IBS Assessment
Name
*
First Name
Last Name
Email
*
example@example.com
IBS Symptoms
Digestive Distress
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Do you often feel abdominal pain or discomfort at least one day per week in the last three months?
*
Yes
No
Do your bowel habits change during periods of discomfort or pain (i.e., you switch between diarrhea and constipation)?
*
Yes
No
Do you notice a change in the frequency or form (appearance) of your stool when you have abdominal pain?
*
Yes
No
Do you feel relief from abdominal pain after a bowel movement?
*
Yes
No
Do you experience more frequent bowel movements when the abdominal pain starts?
*
Yes
No
Do you often find it difficult to fully evacuate during a bowel movement?
*
Yes
No
Do you see mucus in your stool more than twice a week?
*
Yes
No
Have you experienced a sudden urge to have a bowel movement that's difficult to control?
*
Yes
No
Have you noticed a change in the color or consistency of your stool?
*
Yes
No
Have your symptoms been persistent for at least six months?
*
Yes
No
Do you experience bloating or noticeable abdominal swelling?
*
Yes
No
Does your bloating often occur after eating certain foods?
*
Yes
No
Have you observed a relationship between your stress levels and changes in your bowel patterns?
*
Yes
No
Do periods of heightened stress lead to increased discomfort or irregular bowel movements?
*
Yes
No
Have you noticed a link between emotional distress (like anxiety or depression) and the severity of your symptoms?
*
Yes
No
IBS Score
Lifestyle Score
Submit
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