Urinary Health Test

Each question has several possible responses. Answer each question with a response that best describes your own situation.

Urinary symptoms during the past month:

1. How often have you had a sensation of not emptying your bladder completely?

Not at all
Less than 1 time in 5
Less than half the time
About half the time
More than half the time
Almost always

2. How often did you urinate more than once within a 2-hour period?

Not at all
Less than 1 time in 5
Less than half the time
About half the time
More than half the time
Almost always

3. How often have you stopped and started several times while urinating?

Not at all
Less than 1 time in 5
Less than half the time
About half the time
More than half the time
Almost always

4. How often have you had difficulty postponing urination?

Not at all
Less than 1 time in 5
Less than half the time
About half the time
More than half the time
Almost always

5. How often have you had a weak urinary stream?

Not at all
Less than 1 time in 5
Less than half the time
About half the time
More than half the time
Almost always

6. How often did you strain to begin to urinate?

Not at all
Less than 1 time in 5
Less than half the time
About half the time
More than half the time
Almost always

7. How many times did you get up during the night to urinate?

Not at all
Less than 1 time in 5
Less than half the time
About half the time
More than half the time
Almost always

8. Overall, how bothersome has any trouble with urination been during the last month?

Not that bothersome
Bothers me a little
Bothers me some
Bothers me a lot