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Your Pelvic Health Profile - Bladder Questions

This questionnaire asks relevant questions to find out whether you have bladder symptoms or not. The questions focus on bladder function and effects on your day to day life.

The questions are adapted from the Australian Pelvic Floor Questionnaire.

Click the button below to start.

Start

Question 1 of 16

How many times do you pass urine in a day?

A

Up to 7x

B

Between 8-10x

C

Between 11-15x

D

More than 15x

Question 2 of 16

How many times do you get up at night to pass urine?

A

0-1x

B

2x

C

3x

D

More than 3x

Question 3 of 16

Do you wet the bed before you wake up at night?

A

Never

B

Occasionally - less than once per week

C

Frequently - once or more per week

D

Always - every night

Question 4 of 16

Do you need to rush/hurry to pass urine when you get the urge?

A

Can hold on

B

Occasionally have to rush - less than once per week

C

Frequently have to rush - once or more per week

D

Daily

Question 5 of 16

Does urine leak when you rush or hurry to the toilet or can't you make it in time?

A

Not at all

B

Occasionally - less than once per week

C

Frequently - once or more per week

D

Daily

Question 6 of 16

Do you leak with coughing, sneezing, laughing or exercising?

A

Not at all

B

Occasionally - less than once per week

C

Frequently - once or more per week

D

Daily

Question 7 of 16

Is your urinary stream (urine flow) weak, prolonged or slow?

A

Never

B

Occasionally - less than once per week

C

Frequently - once or more per week

D

Daily

Question 8 of 16

Do you have a feeling of incomplete bladder emptying?

A

Never

B

Occasionally - less than once per week

C

Frequently - once or more per week

D

Daily

Question 9 of 16

Do you need to strain to empty your bladder?

A

Never

B

Occasionally - less than once per week

C

Frequently - once or more per week

D

Daily

Question 10 of 16

Do you need to wear pads because of your urinary leakage?

A

None - never

B

As a precaution

C

When exercising / during a cold

D

Daily

Question 11 of 16

Do you limit your fluid intake to decrease urinary leakage?

A

Never

B

Before going out

C

Moderately

D

Always

Question 12 of 16

Do you have frequent bladder infections?

A

No

B

1-3 per year

C

4-12 per year

D

More than 1 per month

Question 13 of 16

Do you have pain in your bladder or urethra when you empty your bladder?

A

Never

B

Occasionally - less than once per week

C

Frequently - once or more per week

D

Daily

Question 14 of 16

Does urine leakage affect your routine activities like recreation, socialising, sleeping, shopping etc?

A

Not at all

B

Slightly

C

Moderately

D

Greatly

Question 15 of 16

How much does your bladder problem bother you?

A

Not at all

B

Slightly

C

Moderately

D

Greatly

Question 16 of 16

Would you like to add any experiences or symptoms relating to the bladder that have not already been covered in the previous questions?

Confirm and Submit