Pelvic Floor Dysfunctional Disorders Questionnaire

  Pelvic floor dysfunctional disorders self-examination form: Self-examination 1: Do I suffer from urinary incontinence?  Symptoms: (Yes, No)  Do you have urine leakage when you laugh, sneeze, cough, or exercise?  Do you try to reduce or avoid some behaviors to reduce urine leakage?  You need diapers or pads to absorb the leaked urine?  Self-test 2: Do I have any other pelvic floor dysfunctional disorders?  Symptoms: (Yes, No)  Your vagina is not as tight as it used to be?  During urination, you are unable to interrupt or continue urination freely?  Do you have pain during sex that makes you feel uncomfortable?  Self-test 3: Do I need to prevent pelvic floor dysfunctional disorders?  Symptoms: (Yes, No) Symptoms: (Yes, No)  Have you given birth? Are you in menopause or are your estrogen levels declining?  You have an obese body type? Do you do heavy physical work or are under stress or work pressure?  Do you suffer from chronic cough? Do you care about your quality of life?  If you answered “yes” to any of the above, you can choose exercise training and bioelectric stimulation for prevention!  Self-test 4: Overactive bladder test form.  Symptoms: (A, B) Symptoms: (A, B, C)  Urination more than 8 times in 1 day ;Yes ;No.  Urinary urgency in time for toileting ;No ;Yes.  Waking up at night to urinate more than 2 times ;often ;rarely.  Unable to control the amount of urine leakage each time; more; less; no.  Sudden and strong urge to urinate; Yes; No.  Leakage due to laughing, coughing, sneezing; No; Yes.  Instructions: 1. If your answers are all A, you may have overactive bladder disorder (urge incontinence).  2. If your answers are all B, you may have stress urinary incontinence.  3.If your answer is BBBBCA, it means you do not currently have either of these diseases.  4.If your answer is not in the above three ranges, you may suffer from other diseases of the urinary tract.