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Ulcerative Colitis Daily Symptom Tracker

Monitor and Record Your UC Symptoms

Gastroenterology

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Template Content

Last updated: Mar 24, 2025

Patient Information

Name: ___________________ Date Range: //___ to //___

Daily Symptoms Log

Rate each symptom on a scale of 0-5 (0 = none, 5 = severe)

Bowel Movements

  • Number of bowel movements today: ___
  • Urgency level (0-5): ___
  • Blood in stool (0-5): ___
  • Consistency (check one): □ Formed □ Soft □ Loose □ Watery

Pain and Discomfort

  • Abdominal pain (0-5): ___
  • Location of pain (check all that apply): □ Upper right □ Upper left □ Lower right □ Lower left

Other Symptoms

  • Fatigue (0-5): ___
  • Joint pain (0-5): ___
  • Nausea (0-5): ___
  • Fever: ___°F/°C

Medication Adherence

List all medications taken today:

  1. _________________ Time: : □ Taken as prescribed
  2. _________________ Time: : □ Taken as prescribed
  3. _________________ Time: : □ Taken as prescribed

Diet Log

Foods that triggered symptoms:

Additional Notes

Weekly Summary

Total days with flare-ups: ___ Worst symptom this week: _______________

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