Do you sometimes experience pelvic pain (in the genitals, perineum, pubic, or bladder area, or pain with urination) that rates higher than a ‘3’ on a 1-10 pain scale, with 10 being the worst pain imaginable?
Do you sometimes experience any of the following urinary symptoms: Accidental loss of urine, Feeling unable to completely empty your bladder, Having to urinate within a few minutes of a previous void, Pain or burning with urination, Difficulty starting or frequent stopping/starting of the urine stream
Do you often or occasionally have to get up to urinate two or more times a night?
Do you sometimes feel increased pelvic pressure or the sensation that your pelvic organs are slipping down or falling out?
Do you have a history of pain in your low back, hip, groin, or tailbone, or do you have sciatica?
Do you sometimes experience any of the following bowel symptoms: Loss of bowel control, Feeling unable to completely empty your bowel movements, Straining or pain with a bowel movement, Difficulty initiating a bowel movement
Do you sometimes experience pain or discomfort with sexual activity or intercourse?
Does sexual activity increase any of your other symptoms?
Does prolonged sitting increase your symptoms?
Do you experience leakage when laughing, sneezing, jumping, or performing other movements that put pressure on your bladder?
Do you wear protective pads or liners to guard against unplanned leaks?
When planning a trip, outing, or event, does the availability or location of restroom facilities influence your decision?
