Using the following chart, please record all urinations and episodes of urinary incontinence. If you leak urine, then gauge it as a small, medium, or large leak and record this is the chart below. It is also helpful to write down what caused the leakage (ie cough, sneeze, etc), and any symptoms felt at the time of leakage (urgency or pain)

If you are emptying your bladder with a catheter, please record the time, and how much is drained. In addition, you should record your Post-Void Residual (PVR) once daily. This is done by urinating normally without the aid of a catheter, then immediately inserting a catheter to see how much was left behind. This is a good measure of the emptying capacity of your bladder.

Use the following Symbols:
V = Normal Void
C = Catheterized Void
I = Incontinent
PVR = Post Void Residual