Any screening questionnaire would ideally be able to identify a wide variety of pelvic floor dysfunction including patients with chronic pelvic pain pelvic organ prolapse orthopedic pain with a pelvic floor component low back hip groin urinary urgency frequency and or bowel dysfunction.
Pelvic floor pain questionnaire.
Answer these by circling the appropriate number.
These questions will ask you if you have certain bowel bladder or pelvic symptoms and if you do how much they bother you.
Previously the 93 item pfiq long form was used but the pfiq 7 has been developed and demonstrated substantial validity and reliability.
How many times do you pass urine in the day.
Please answer all of the questions in the following survey.
Pelvic floor disability index pfdi 20 questionnaire appropriate for women 20 questions assesses levels of disability and distress how much it bothers you subsections assess pelvic organ prolapse pop distress colorectal anal distress and urinary distress pelvic floor impact questionnaire pfiq 7 questionnaire appropriate for women 7 questions assesses impact of pelvic symptoms on.
Check all the apply.
Pfdi 20 instructions.
Cozean pelvic dysfunction screening protocol instructions.
It was created by barber and colleagues 2004 to save time yet remain effective in clinical and research encounters.
Please answer all of the questions in the following survey.
It is a health related quality of life questionnaire for women with pelvic floor conditions to fill out.
Your pelvic floor is the group of muscles and ligaments in your pelvic region the pelvic floor acts like a.
How many times to you get up at night to pass urine.
I sometimes have pelvic pain in genitals perineum pubic or bladder area or pain with urination that exceeds a 3 on a 1 10 pain scale with 10 being the worst pain imaginable i can remember falling onto my tailbone lower back or buttocks even in childhood.
0 up to 7 1 between 8 10 2 between 11 15 3 more than 15 2.
A seven question self report measure assessing pelvic floor impact on qol daily activities and emotional health.
For each question check the response that best.
The australian pelvic floor questionaire please circle your most applicable answer.
Some women find that bladder bowel or vaginal symptoms affect their activities relationships and feelings.
Pelvic floor impact questionnaire short form 7 pfiq 7 name date dob instructions.
Consider your experiences during the last month.
Pelvic floor disability index pfdi 20 instructions.
The pelvic floor impact questionnaire 7 pfiq 7 is a shortened less comprehensive version of the pelvic floor impact questionnaire pfiq.
