1. Do you leak urine after an urge to rush to the toilet?
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2. Do you leak urine after strenuous activity or exercise?
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3. Do you have uncontrollable leakage of feaces?
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4. Do you have difficulty initiating urination?
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5. Do you have difficulty moving your bowels?
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6. Do you have difficulty releasing gas/flatus?
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7. Do you have feelings of incomplete emptying?
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8. Do you have pelvic pain or spasm?
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9. Do you ever get feelings of heaviness in the pelvic region?
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10. Do you have pain with sexual intercourse?
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