Women can answer the following questions to get a sense of their likelihood of having or developing incontinence.
Do you experience urine, stool, or gas leakage sometimes when you cough, laugh, sneeze, or exert yourself physically?
Yes
No
Do you experience urine, stool, or gas leakage that affects your ability to participate in activities?
Yes
No
Have you experienced urine, stool, or gas leakage after childbirth or after a surgical procedure?
Yes
No
Do you feel the need to pass urine, stool, or gas more frequently than normal?
Yes
No
When you feel the need to pass urine or stool, is the feeling often urgent?
Yes
No
If you can’t get to the bathroom quickly, do you experience leakage of urine or stool?
Yes
No
Do you experience pain during urination or pain specifically in the bladder during urination, or both?
Yes
No
Do you often develop bladder infections?
Yes
No
Do you sometimes have difficulty in urinating?
Yes
No
Does your urinary stream seem to have become weaker?
Yes
No
Does it sometimes feel as though your bladder is not emptying completely?
Yes
No
Have you suffered any conditions that might have damaged nerves affecting continence (such as multiple sclerosis, Parkinson’s
disease, Alzheimer’s disease, spinal injury, or stroke)?
Yes
No
Do you notice urine leakage more often just before your period?
Yes
No
Have you noticed urine leakage more since menopause?
Yes
No
Do you have vascular disease caused by diabetes or other condition?
Yes
No
Are you over age 50?
Yes
No
Are you overweight?
Yes
No
Do you experience smoker’s cough?
Yes
No
Do you often wake at night with the need to urinate?
Yes
No
The more often you answered “Yes” to the above questions, the greater your risk for developing or already having incontinence.
If you answered “Yes” to questions above, consider discussing incontinence with one of our Women’s Center healthcare providers.
Print this page and bring it with you, filled out, to your appointment.
