Do you experience, and if so, how much are you bothered by
Frequent urination? NoYes
If yes, how much does it bother you? Not at allSlightyModeratelyGreatly
Night time urination? NoYes
Urine leakage related to the feeling of urgency? NoYes
Urine leakage related to physical activity, coughing or sneezing? NoYes
General urine leak not related to urgency or activity? NoYes
Small amounts of urine leakage (drops) ? NoYes
Large amounts of urine leakage? NoYes
Difficulty emptying your bladder? NoYes
Pain or discomfort in the lower abdominal or genital area? NoYes