Questionnaire for assessing urinary complaints

Date of birth


Regarding urination in the past month...
How many times have you felt like you couldn't completely empty your bladder?
NeverVery rarelyIn less than half of the casesIn half of the casesIn more than half of the casesAlmost always
How often did you have to urinate again within two hours of urinating?
NeverVery rarelyIn less than half of the casesIn half of the casesIn more than half of the casesAlmost always
How often has it happened that your urine has stopped flowing several times while urinating and then started flowing again?
NeverVery rarelyIn less than half of the casesIn half of the casesIn more than half of the casesAlmost always
How often have you felt like you couldn't hold your urine in any longer?
NeverVery rarelyIn less than half of the casesIn half of the casesIn more than half of the casesAlmost always
How often have you noticed a weak urine stream while urinating?
NeverVery rarelyIn less than half of the casesIn half of the casesIn more than half of the casesAlmost always
How often did you have to strain or push to start urination?
NeverVery rarelyIn less than half of the casesIn half of the casesIn more than half of the casesAlmost always
How many times did you have to get up to urinate at night?
012345
How would you react if your ability to urinate remained the same for the rest of your life?
0 Happily123456 I would find it awful
I have read and accept the Privacy Policy