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Do you have Pelvic Floor Dysfunction?

Check All That Apply Below

Note: This screening is modified from the Cozean Pelvic Dysfunction Questionnaire, validated for screening for pelvic floor dysfunction, used with permission.


I sometimes have pelvic pain (in genitals, perineum, pubic or bladder area, or pain with urination) that exceeds a ‘3’ on a 1-10 pain scale, with 10 being the worst pain imaginable.

I can remember falling onto my tailbone, lower back, or buttocks (even in childhood).

I sometimes experience one or more of the following urinary symptoms:

  • Accidental loss of urine 

  • Feeling unable to completely empty my bladder 

  • Having to void within a few minutes of a previous void 

  • Pain or burning with urination 

  • Difficulty starting or frequent stopping/starting of urine stream 

I often or occasionally have to get up to urinate two or more times at night.

I have a history of pain in my low back, hip, groin, or tailbone or have had sciatica.

I sometimes have a feeling of increased pelvic pressure or the sensation of my pelvic organs slipping down or falling out.

I sometimes experience one or more of the following bowel symptoms: 

  • Loss of bowel control 

  • Feeling unable to completely empty my 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 one or more of my other symptoms.

Prolonged sitting increases my symptoms.

If 3 or more apply, 

Pelvic Floor Muscle Dysfunction is likely.

Reach out to find out how you can find relief!

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