Read each question carefully and circle the number of the answer that best describes your own experiences. |
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Total score of 0-3 points is a normal result, 4-6 mild symptoms, 7-11 moderate symptoms and 12 or over severe symptoms. |
1. During the past month, how often have you felt a strong need to urinate with little or no warning? | 0. Not at all |
1. Less than 1 time in 5 |
2. Less than half the time |
3. About half the time |
4. More than half the time |
5. Almost always |
2. During the past month, have you had to urinate less than two hours after you finished urinating? | 0. Not at all |
1. Less than 1 time in 5 |
2. Less than half the time |
3. About half the time |
4. More than half the time |
5. Almost always |
3. During the past month, how often did you most typically get up at night to urinate? | 0. Not once |
1. Once per night |
2. Twice per night |
3. Three times per night |
4. Four times per night |
5. Five times or more per night |
4. During the past month, have you experienced pain or burning in your bladder? | 0. Not at all |
1. A few times |
2. Fairly often |
3. Usually |
4. Almost always |