• Pelvic Floor Dysfunction

    This questionnaire used to evaluate pelvic floor function is based on the Cozean Protocol and was developed for the general population to improve pelvic floor function throughout a person’s lifetime.
  • I sometimes have pelvic pain (in genitals, perineum, pubic, or bladder area, or pain with urination) that exceeds a ‘3’ on a 1-10 pain scale with 10 being the worst pain imaginable.
  • I can remember falling onto my tailbone, lower back or buttocks (even in childhood).
  • I often or occasionally have to get up to urinate two or more times a night.
  • I sometimes have a feeling of increased pelvic pressure or the sensation of my pelvic organs slipping down or falling out.
  • I have history or pain in my low back, hip, groin, or tailbone or have sciatica.
  • Prolonged sitting increases my symptoms.
  • I sometimes experience pain or discomfort with sexual activity or intercourse.
  • Sexual activity increases one or more of my other symptoms.
  • I have experienced sexual trauma
  • My work and/or life activities regularly place strain on my pelvic floor muscles.
  • I have been pregnant before
  • I have given birth vaginally or caesarean.
  • I sometimes experience one or more of the following urinary symptoms:
  • I sometimes experience one or more of the following bowel symptoms:

  • IF YOU CHECKED 3 OF MORE BOXES OR ANSWERS YES MORE THAN 3 TIMES,

    PELVIC FLOOR DYSFUNCTION IS LIKELY!

     

     

  • Should be Empty: