Pelvic Floor Dysfunction Quiz
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Please check all that apply. Please check all that apply
Sometimes I have pelvic pain in genitals, perineum, pubic or bladder area or pain with urination that is greater than 3/10 on a pain scale with 10 being the worst pain imaginable.
I remember falling on my tailbone, lower back or buttocks in the past, even in childhood.
I sometimes experience any of the following: leakage of urine, unable to completely empty my bladder, having to pee again within a few minutes of a previous pee, pain or burning with urination, difficulty starting or frequent stopping/starting of urine stream.
I often or occasionally have to get up two or more times at night to pee.
I sometimes have increased pelvic pressure or the sensation of my pelvic organs falling down or out.
I have a history of lower back pain, hip pain, groin pain, tailbone pain or have/have had sciatica.
I sometimes experience any of the following: leakage of bowels, feeling unable to completely empty bowels, straining or pain with a bowel movement, difficulty initiating a bowel movement.
I sometimes experience pain or discomfort with sexual activity or intercourse.
Sexual activity increases 1 or more of my symptoms.
Prolonged sitting increases my symptoms.
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