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How Much Do Your Bladder Control Problems Bother You? The American Urological Association has developed a quality-of-life question to help you and your doctor understand how bothersome your bladder control problems are. To get your bother score, print this page and circle the number that best represents how you feel about the question below. Bring this bother score to your next doctor visit. Quality of life due to urinary symptoms If you were to spend the rest of your life with your urinary condition the way it is now, how would you feel about that? Delighted 0 Pleased 1 Mostly Satisfied 2 Mixed – about equally satisfied and dissatisfied 3 Mostly dissatisfied 4 Unhappy 5 Terrible 6 Next: Are Bladder Control Issues Affecting Your Life? How Much Are Bladder Control Issues Affecting Your Life? To rate your bladder control symptoms, print this page and circle the number for each question that is closest to what you have recently experienced. When you have finished the survey, add up the points to find out your score. The possible total ranges from 0 to 32 points, with higher scores indicating more severe symptoms. Bring this symptom score to your next doctor visit. 1. Have you ever felt like you can't control your bladder like you used to? 0 1 2 3 4 2. Do you wake up at night having to use the bathroom? 0 1 2 3 4 3. Do you sometimes have to push or strain to urinate? 0 1 2 3 4 4. Do you feel like you have to urinate all the time or urinate more than 7 times each day? 0 1 2 3 4 5. Do you find yourself staying near bathrooms or wearing absorbent undergarments because you sometimes leak urine? 0 1 2 3 4 6. Are there activities you no longer enjoy because of bladder control issues? 0 1 2 3 4 7. Do you turn down invitations from friends or family because you're afraid you'll experience incontinence? 0 1 2 3 4 8. Do bladder control issues occupy your thoughts? 0 1 2 3 4 8. Do bladder control issues occupy your thoughts? 0 1 2 3 4 Next: Symptom Tracker FOR PDF OF SYMPTON TRACKER CLICK HERE You will need Adobe Acrobat to view the downloads. Click icon to download PLEASE COPY AND PASTE OR CLICK TO PRINT THIS DOCUMENT AND ENTER YOUR VOIDING DIARY, feel free to FAX IT TO (407) 332 8767 With the TITLE " DRY PANTS IS MY DREAM" and there will be no charge for a physician to analyze your report and give you a basic opinion via telephone or e mail. The rest it's up to you. If you feel a visit with the urologist would be beneficial based on the report you have received we will welcome you as a patient.  BACK TO TOP

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