you're going to the bathroom. The next column is leaking, right?
So if you had a leak, you're going to put a check in this column. On my voiding diary, I have it divided into three quantities of leaking, so drops, splashes and more, and that can just help you diagnose your own severity and help you keep track of it. If you just want to write down leaks, that is fine too.
And I would tell you that whether it's a drop or a splash, that's very subjective and up to you. There isn't an official, um, definition here. The next column is activity at the time of the leaks. You want to write down what you were doing, right? So did your leak happen when you were coughing, when you were laughing or playing tennis or running?
Those are all signs of stress urinary incontinence. Or did it happen as you were walking to the bathroom wh,en you heard running water, or when you put a key in the door? Those are more symptoms of overactive bladder or urgency urinary incontinence. And then the last column is, was there an urge present, yes or no?
Right, so you can document that urgency component as well. So again, for the outs, you're writing down the time, you're writing down voids, which is how often you're going to the bathroom, you're writing down, um, when you leaked, and you can document the amount if that is helpful to you, the activity at the time of the leak, and urgency, whether it was present or not.
Once you have done this and you've done it for three days and they feel like they're typical days for you, you want to look at it and you want to look at it and ask yourself the following question. So how often are you emptying your bladder? Do you feel like you're emptying too frequently? Do you feel like that's just right on cue?
Do you feel like, you know, yes, I empty more after I have coffee, but I'm not giving that up and I'm okay with that. So you want to look at how frequently you're emptying. You want to look at When you're leaking. And if it is associated with anything that you're drinking. And I think at this point in time, the biggest culprit that I see here right now is really, um, flavored sparkling water.
So, I, I feel like everybody's kind of switched to sparkling water at this point in time. The carbonation in sparkling water is a bladder irritant. Some of the flavors are also bladder irritants. Um, and so, you know, sometimes when you look at that, you'll look and you'll say, Oh my gosh, I'm, you know, every time I drank, you know, lemon, Sparkling water, you know, an hour later, I'm, I'm having a leak or I'm having this urgency and that's a cue to you that you should, I mean, if it's lemon sparkling water, then I would say, okay, go to plain sparkling water, see if it's a problem for you.
And then if it is, then I would say, just go to plain water and stop that. So sometimes there are things that can be impacting your bladder that you may not be. considering, or you may think is a healthy choice. So you're looking at different types of fluid and if they're irritating you. And I think most people know that coffee and tea and alcohol are all bladder irritants.
So you want to stop. You know, particularly pay attention to those fluids. And then the other thing you want to look at is how much you're drinking. You'll see a lot of recommendations that the average woman should drink 64 ounces in a day. And it really depends on how active you are. I would say in general you should be going to the bathroom every three to four hours.
You should be um, you know, urinating about a cup of urine, um, and it should be a light yellow color. And if you're hitting that, then you're drinking the the right amount. If your urine is totally clear, you're probably over drinking. Um, if you're li urine looks really concentrated, then you're probably underdrinking, but it does depend a lot on your medical conditions and how active you are and what you're eating too.
And then I usually tabulate, you know, kind of how many times you're going to the bathroom in a day and, and how many leaks you're having. You can also use this to look at Whether you have stress incontinence, right? So if you're the only times you're leaking or when you're coughing, laughing or exercising, then you have stress incontinence.
If it's all urge related, then it's urgency urinary incontinence. And then you could also have both, right? You could have mixed urinary incontinence and you could recognize that looking at this too. I think when you're doing the, this journaling, you're doing avoiding diary, maybe you're looking at a food trigger diary as well.
I think it's helpful to have a list of bladder irritants. So, there are a lot of different foods and liquids that can irritate the bladder. It's different for everybody. Some things will irritate one person, but not the other, and vice versa. And one of the ways that we identify triggers, right, so something that irritates your bladder, is by using a voiding diary.
So, when you complete the voiding diary, it may become very obvious to you. But it's, it's also helpful to have an idea of the different bladder irritants, um, just so that you can be a little bit more focused. So coffee and teas are bladder irritants and this sadly includes decaffeinated coffee as well.
Acidic fruits like citrus, cranberries, and tomatoes can also irritate the bladder. So when I say citrus, I'm including fruits like oranges, limes, lemons, mandarins. Cranberries can absolutely be irritating to the bladder, right? So you don't want to be eating a lot of cranberries thinking that that's helping your bladder in some way.
That's very different than kind of cranberry supplements. And then all of the associated fruit juices can be irritating, too. Tomatoes are an important one to pay attention to because there are so many different sauces that are made out of tomatoes. And so that, you know, may be an important bladder irritant for you.
Corn syrup, sugar, honey, and artificial sweeteners can be irritants, and artificial sweeteners can be really difficult to track down in a food diary, because they're added to other things. So if it's not, clear to you what's going on, but you know something is irritating your bladder, um, or it happens with just such varied foods, then you want to be looking at additives like artificial sweeteners.
For some patients, milk and dairy products can be irritants. Carbonation, like I said before, can absolutely be a bladder irritant. So I think people think about this in soda, but It is absolutely true for sparkling water as well. So that's an important thing to know. And then spicy foods can also irritate the bladder.
One of the questions that I get asked a lot is, is it better to remove one food at a time and see the impact on your bladder? Or is it better to do an elimination diet? and remove everything. My personal feeling, and maybe this is more about me than it is about you, is that it's easier to remove one thing at a time.
Elimination diets are really hard for most people. Um, but you basically have two choices. You can remove one food at a time and see what the impact is on your bladder. Or you can do elimination diet where you're eating just an incredibly bland diet and then add in. one thing at a time to see the impact.
Either one of those approaches is a reasonable approach. So, we've talked about avoiding diarrhea. We've talked about bladder irritants. You can also do a food trigger diarrhea if you still have some symptoms and you're not really sure what's causing it. This is helpful for overactive bladder symptoms or urgency urinary incontinence.
symptoms. There are definitely foods that irritate the bladder, and this is the best way to figure out what is irritating your bladder. So, with a food trigger diary, there are going to be five columns. So you're going to write down the time, you're going to write down the food that was eaten, you're going to write down the quantity of the food, because you might be able to tolerate small amounts of the food, but not big amounts.
And then you're going to write down if you're leaks or if you're having urgency. If you want to put in another time column for the leaks and urgency, you can definitely do that as well. And again, this food trigger diary that I've created is going to be attached to the show notes. And here, for three days, again, you're just going to write down what you're eating, and you're going to be looking at your symptoms to see if you can identify a correlation.
You know, I've seen some patients that are triggered by MSG. I've seen some patients that are triggered by artificial sweeteners. Sometimes milk can definitely be a problem. Tomato is definitely something that you have to look carefully at. And then citrus can be a big one too. So just paying attention to those things.
You know, once you have this data and once you know how these things impact you, it doesn't necessarily mean that you have to give them up. But it is important for you to know how different foods and liquids impact you, right? So, you know, let's say on your routine days, you really like Having a cup of coffee.
So you have a cup of coffee, you know that cup of coffee causes you to have some urgency and frequency So maybe you skip that coffee when you're traveling or if you have an important event like a wedding, right? It just allows you to be much more calculated In what you are doing So I think voiding diaries and food trigger diaries are really important tools.
The voiding diary we use to track progress as well. But if you're trying to figure out your triggers, trying to figure out what is Not working for you avoid,ing a diary and then doing a food triggered diary can be hugely beneficial. So again, I have these diaries on my website. They're going to be attached to the show notes. So if you think that's helpful, um, you can go ahead and look for it there, and good luck getting started
