Cozean Pelvic Dysfunction Screening

Please read through the questions below. Keep count of all that apply.

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.