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Bladder Health Assessment

Please select the most appropriate response to the following questions.


* Name:
* Email:



*1. How often have you felt the strong need to urinate with little or no warning?


*2. Is needing to urinate with little warning a problem for you?
*3. Is frequent urination during the day a problem for you?
*4. Have you had to urinate less than 2 hours after you finished urinating?
*5. How often did you most typically get up at night to urinate?
*6. Is getting up at night to urinate a problem for you?
*7. Have you experienced pain or burning in your bladder?
*8. Is burning, pain, discomfort or pressure in your bladder a problem for you?
*9. Do you leak urine when you cough, laugh, sneeze, lift heavy objects or during any other activity?
*10. Do you notice any pressure in your pelvis or bulging from your vagina?