Using Voiding Diaries in Incontinent Patients

The primary use of voiding diaries in incontinent patients is documentation of incontinence episodes. Diaries may provide clues to the underlying cause of incontinence, particularly if the diary includes patient comments about the reason(s) or condition(s) associated with the incontinence episodes. Voiding diaries can be used in evaluation of the severity of urinary incontinence because the patient can report the number of pad used and the amount of leakage.

Voiding diaries have been tried in the evaluation of urge incontinence. In one study, a group of women with urge incontinence was compared with another group of normal individuals. There were significant differences between groups in frequency, mean voided volume, and largest single voided volume (Figure 14-1.5), although the overlap was large.13 A similar study compared women with genuine

Figure 14-1.5. Average voided volumes in patients with motor urgency compared with normal group.

stress urinary incontinence to a normal group, and surprisingly showed that total voided volume, frequency of micturition, and largest single voided volume were all significantly higher in the genuine stress urinary incontinence group than in the normal group.14 Therefore, the diagnostic role of the diary is limited.

The voiding diary has been used to differentiate between urge and stress incontinence.15 Most of these studies have shown not only significant differences between populations with urge and stress incontinence, but also considerable overlap. Total voided volumes, mean voided volumes, and largest single voided volumes were less in urge incontinent than stress urinary incontinent groups. Frequency of micturition during the day and at night was greater in the urge than the stress incontinent groups. Analysis of one of these studies showed that the frequency of micturition at night was the single parameter that best discriminates the two conditions. Combining daytime micturition frequency with the largest single voided volume or the mean voided volume increased the discrimination power.15

It is reasonable to evaluate incontinent patients with a voiding diary before other more invasive tests such as uro-dynamic investigation because it is a simple, noninvasive, and inexpensive tool. It evaluates the patient over a longer period of time, away from the laboratory. If urodynamic studies are indicated, a voiding diary can help the clinician choose which studies should be performed. A voiding diary is also reliable and valid when measuring the symptoms of overactive bladder, including urge and urge incontinence episodes, and nocturia.16

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