Incontinence chart
Peer reviewed by Dr Helen Huins, MRCGPLast updated by Dr Laurence KnottLast updated 20 Sept 2017
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This form is to: 1) Record the times you pass urine, 2) Record the amount of urine you pass on each occasion and 3) Record the times you leak urine (are incontinent).
Tick (to the nearest hour) each time you go to the toilet to pass urine.
If your doctor or nurse asks, when possible, also record the amount (volume) of urine you pass each time. You can use a household measuring jug to do this. If you are away from home and it is inconvenient to measure the amount then just record the time with a tick.
If you leak urine unintentionally, record the times it happens (to the nearest hour). Put one, two or three + signs in the box. + = damp. ++ = wet. +++ = soaking.
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About the authorView full bio
Dr Laurence Knott
General Practitioner, Medical Author
BSc (Hons) Biochemistry, MBBS
Dr Laurence Knott qualified in 1973 and has had extensive experience as a General Practitioner.
About the reviewerView full bio
Dr Helen Huins, MRCGP
General Practitioner, Medical Author
MB, BS, Lond, DCH, DRCOG, MRCGP, JCPTGP, DFFP
Helen qualified at Guy’s Hospital in 1989 and left London in 1990 to settle in the countryside.
Article history
The information on this page is peer reviewed by qualified clinicians.
Article also available in English, German, Spanish, French, Italian, Portuguese, Hindi, Hebrew, Arabic, and Swedish.
20 Sept 2017 | Latest version
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