OVERACTIVE BLADDER

Please complete the following questionnaire for your personal evaluation and discuss with your doctor. Feel free call or email us, we would be happy to answer any of your questions.

1. How bothered have you been by frequent urination during the daytime hours?

1 2 3 4 5

2. How bothered have you been by an uncomfortable urge to urinate?

1 2 3 4 5

3. How bothered have you been by a sudden urge to urinate with little or no warning?

1 2 3 4 5

4. How bothered have you been by accidental loss of small amounts of urine?

1 2 3 4 5

5. How bothered have you been by nighttime urination?

1 2 3 4 5

6. How bothered have you been by waking up at night because you had to urinate?

1 2 3 4 5

7. How bothered have you been by an uncontrollable urge to urinate?

1 2 3 4 5

8. How bothered have you been by urine loss associated with a strong desire to urinate?

1 2 3 4 5

 

Result




What Your Result Means

Score

00 - 07 Mildly symptomatic

08 - 19 moderately symptomatic

20 - 35 severely symptomatic

SOURCE: ¹Coyne KS, Zyczynski T, Margolis MK, Elinoff V, Roberts RG. Validation of an overactive bladder awareness tool for use in primary care settings. Adv Ther. 2005;22(4):381-394.