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:
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Accidental loss of urine
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Feeling unable to completely empty my bladder
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Having to void within a few minutes of a previous void
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Pain or burning with urination
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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:
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Loss of bowel control
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Feeling unable to completely empty my bowels
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Straining or pain with a bowel movement
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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!