BPH SYMPTOM TRACKER & Self-Assessment Journal

Your Personal Guide to Understanding Prostate Symptoms

Based on the American Urological Association (AUA) Symptom Score
Also known as the International Prostate Symptim Score (IPSS)

Created by: The Health Knowledge Base
Date: December 2025

Welcome to Your BPH Symptom Tracker

Tracking your symptoms is the first step toward better prostate health. This 30-day journal helps you:

✅ Quantify what you’re feeling – Turn “annoying” into measurable data
✅ Identify patterns & triggers – What makes symptoms better or worse?
✅ Communicate effectively – Bring objective data to your urologist
✅ Monitor treatment progress – See if interventions are working

How to Use This Tracker

1. Complete the Initial Assessment
Take the official AUA Symptom Score quiz to establish your baseline.

2. Daily Tracking
Spend 2 minutes each evening rating your symptoms.

3. Weekly Review
Spot trends and calculate weekly averages.

4. Doctor Visit Prep
Summarize your findings before appointments.

Pro Tips for Accurate Tracking:

Be consistent – Fill it out at the same time each day
Be honest – This is for you, no one else sees it
Note everything – Fluid intake, medications, stress levels
Look for patterns – Not just daily scores, but weekly trends

Important Medical Disclaimer:
This tracker is for informational purposes only and does not constitute medical advice. Always consult with a qualified healthcare provider for diagnosis and treatment. If you experience sudden inability to urinate, fever with painful urination, or blood in urine, seek immediate medical attention.

BASELINE ASSESSMENT: AUA Symptom Score (IPSS)

Date: Time:

Instructions: For each question, circle the number that best describes your experience OVER THE LAST MONTH.

1. INCOMPLETE EMPTYING

How often have you had a sensation of not emptying your bladder completely?
0 – Not at all
1 – Less than 1 time in 5
2 – Less than half the time
3 – About half the time
4 – More than half the time
5 – Almost always

2. FREQUENCY

How often have you had to urinate again less than 2 hours after finishing?
[Same scale 0-5]

3. INTERMITTENCY

How often have you stopped and started again several times while urinating?
[Same scale 0-5]

4. URGENCY

How often have you found it difficult to postpone urination?
[Same scale 0-5]

5. WEAK STREAM

How often have you had a weak urinary stream?
[Same scale 0-5]

6. STRAINING

How often have you had to push or strain to begin urination?
[Same scale 0-5]

7. NOCTURIA

How many times did you typically get up at night to urinate?
0 – None
1 – 1 time
2 – 2 times
3 – 3 times
4 – 4 times
5 – 5 or more times

CALCULATE YOUR SCORE:

Voiding Symptoms Total (Q1+Q3+Q5+Q6): _ Storage Symptoms Total (Q2+Q4+Q7):
TOTAL AUA SCORE: __ / 35

Severity Interpretation:

0-7 = Mild
8-19 = Moderate
20-35 = Severe

Quality of Life Question:

“If you were to spend the rest of your life with your urinary condition just as it is now, how would you feel?”
0 – Delighted
1 – Pleased
2 – Mostly satisfied
3 – Mixed
4 – Mostly dissatisfied
5 – Unhappy
6 – Terrible

Even with mild symptoms, if your quality of life score is 4+, treatment may be warranted.

Understanding Your Symptoms

Voiding (Emptying) Symptoms:

Incomplete Emptying – Feeling bladder isn’t fully empty
Intermittency – Flow stops and starts
Weak Stream – Reduced urine force
Straining – Needing to push to start

Storage (Filling) Symptoms:

Frequency – Urinating often (>8x/day)
Urgency – Sudden, strong need to go
Nocturia – Waking at night to urinate

My Personal Health Goals

Primary Goal: [ ]
□ Reduce nighttime trips
□ Improve stream strength
□ Reduce urgency
□ Other: __

Target AUA Score: Current _ → Goal _ in 3 months

Lifestyle Changes I’ll Try:
[ ] Limit fluids 2 hours before bed
[ ] Reduce caffeine/alcohol
[ ] Try pelvic floor exercises
[ ] Schedule bathroom trips
[ ] Other: __

Doctor Appointment Date:
Questions to Ask: _______

DAY 1: [Date] _

Morning Check-In:

Weight: _ lbs Blood Pressure: / (optional)
Medications Taken: _________________
Notes: ________________________

Symptom Ratings (0-5 Scale):

Incomplete Emptying: 0 1 2 3 4 5
Frequency: 0 1 2 3 4 5
Intermittency: 0 1 2 3 4 5
Urgency: 0 1 2 3 4 5
Weak Stream: 0 1 2 3 4 5
Straining: 0 1 2 3 4 5
Nocturia (# of times): 0 1 2 3 4 5

DAILY SCORE: _ / 35

Fluid & Voiding Diary:

Time	Fluid (oz)	Urinated?	Notes
7AM
9AM
… etc for 8-10 time slots

Triggers & Patterns Today:

Caffeine: None / 1 cup / 2+ cups
Alcohol: None / 1 drink / 2+ drinks
Spicy food: Yes / No
Stress Level: Low / Medium / High
Exercise: Type Duration
Medications: ________________
Other notes: _____________

Evening Reflection:

What was today’s most bothersome symptom? ____
What helped today? ___________________

WEEKLY REVIEW: Week of _

Daily Scores:

Day 1: _ Day 2: Day 3:
Day 4: Day 5: Day 6: Day 7: __

Weekly Average: _ High Score: (Day )
Low Score: (Day __)

Symptom Patterns Noticed:

□ Worse in mornings
□ Worse after caffeine/alcohol
□ Better with exercise
□ Worse with stress
□ Consistent throughout day
□ Other: ____

Fluid Intake Patterns:

Average daily ounces: _ Main fluid types: Water % Coffee/Tea % Soda % Alcohol % Noticed connection to symptoms? ________________

What Worked This Week:

Effective strategies: ____________________
To try next week: ______________________

Progress Snapshot:

Starting AUA Score (Page 2): _ This Week’s Average: _
Change: □ Improved □ Same □ Worse

Most Improved Symptom: ____
Most Persistent Symptom: ___

DOCTOR VISIT SUMMARY

Appointment Date:
Doctor: __________
Purpose: □ Initial consult □ Follow-up □ Treatment review

Key Data to Share:

Baseline AUA Score: _ (from Page 2)
Tracking Period: _ days total
Average AUA Score: _
Range: High _ to Low _
Quality of Life Score: _ (0-6 scale)

Most Bothersome Symptoms:

____ (rated average _/5)
____ (rated average _/5)
____ (rated average _/5)

Clear Patterns Identified:

Symptoms worse when: ____
Symptoms better when: ____
Strongest triggers: ________

Questions for My Doctor:

________________________
________________________
________________________
________________________
________________________

Treatment Goals to Discuss:

□ Reduce nocturia from _ to _ times/night
□ Improve stream strength
□ Reduce urgency episodes
□ Other: __________________

Appointment Notes:

Diagnosis/Impressions: __________________
Recommended Tests: ____________________
Treatment Plan: ________________________
Next Steps: ___________________________
Follow-up Date: _______________________

Additional Resources from The Health Knowledge Base

Continue Your BPH Education:

Lifestyle Support:

Emergency Red Flags:

Seek IMMEDIATE medical attention if you experience:

Complete inability to urinate
Fever with painful urination
Visible blood in urine
Severe abdominal/pelvic pain

For Non-Emergency Concerns:

Worsening symptoms
Medication side effects
Questions about treatment
→ Contact your urologist or primary care provider

Thank you for taking control of your prostate health!

Bring this completed tracker to your next appointment for more productive conversations with your healthcare team.

The Health Knowledge Base Team