Your personal incontinence story
About this questionnaire
This first part of this assessment contains 12 questions, and should not take more than 5 minutes to complete. None of the questions are mandatory, and none of the information will be stored on our servers or shared with any third party.
You have identified one or more incontinence symptoms
Based on this, it is possible that you do have a bladder or bowel problem. The next step is to talk to a healthcare professional – we’ll now ask you a few more questions to get a better idea of your personal situation. At the end you’ll have a personal incontinence story that can help you prepare for the appointment, and that can even be printed and brought along. Many people find that having the information organised in this way makes the conversation somewhat easier.
Complete your personal incontinence story
Depending on your profile, you will now be asked 10-12 further questions that should take no longer than five minutes. None of the questions are mandatory, and none of the information will be stored on our servers or shared with any third party.
Your personal assessment
Here’s your tailored assessment that can help you prepare for the appointment, and that can even be printed and brought along. Many people find that having the information organised in this way makes the conversation somewhat easier.
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None of the information provided will be stored on our servers or shared with any third party. This information will be deleted once you close this page.
Q1.Urine. I Leak when I:
Q2.Faecal matter or wind from the bowel. I leak when I
Q3.I sometimes feel I have not completely emptied my bladder or bowel
Q4.I frequently have a sudden urge to rush to use the toilet
Q5.I am frequently nervous because I think I might lose control of my bladder or bowel
Q6.I wake up twice or more during the night to go to the toilet
Q7.I sometimes don’t get to a toilet in time
Q8.I often strain to empty my bladder or bowel
Q9.I sometimes find it hard to start going to the toilet, even when my bladder or bowel feels full
Q10.I sometimes soil my underwear
Q11.I often plan my daily routine around where the nearest toilet is
Q12.Needing to go to the toilet prevents me from leaving home/traveling/visiting family/friends etc.
Q1.What is your biological sex?
Q2.What is your age?
Q3.Are you concerned about your:
Q4.Are you overweight? (WHO BMI calculator)
Q5.Have you ever had abdominal surgery?
Q6.Have you ever had a pelvic injury?
Q7.Have you ever been pregnant?
Q8.Are you pre-menopausal?
Q9.Are you post-menopausal?
Q7.Have you had a prostate problem or operation?
Q7.Have you ever been pregnant?
Q8.Are you pre-menopausal?
Q9.Are you post-menopausal?
Q7.Have you had a prostate problem or operation?
Q8.How long have you been concerned about your bladder or bowel symptoms?
Q8.Have you ever visited a healthcare professional in the past about your concerns?
If yes, what kind of healthcare professional?
Q7.Do you have any specific questions you would like to ask your healthcare professional?
You have not identified any incontinence symptoms
Based on this, it is unlikely that you have a bladder or bowel problem. However, if you are concerned about your health then you should talk to a healthcare professional or contact a local help line.
