Pelvic Health Quiz

Are you Male, Female or Non-Binary?*

1. Is there a delay before you can start to urinate?*

2. Do you have to strain to continue urinating?*

3. What would you say the strength of your urinary stream is?*

4. Do you have a sudden need to rush to the toilet to urinate?*

5. Does urine leak when you cough or sneeze?*

6. How often do you pass urine during the day?*

7. During the night, how many times do you get up to urinate, on average?*

8. Do you ever have groin or pelvic floor pain?*

9. Do you have regular bowel movements?*

10. Do you have sexual dysfunction or pain with sexual activity?*

Adapted from The International Continence Society*

1. Do you have a sudden need to rush to the toilet to urinate?*

2. How often do you pass urine during the day?*

3. During the night, how many times do you get up to urinate, on average?*

4. Do you have regular bowel movements?*

5. Do you have pain with sexual activity?*

6. Do you ever have groin or pelvic floor pain?*

6. Do you have painful periods?*

7. Do you feel pain or heaviness in the Pelvic Floor?*

8. If you have been pregnant, did you have any of the following?*

Select all that apply

Are you 18 years or older?*

What is your First Name?*

What is your Last Name?*

Email Address*

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Phone

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