Cozean Pelvic Floor Dysfunction Screening Questionnaire

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Take the questionnaire below to find out if you have a pelvic floor dysfunction and would benefit from seeing a pelvic health physical therapist!

Answer YES or NO to the following:

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1. 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
2. I can remember falling onto my tailbone, lower back, or buttocks (even in childhood)
3. I sometimes experience one or more of the following urinary symptoms
   • Accidental loss of urine 
   • Feeling unable to completely empty my bladder
   • Having to void within a few minutes of a previous void
   • Pain or burning with urination
   • Difficulty starting or frequent stopping/starting of urine stream
4. I often or occasionally have to get up to urinate two or more times at night
5. I sometimes have a feeling of increased pelvic pressure or the sensation of my pelvic organs slipping down or falling out
6. I have a history of pain in my low back, hip, groin, or tailbone or have had sciatica
7. I sometimes experience one or more of the following bowel symptoms
   • Loss of bowel control
   • Feeling unable to completely empty my bowels
   • Straining or pain with a bowel movement
   • Difficulty initiating a bowel movement
8. I sometimes experience pain or discomfort with sexual activity or intercourse
9. Sexual activity increases one or more of my other symptoms
10. Prolonged sitting increases my symptoms

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If you answered YES to 3 or more of the above, you are highly likely experiencing pelvic floor dysfunction. Seek help from a pelvic floor physical therapist to find a treatment plan that works for you! Contact our pelvic health team today at Regenerative Edge Physical Therapy & Wellness to set up an appointment.

*The Cozean Questionnaire was created by Nicole Cozean, PT, DPT, WCS, CSCS* and Jesse Cozean, MBA

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