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How to Keep a Bladder Diary

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Overactive bladder (OAB) is an umbrella term for several urinary symptoms. The most common symptom is a sudden urge to urinate that you can’t control. Other symptoms include leaking urine, frequent urination, and waking up at night to urinate. 

OAB is a common condition, affecting as many as 40% of women and 30% of men in the United States. It can usually be managed with lifestyle changes, prescription medications, botulinum toxin (Botox) treatments, nerve stimulation, and, in severe cases, surgery. 

Whether you’ve already been diagnosed with OAB or you suspect you have it, you may want to consider keeping a bladder diary. This can give you clues about what’s behind your OAB symptoms and even help you manage them. 

“The bottom line is, these are very easy to do,” says Howard Goldman, MD, a urologist at Cleveland Clinic. “They don’t cost anything, there’s no risk, and many of the guidelines on how to treat overactive bladder suggest that a keeping a diary before starting treatment can be very helpful.”

There are several reasons you may want to start a bladder diary.

To gather data for yourself: “If you think something might be going on, keeping a bladder diary could be really helpful just to see how often you’re really going to the bathroom and when you leak urine,” says Margaret Mueller, MD, a urogynecologist at Northwestern Medicine in Chicago. 

That said, Mueller notes that women in particular tend to think that they urinate too frequently because “their bladder is interfering with their being able to do 100 million things in a day.” In reality, she says they’re often within the range of normal. A bladder diary can show this and give you reassurance.

To take to your health care provider: If you decide to see your health care provider about your symptoms, it’s helpful to have a bladder diary completed. For instance, keeping track of how much you’re urinating can give your provider a much better sense of how much your bladder can hold and how much you’re actually going to the bathroom. “We have patients who think they’re going all the time, but you see their diary and they’re only going five times,” says Goldman. “It’s a big difference if someone’s holding just 6 ounces in their bladder versus 15 ounces.”

To pinpoint behaviors that you can change: Maybe you’re having bothersome symptoms like having to go to the bathroom too often or needing to run to get to the bathroom in time. Goldman says a bladder diary may show you some behaviors that you can change on your own before you even go to the doctor. 

For example, you might see that you’re drinking a lot right before you go to bed or consuming more Diet Cokes a day than you thought. “Sometimes, part of the OAB problem is that someone may be taking in too much fluid or too much caffeine, which may be an underlying contributing factor,” Goldman says.

When your health care provider requests it: Goldman has his patients keep a bladder diary when he first sees them. “It’s most important right at the start to get some idea of what’s going on,” he says.

Both Mueller and Goldman also sometimes have their patients keep a bladder diary when they start a new treatment or to measure their response to treatment. “There are some therapies where we may do a trial. In those cases, we may do a diary beforehand and then during the therapy to get a sense of how much it’s helping,” Goldman says.

Mueller uses a bladder diary to see how often her patients leak urine with a strong urge to go to the bathroom and how often they leak urine with coughing, sneezing, etc. She also wants to see how often they’re urinating. This combination helps her determine what treatment may be needed.

“Let’s say there’s no leakage, but they’re going to the bathroom every 30 minutes,” Mueller says. “You might be able to do an intervention called timed voiding, which is basically retraining the bladder. This has been shown to be effective.” In this example, you would try to stretch out going to the bathroom to an hour instead of 30 minutes. Gradually, you would keep adding another 30 minutes until you’re urinating every 2 hours.

When you get up multiple times during the night: A bladder diary is important for people who urinate often at night “because we can see if they’re putting out more urine at night than they should,” says Goldman. Typically, you should urinate less than a third of your total volume of urine at night, he explains. If you’re voiding more than that, this could indicate other medical problems that are causing your body to put out more fluid in the evening.

One of the more common causes of making too much urine at night, known as nocturnal polyuria, is obstructive sleep apnea. “When you have obstructive sleep apnea, you make less antidiuretic hormone because the body thinks it’s daytime and makes urine like normal,” says Mueller. If someone has risk factors for sleep apnea such as snoring, overweight, or obesity, “we’ll typically have them referred for a sleep study to see if that might be part of the picture,” she says. “The benefit is that sleep apnea is reversible and getting treated for it can really reduce those bladder symptoms.”

Pick your tracking method. You can write your bladder diary in a notebook, download a template and print it out (Goldman recommends this one), or find an app for your phone. There are even companies that sell cups that measure your urine and automatically upload your volume to an app, according to Goldman. “Your average person probably doesn’t need to be that fancy though,” he says.

Keep the diary for 3 days. One day isn’t enough because things can change too much from day to day, Goldman says. “There have been studies that show that a 3-day diary isn’t much different than longer diaries, so 3 days is short enough to get a sense of what’s going on but long enough to give you an accurate idea,” he explains. 

Use 24-hour periods. Start tracking when you wake up in the morning. You don’t have to track for 3 days in a row, but you should do 24 hours at a time. For example, if you get up at 7 a.m. the first day, fill out your diary until 7 a.m. the next day.

Measure your urine. You’ll need a cup unless you have a collection device from your health care provider. A measuring cup is a good choice so you can see exactly how much you’ve passed. You’ll need to rinse the cup or collection device with water after every use. Be sure to measure and keep track of how much urine you pass both during the day and at night.

Use a bladder diary to track information and symptoms such as:

  • How much fluid you drink
  • How often you drink
  • How often you urinate
  • How much you urinate
  • How often you feel an urgent need to urinate
  • When and how much urine you leak, if applicable

Goldman stresses that it’s important to have your health care provider check everything out if you have OAB symptoms. “There’s everything now, from certain exercises to plenty of medications to Botox injections and pacemakers,” he says. “We can do all kinds of things, so OAB is not something people should have to live with.”



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5 Family and Community Engagement Strategies to Improve Student Outcomes

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Strong school-family-community partnerships bring exceptional value to children’s education. A recent book by Karen L. Mapp, a senior lecturer at the Harvard Graduate School of Education, and four other co-collaborators synthesizes the available research to explain who benefits from these partnerships and the many advantages of family and community engagement.

Everyone Wins! The Evidence for Family-School Partnerships & Implications for Practice (Scholastic, 2022) cites various research to demonstrate how family-community-school partnerships benefit all stakeholder groups when they’re approached effectively:

  • Students have higher grades, better attendance, deeper engagement in school, greater self-esteem, and higher rates of graduation and college attainment.
  • Educators enjoy better job satisfaction, better success motivating students from different backgrounds, more family support, and an improved mindset about students and their families.
  • Families have stronger relationships with their children and better rapport with educators. They can navigate school policies and advocate for their children more effectively.
  • Schools enjoy a better climate, more support from their community, and improved staff morale—leading to better teacher retention.
  • School districts and communities become better places to live and raise children. They experience fewer disciplinary problems, greater participation in afterschool programs, and more family and student involvement in decision-making.
community members talking and hugging in matching green volunteer t-shirts in front of an outdoor mural

What elements make school-family-community partnerships particularly effective? Here are five tips for how school systems can successfully promote family and community engagement in education and drive better student outcomes.

1. Successful Family Engagement Requires Intentional Leadership

Engaging with families has to be a core activity and not just an afterthought. It requires a total commitment by school and district leaders, and this commitment must include investing in the tools and training needed to help educators effectively engage with families from all backgrounds. It must be a real and intentional focus, and as Mapp says: “It’s real when I see it on your budget sheets.”

2. Teachers and Administrators Must Communicate Clearly and Consistently

To encourage family involvement in their children’s education, educators must interact with families frequently—and in many ways. For instance, teachers and administrators might engage with families in person during school drop-off and pick-up periods, set up a Family Information Board in the school’s lobby, write and distribute regular newsletters or blog posts, and/or send emails or text messages to parents.

Communicating effectively is one of the National PTA’s “National Standards for Family-School Partnerships,” which guides how schools and families should work together to support student success. Teachers and administrators should learn about and meet families’ preferred methods of communication, and families should be able to share and receive information in culturally and linguistically relevant ways.

3. Develop Healthy, Positive Relationships Based on Mutual Trust and Respect

Interactions between educators and families should be positive and reciprocal, with families feeling valued and supported. Educators can establish trust and encourage healthy, two-way communications with families by sharing information about their children’s positive behaviors and accomplishments and which skills may need work. Listen to all parents and provide opportunities for shared decision-making.

4. Be Mindful of Diversity, Equity, and Inclusion

Welcoming all families and fostering a sense of belonging is another National PTA standard. When families engage with your school, do they feel respected, understood, and connected to the school community?

To ensure equity and inclusion, learn about the families you serve and their unique needs and challenges. Use culturally responsive engagement practices. Create opportunities for connection, especially with historically marginalized families and students. Learn about and seek to remove barriers for families to participate fully in their children’s education.

5. Help Families Support and Extend the Learning at Home

Students learn more effectively when they have opportunities at home to practice, reinforce, or extend the skills and lessons they’ve learned in school. Educators can facilitate this process by giving families specific ideas for expanding their children’s learning at home, such as by incorporating core math and literacy concepts into everyday routines.

Schools can also make instructional resources such as take-home packs, activity sets, and other materials available to families to support their children’s education.

How School Specialty® Can Help

School Specialty has more than six decades of experience in providing tools, resources, and strategies that promote successful education both in school and at home. We offer arts and crafts, early childhood, ELA, math, science, STEM/STEAM, physical education, special needs, and social emotional learning resources for families, as well as games, puzzles, and general supplies.

How do you promote family engagement in your classroom and community? Let us know in the comments!





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Preteens and skincare: What parents should know – CHOC

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Published on: April 16, 2024
Last updated: April 9, 2024

Should teens and preteens be using so many skincare products with fancy ingredients? A pediatric dermatologist answers parents’ questions.

Link: https://health.choc.org/preteens-and-skincare-what-parents-should-know/



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Living With Crohn’s: My Daily Routine

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By Michelle Pickens, as told to Danny Bonvissuto

As early as I can remember, I’ve had issues with my health. When I was little, I had severe constipation, nausea, vomiting, and food sensitivities.

As I got older, those symptoms transitioned into diarrhea, irregular bowel movements, and pain. I was always very fatigued and my immune system was weak: The second someone in my class had the cold or flu, I’d get it, too. Looking back, it was a sign.

From a mental perspective, my anxiety was high. What if I need to find a bathroom? What if I’m nauseous? Doctors would say, “Oh, you’ll grow out of it. It’s just your anxiety.”

Finally, a Diagnosis

After years of misdiagnosis, I was finally diagnosed with Crohn’s disease in 2015. I was 23 and had just finished up college while working full time. My symptoms were getting worse. I had a lot of vomiting and pain. The fatigue was at the point where it was difficult for me to work or even get out of bed some days.

It was so bad it pushed me to seek additional care. I took a couple months off, looked for another job, and went through all the doctor appointments it took to get the diagnosis.

There’s no blood test for Crohn’s. No way to prove what you’re feeling. Eventually I saw the right doctor, who did a test with a pill camera called a small bowel capsule. (This is a pill-sized camera that you swallow, allowing doctors to see inside your digestive system.) It tracked my intestines and was able to get into a blind spot where neither a colonoscopy nor endoscopy can see inflammation. 

It was such a relief to get the diagnosis because it made me feel like I wasn’t crazy. For so many years I knew something was wrong and couldn’t name it. I also felt hopeful. Once I knew what I was dealing with, I knew I could work to get to a better place.

Sharing My Story

In 2016, I started a blog called Crohnically Blonde as an outlet to connect with people as I go through the stages of dealing with Crohn’s. When I first started to share, there weren’t as many people talking about it.

I’ve been able to form relationships in an online community through shared experiences. I hope someone can see my story and feel that, if they’re at the beginning of their journey, there’s a way to get through.

Managing My Medication

At first, I was on a lot of medication that wasn’t working well and was a huge imposition on my schedule. Now I get infusions of an immunosuppressive drug every 7 weeks.

It means being away from my family and job for 4-5 hours, and managing child-care coverage during the treatment and the weekend after, because I feel almost flu-like. The extra help allows me to rest and fuel back up after the treatment.

I have the option to be on more medications to control my symptoms. But I try to shy away from those and manage it on my own because I don’t want to be on medicine for every single thing.

Before I had my son, I was more willing to try different medications. But while I was pregnant, I could barely be on any of the Crohn’s medicines. After I had him, it didn’t make sense to be reliant on them.

Crohn’s, Pregnancy, and Motherhood

Crohn’s affected me throughout my pregnancy. I got very sick in my third trimester because I went off my immunosuppressive drug to avoid passing any on to the baby. I ended up having to be induced early so I could get back on the medication as soon as possible.

My son, Maddox, is 1 now. Crohn’s changed my expectation of what I thought motherhood would be.

I’ve learned that I’d rather be present and able to enjoy him in the good moments than push it when I’m sick. It’s been difficult. But if I’m not well, I can’t be there for my child. I try to be with him as much as I can, but there are times when I need to step back and take an hourlong nap.

I have a great support system: My husband, mom, or mother-in-law can step in and help out for a little while, and when I feel better, I can be a better mom. There are also days when I don’t have accessible help. In those situations, I’ll do lower-key activities that I can enjoy with him but that aren’t physically demanding on me.

Schedule and Adjust

Right now I’m in a pretty good spot. I work from home now, as a recruiter for a tech company, and that makes a huge difference. A lot of my anxiety in the past was around being in an office and being sick. Now that I can work remotely, it’s such a game changer.

But Crohn’s still affects my day-to-day. I have days where I’m feeling sick, and need to rest and change my plans so I’m home and not out somewhere.

No matter how planned-out I have my day or week, if I’m not feeling well that takes precedence. I like to be a very scheduled person. But I have to roll with the punches and have a plan B.

The biggest challenge is managing my sleep and stress. They’re both very influential in symptom flare-ups. I have to get at least 8 hours of sleep, no matter what. And I try to incorporate time to de-stress, like reading a book or relaxing at the end of the day.

Going to therapy helps offset stress as well, and is now part of my ingrained self-care schedule.

Social Life Strategies

My co-workers, family, and friends are very understanding. But that wasn’t the case at first. The more open I’ve been about Crohn’s, the more people understand that I’m not flaking out if I have to change plans; there’s an underlying reason.

I only have a certain amount of energy, so now I pick and choose. I know I need to work and be with my family, which means I have less energy to put into social situations.

I plan out what I’m comfortable doing, but have also become comfortable with changing plans. Even if I’m excited to go out to dinner with a friend, I don’t push it if I feel terrible that day.

Food in Flux

I’ve followed a gluten-free diet for years. I started with an elimination diet and realized that gluten was bothering me.

Other foods aren’t as black and white. I can eat a salad one day and it’s fine, and eat the same salad the next day and it makes me sick. I repeat the safe foods that don’t make me sick and stick to a general schedule of three meals a day that are pretty much all gluten free.

Sometimes the timing matters: I’ll wake up and feel nauseated and need a starchy food like dry cereal. If I’m going on a road trip, or have a big event, like a wedding, I plan it out and try to be careful about what I eat leading up to it because I don’t want to be sick. But it’s hard because you never really know. It’s kind of a gamble.

Flexibility Is Key

I’ve learned to be as flexible as possible. I never know what each day is going to bring, I just have to trust that my body is telling what it needs for that specific day. That’s my priority, and everything else can wait.

 



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