Tracking leaks, with the detail that classifies them

The three patterns

Urinary incontinence is usually sorted into a small number of patterns, and almost everything about the assessment follows from which one you have.

Stress incontinence

Leaking on effort or exertion, with no warning urge beforehand: a cough, a sneeze, laughing, lifting something, standing up, exercise. The mechanism is physical - pressure rising above what the supporting structures can hold against.

Urgency incontinence

Leaking that follows a sudden, compelling need to pass urine that could not be deferred. The classic account is not making it to the bathroom, or leaking as you arrive. This sits within the overactive bladder picture.

Mixed incontinence

Both, in some proportion. This is common, and it is the case where a diary earns the most, because the proportion determines where treatment starts. Someone with occasional stress leaks and daily urgency leaks needs a different plan from the reverse, and neither is reliably estimated from memory.

Why context beats counting

Most people asked to keep a leak diary record how many times they leaked. That number, alone, is close to useless.

Six leaks in three days tells a clinician the frequency and nothing about the mechanism. Six leaks in three days, of which four happened within seconds of a sudden urge and two happened while lifting, describes mixed incontinence with a urgency-dominant pattern - which is an assessment.

The most valuable field in a leak diary is the one that says what you were doing. It costs a few words and it is what converts a tally into something clinically usable.

Sequence matters too, which is why leaks are worth recording on the same timeline as your voids and drinks rather than in a separate list. A leak forty minutes after a large coffee, following two small-volume voids, tells a story that the same leak in isolation does not.

Measuring severity

Frequency is one axis; how much is another. Precision is not required and chasing it tends to end in an abandoned diary. What helps is a consistent scale you actually apply - drops, a small amount, a soaking - used the same way each time, so that a change over weeks means something.

If you use pads, record how many you changed and roughly how saturated they were. Pad usage is a practical severity measure that clinicians are used to interpreting, and it captures impact in a way an episode count does not.

Note what you were wearing or doing if it affected whether the leak mattered - reaching the bathroom in time at home but not at work is itself information about how much warning you get.

What treatment looks like, and how the diary measures it

First-line treatment for urinary incontinence is behavioural rather than surgical, and both main options are measured through a diary.

For stress and mixed incontinence, NICE recommends a trial of supervised pelvic floor muscle training for at least three months. Supervision matters: the exercises are commonly performed incorrectly when self-directed, and a physiotherapist checking technique is the difference between three useful months and three wasted ones.

For urgency and mixed incontinence, bladder training for a minimum of six weeks is the recommended starting point - gradually extending the intervals between voids using urge suppression techniques.

Both are slow, and slow treatments fail for a predictable reason: without a record, week six feels much like week one. A diary kept from before you start gives the baseline that makes gradual improvement visible, which is often what keeps people doing the exercises long enough for them to work.

How Vesi records leaks

Leaks are a first-class entry type in Vesi, alongside drinks and voids, rather than an afterthought. Each takes a time, optionally a volume and duration, an urgency rating, a pain rating, and a free-text comment - which is where what you were doing goes, and it is the field worth using every time.

Everything lands on one daily timeline, so the run-up to each leak stays visible: what you drank, when you last went, how urgent it was. The Trends charts cover void frequency, urgency, time between voids, and intake against output across a week, a month or a year, so a treatment programme has something to be measured against.

Your entries stay on your iPhone. There is no account, nothing is uploaded, and nothing leaves the device until you export a report and send it yourself - which for a document of this kind is the property that matters most. The PDF export lets you choose what appears, so the comments that were useful to you need not be in the copy you hand over.

Getting assessed

Incontinence goes unreported far more often than it goes untreated, and embarrassment is the usual reason rather than any shortage of options. First-line treatments are conservative, well evidenced, and do not start with surgery.

Bring a diary covering the number of days your clinic asked for, with the context recorded. It changes the appointment from a description of something difficult to talk about into a document that classifies itself.