Women's Services

This brief questionnaire will help you assess your symptoms and determine if a pelvic health assessment with a specialist might be helpful.

If you answer 'Yes' to one or more of these questions, it is recommended that you schedule an appointment with a pelvic health specialist or contact the Pelvic Health Nurse Navigator at 314-205-6654. You will speak confidentially with a registered nurse who can help guide you to the appropriate evaluation and treatment options based on your needs, as well as provide referral to a specialist.

Do you experience leakage of urine with:
coughing, sneezing, walking, running or heavy lifting?
Yes     No

changes in posture (laying down to sitting and/or sitting to standing)?
Yes     No

the sudden urge to empty your bladder?
Yes     No

Do you experience urine leakage on the way to the bathroom?
Yes     No

Do you wear pads or pantyliners to manage a urine leakage problem?
Yes     No

Do you empty your bladder more frequently than every 2-3 hours daily?
Yes     No

Do you empty your bladder more than one time nightly?
Yes     No

Do you suffer from frequent urinary tract infections?
Yes     No

Do you have pelvic heaviness or feel like your pelvic organs are falling out?
Yes     No

Do you feel something bulging through the vaginal opening?
Yes     No

Has it become more difficult or painful to have sex?
Yes     No

Do you experience leakage of gas, liquid stool or solid stool?
Yes     No

Do you wear pads or pantiliners to manage a stool leakage problem?
Yes     No

Do you have to strain frequently to pass a bowel movement?
Yes     No

Do you have to frequently press vaginally or around the anal area to help with passing a bowel movement?
Yes     No