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-- Transcript --
So the good ol’ bowel, bladder and food diaries…. It’s a powerful trio! And they are amazing for examining how our clients' habits may be contributing to their symptoms. This is so important because whoever takes the time to review things like this with them? It is so valuable for the big picture, combined with all the other tools we bring to the table.
I love giving them the diaries to fill out before the first session and it's ideal for the diaries to span 3-5 days to get an accurate read of their habits, and I love it to span the weekday and weekend. I wanna see it all!
When I talk with my clients about why I am asking them to fill it out, because it is a big ask, I share the following with them:
A Diary Gives us A Good Snapshot Of What’s Happening With their Body
For example, if they are leaking. Knowing how often they leak, when, and how much can help us create voiding habits that work with their body, as well as better assess what we need to address the leakage. Do they Always have a problem at 10 in the morning? Perhaps they need to examine what foods they are having for breakfast or how much time they are allowing yourself to use the toilet. Keeping a diary will help illuminate these patterns so we can investigate the whys.
Another example is if they are having FI, keeping a diary Helps us To Identify Triggers That May Be Causing them To Have it. By keeping a record, you can start to uncover trends that may be contributing to the issue. For instance, that cup of coffee first thing in the morning may be i
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So the good ol’ bowel, bladder and food diaries…. It’s a powerful trio! And they are amazing for examining how our clients' habits may be contributing to their symptoms. This is so important because whoever takes the time to review things like this with them? It is so valuable for the big picture, combined with all the other tools we bring to the table.
I love giving them the diaries to fill out before the first session and it's ideal for the diaries to span 3-5 days to get an accurate read of their habits, and I love it to span the weekday and weekend. I wanna see it all!
When I talk with my clients about why I am asking them to fill it out, because it is a big ask, I share the following with them:
A Diary Gives us A Good Snapshot Of What’s Happening With their Body
For example, if they are leaking. Knowing how often they leak, when, and how much can help us create voiding habits that work with their body, as well as better assess what we need to address the leakage. Do they Always have a problem at 10 in the morning? Perhaps they need to examine what foods they are having for breakfast or how much time they are allowing yourself to use the toilet. Keeping a diary will help illuminate these patterns so we can investigate the whys.
Another example is if they are having FI, keeping a diary Helps us To Identify Triggers That May Be Causing them To Have it. By keeping a record, you can start to uncover trends that may be contributing to the issue. For instance, that cup of coffee first thing in the morning may be irritating their bowels more than they thought before, hinting that it’s time to rethink your java habit.
Lastly, It Provides them With A Roadmap For A Discussion with us. Recording leaks and daily habits gives us a chance to outline everything they have been experiencing can really help detail the discussion. For many, when and how they eliminate is not something they really record and recall with incredible accuracy --it’s really not the highlight of their day, right? So having this roadmap really makes these patterns black and white, which helps us create a customized tx plan for them.
some of my faves are
https://www.niddk.nih.gov/-/media/Files/Weight-Management/Stool_Diary_508.pdf
https://medicine.umich.edu/sites/default/files/content/downloads/Food%20Fiber%20Fluid%20and%20Bowel%20Diary%207%2015.pdf
Which combines it most of it in one sheet! It excludes urgency and meds
What are we looking at with these diaries?
· Analyze water intake (total amount, do they spread out their drinking over the day or do they cluster drink/chug?)
· Analyze caffeine intake (total amount)
· What is the ratio between these two fluids?
· Analyze fiber (are they getting an appropriate amount?)
· What type of stool are they producing based on the Bristol chart?
· Do they have urgency? I have them rate their urgency too.
· What types of meds are they on and look up whether they may be contributing to their symptoms
what do you look for?
When I gather this information, I gain a holistic view of their habits and routines. And help them achieve more ideal habits around water, caffeine, fiber and track stool consistency. I look at things like:
How often are they going? Normal bladder frequency is typically around 6-8 times each day. Normal bowel frequency varies quite a bit from 1 time over 3 days to 3 times each day.
How strong are their urges when they go? Generally, I recommend grading urges on a 0-3 scale (from no urge –> gotta go right now!). Were most of their urges very small? Were they running to the bathroom all day?
How much did they urinate? The best way to track this is to actually measure their output (usually a cheap plastic cup or a dollar tree measuring cup works well). Normal output of urine is 400-600 mL per void. They can also try just counting the seconds of your stream, however, this does tend to be less accurate. We generally tell people that each stream should be at least 8 seconds.
What did their poop look like? Was the stool soft and formed? Little rabbit pellets? Did they have to push hard to empty their bowels or did they come out easily? Did they have any discomfort or pain?
What was their diet like? Do you notice any trends in what they eat or drink? Were they drinking some well-known bladder offenders (like caffeinated drinks, soda, coffee, artificial sweeteners or sugary drinks)? Did they eat at really regular intervals?
any trends? Did they always go to the bathroom when they had the littlest urge? Was most of their leaking with coughing or sneezing? Does running water send them running to the bathroom? Did you always have a bowel movement after your morning coffee?
I share with them how they may be able to change their fluid intake so that they are getting an ideal amount of water per day (½ their body weight in ounces, spread out throughout the day), and minimal or no caffeine (if appropriate for their symptoms). I offer personalized suggestions based on their feedback, such as if they share that they don’t like drinking water, I suggest adding pieces of fruit or herbs into their water. Anything that makes it fun! If they only drink coffee, I am suggestions alternates to weave in slowly over time such as chicory or herbal tea. For ex: They drink 4 cups of coffee per day. Next week:, 3 cups of coffee per day, 2 cup of chicory. 2nd week: 2 cups of coffee per day, 1 cup of chicory, 1 cup of tea. Etc.
If they aren’t getting enough fiber, I share with them foods that offer the kind of fiber they need. I usually add that if you put into the google search engine the food type, the amount and the word fiber, you get great results that can help guide their fiber choices! For ex, I type in : “blueberries, 1 cup, fiber” and the result is “3.6 grams.” The colon likes gradual change, so I share with them how important it is to slowly increase fiber over time while tracking how it changes their stool.
The stool chart results gives us a more accurate assessment of their stool type and we can track it over time as they implement our new strategies.
Urgency scores helps us track that in a quantifiable way with numbers, and the meds info can shed some light on possible side effects such as “gabapetin,” which is also associated with constipation.
The Bowel, bladder food diary is a great insight into the roles, habits and routines of our clients and can lend so much perspective on how we can guide their healing.