Prostate Disease Symptoms Journal

Keeping a record of your urinary health can give you an objective view of your prostate disease symptoms and help you and your doctor decide on a course of action. Print this weekly journal and use it to record your symptoms so that you and your doctor can discuss treatment options and progress. When you record a day, include overnight time as the day before. In other words, Tuesday begins when you wake up in the morning.

Print this page to take to your next appointment with your doctor.


Mon

Tue

Wed

Thu

Fri

Sat

Sun
How many times did you urinate?

How many of these times
were after you had gone to bed?
How many of these were urgent
trips to the bathroom?
During how many trips did you
experience leakage prior to urination?
During how many of these times
did you stop and start again?
During how many of these times
did you have a weak stream?
During how many of these times
did you push or strain to begin?
During how many of these times did you experience pain?
Approximately how many ounces of fluid
did you drink during the day?
How many times during the day did
urination interfere with your regular activities?
Notes: