Now

If you require translation services or a copy of this document in
other languages, audio tape, Braille or larger print, please speak to
a member of CWP staff, e-mail [email protected] or write to:
Communications, Cheshire and Wirral Partnership NHS Foundation
Trust, Upton Lea, Countess of Chester Health Park, Liverpool
Road, Chester, CH2 1BQ.
Continence Advisory Service
Jeśli wymagane jest tłumaczenie lub kopia niniejszego dokumentu
w innych językach, na taśmie magnetofonowej, w języku Braille’a
lub dużym drukiem, prosimy o skontaktowanie się z członkiem
personelu CWP (Organizacja partnerska krajowego systemu
zdrowia regionów Cheshire i Wirral) lub przez pocztę elektroniczną:
[email protected] lub na adres: Communications, Cheshire and
Wirral Partnership NHS Foundation Trust, Upton Lea, Countess of
Chester Health Park, Liverpool Road, Chester, CH2 1BQ.
Os oes arnoch angen gwasanaeth cyfiethu neu gopi o'r ddogfen
hon mewn ieithoedd eraill, tâp sain, Braille neu brint mawr,
siaradwch ag aelod o staff CWP, e-bost [email protected] neu
ysgrifennwch i: Communications, Cheshire and Wirral Partnership
NHS Foundation Trust, Upton Lea, Countess of Chester Health
Park, Liverpool Road, Chester, CH2 1BQ.
Feedback
We welcome any suggestions you have, please send your
comments, concerns, complaints and compliments to:
Cheshire & Wirral Partnership NHS Foundation Trust,
PALS, Complaints and Incidents Team, Trust Headquarters
Redesmere, Liverpool Road, Chester, CH2 1HJ.
For more information see www.cwp.nhs.uk
© CWP NHS Foundation Trust
The information in the leaflet was valid at the date of
production December 2015 and is due for review in
December 2017.
Leaflet code: F-CASBABC-13-443
BLADDER and BOWEL CHART
Name: …………………………………..… Date: ………………….
Day 1
Bladder Record Chart
This chart will help us to assess how your bladder works.
It should be filled in over 2 – 3 days.
How to Use
Column 1 ‘IN’
Please measure and record how much fluid you drink and record it alongside the
right time of day.
Column 2 ‘OUT’
Each time you go to the toilet please measure and record how much urine you
pass alongside time of day
(For example: use a small plastic measuring jug)
Column 3 ‘D or W’
Please record any damp or wet times you may have during the day and night.
D
=
DAMP
W
=
WET
Column 4 ‘B.O.’

When you have your bowels open
Comments
Please record the type of fluid you have. For example: tea, coffee, water, beer.
Also please note any other information that may help the nurse during your
assessment.
……………………………………………………………………………………
………………………………………………………………………………………………………………………………
People who access our services are welcome to talk to the Team Manager if they
are experiencing any problems with their care.
TIME
6 am
7 am
8 am
9 am
10
am
11
am
12
noon
1 pm
2 pm
3 pm
4 pm
5 pm
6 pm
7 pm
8 pm
9 pm
10
pm
11
pm
12
midnight
1 am
2 am
3 am
4 am
5 am
IN
OUT
Day 2
D
or
W
B.O.
IN
OUT
Day 3
D
or
W
B.O.
IN
OUT
D
or
W
B.O.