Bowel and Bladder Tracking Record

Three-day continence tracking record used to evaluate bowel and bladder patterns, intake/output trends, and related symptoms.

Tracking Instructions

• Tracking period
  Record bowel and bladder activity for 3 consecutive days. Enter each event as it occurs when possible.
• Consent and disclosure acknowledgement
  I understand this form collects health-related information for continence tracking and may be reviewed by authorized caregivers or clinicians.

Submitter and Record Details

• Date of record
• Day number
• Completed by
• If other, specify role

Fluid Intake

• Total fluid intake for the day (mL)
• Fluid intake notes
  Optional notes such as timing, type of fluids, or unusual intake patterns.

Bladder Tracking

• Number of urination events today
• Urine characteristics
• Any urinary symptoms?
• Urinary symptom details
  Describe urgency, frequency, pain, leakage, or other symptoms.
• Incontinence episode occurred?
• Incontinence episode details
  Optional details such as time, trigger, pad/brief use, or assistance needed.

Bowel Tracking

• Bowel movement occurred today?
• Number of bowel movements
• Stool consistency
• Any bowel symptoms?
• Bowel symptom details
  Optional notes about timing, discomfort, or factors that may affect bowel patterns.

Patterns and Additional Notes

• Pattern observations
  Summarize any noticeable trends, such as timing, triggers, constipation, urgency, or leakage patterns.
• Additional notes
  Include only information relevant to continence tracking and care planning.