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Your Pelvic Health Profile - Bowel Questions

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

The questions are adapted from the Australian Pelvic Floor Questionnaire.

Click the button below to start.

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Question 1 of 13

How often do you usually open your bowels?

A

Every other day or daily

B

Less than every 3 days

C

Less than once per week

D

More than once per day

Question 2 of 13

How is the consistency of your usual stool?

A

Soft

B

Firm

C

Hard Pebbles

D

Variable

E

Watery

Question 3 of 13

Do you have to strain to empty your bowels?

A

Never

B

Occasionally - less than once per week

C

Frequently - once or more per week

D

Daily

Question 4 of 13

Do you use laxatives to empty your bowels?

A

Never

B

Occasionally - less than once per week

C

Frequently - once or more per week

D

Daily

Question 5 of 13

Do you feel constipated?

A

Never

B

Occasionally - less than once per week

C

Frequently - once or more per week

D

Daily

Question 6 of 13

When you get wind or flatus, can you control it, or does wind leak?

A

Never

B

Occasionally - less than once per week

C

Frequently - once or more per week

D

Daily

Question 7 of 13

Do you get an overwhelming sense of urgency to empty bowels?

A

Never

B

Occasionally - less than once per week

C

Frequently - once or more per week

D

Daily

Question 8 of 13

Do you leak watery stool when you don't mean to?

A

Never

B

Occasionally - less than once per week

C

Frequently - once or more per week

D

Daily

Question 9 of 13

Do you leak normal stool when you don't mean to?

A

Never

B

Occasionally - less than once per week

C

Frequently - once or more per week

D

Daily

Question 10 of 13

Do you have a feeling of incomplete bowel emptying?

A

Never

B

Occasionally - less than once per week

C

Frequently - once or more per week

D

Daily

Question 11 of 13

Do you use finger pressure to help empty your bowel?

A

Never

B

Occasionally - less than once per week

C

Frequently - once or more per week

D

Daily

Question 12 of 13

How much does your bowel problem bother you?

A

Not at all

B

Slightly

C

Moderately

D

Greatly

Question 13 of 13

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

Confirm and Submit