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CPPS Daily Symptom Log, free printable
Use this CPPS daily symptom log to track pelvic pain, urinary symptoms, sitting tolerance, sleep, stress, and activity notes. It can be used before or after a formal diagnosis.
Updated May 2026. By Intero.
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What is on the form
- Pelvic and perineal pain scales
- Urinary symptom row
- Ejaculatory pain field
- Sitting tolerance notes
- Sleep, stress, and activity context
How to use it
- 01Fill in one row per day.
- 02Separate pain locations when they feel different.
- 03Track sitting tolerance if sitting is part of your symptom pattern.
- 04Bring several weeks if you want to discuss changes over time.
Common questions
- Is this only for men diagnosed with CPPS?
- No. The categories are common symptom areas that may be useful before or after a diagnosis.
- Why include sitting tolerance?
- For some people with pelvic pain, sitting is a useful context marker. Skip it if it does not apply.
- Is the form really free?
- Yes. The PDF is free to download.
Sources used
These sources informed the structure and language of this tracking worksheet. The form is informational and does not replace medical advice.