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.
Pelvic floor pain questionnaire.
Pfdi 20 instructions.
Consider your experiences during the last month.
Pelvic floor impact questionnaire short form 7 pfiq 7 name date dob instructions.
Answer these by circling the appropriate number.
It was created by barber and colleagues 2004 to save time yet remain effective in clinical and research encounters.
The australian pelvic floor questionaire please circle your most applicable answer.
Pelvic floor disability index pfdi 20 instructions.
It is a health related quality of life questionnaire for women with pelvic floor conditions to fill out.
The pelvic floor impact questionnaire 7 pfiq 7 is a shortened less comprehensive version of the pelvic floor impact questionnaire pfiq.
Pelvic floor dysfunction is the inability to control the muscles of your pelvic floor.
Please answer all of the questions in the following survey.
How many times do you pass urine in the day.
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.
For each question check the response that best.
Previously the 93 item pfiq long form was used but the pfiq 7 has been developed and demonstrated substantial validity and reliability.
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.
How many times to you get up at night to pass urine.
A seven question self report measure assessing pelvic floor impact on qol daily activities and emotional health.
Your pelvic floor is the group of muscles and ligaments in your pelvic region the pelvic floor acts like a.
0 up to 7 1 between 8 10 2 between 11 15 3 more than 15 2.
Pelvic floor distress inventory pfdi 20 patient name.
Please answer all of the questions in the following survey.
0 0 1 1 2 2 3.
Check all the apply.
