Pelvic Floor Disability Index (PFDI-20) Personal InformationName* First Last Today's Date MM slash DD slash YYYY Who is your therapist?-Choose-Jennifer CummingSarah DominguezMichelle WebbKelsey BeachSamantha CragerNicole DeBrieChristina WisdomNo therapist assigned yet / I don't knowInstructions: Please answer all of the questions in the following survey. These questions will ask you if you have certain bowel, bladder, or pelvic symptoms and, if you do, how much they bother you. Answer these by circling the appropriate number. While answering these questions, please consider your symptoms over the last 3 months. The PFDI-20 has 20 items and 3 scales of your symptoms. All items use a response scale from 0 to 4. Pelvic Organ Prolapse Distress Inventory 6 (POPDI-6)1. Do you usually experience pressure in the lower abdomen?*0 = not present1 = not at all2 = somewhat3 = moderately4 = quite a bit2. Do you usually experience heaviness or dullness in the pelvic area?*0 = not present1 = not at all2 = somewhat3 = moderately4 = quite a bit3. Do you usually have a bulge or something falling out that you can see or feel in your vaginal area?*0 = not present1 = not at all2 = somewhat3 = moderately4 = quite a bit4. Do you ever have to push on the vagina or around the rectum to have or complete a bowel movement?*0 = not present1 = not at all2 = somewhat3 = moderately4 = quite a bit5. Do you usually experience a feeling of incomplete bladder emptying?*0 = not present1 = not at all2 = somewhat3 = moderately4 = quite a bit6. Do you ever have to push up on a bulge in the vaginal area with your fingers to start or complete urination?*0 = not present1 = not at all2 = somewhat3 = moderately4 = quite a bitColorectal-Anal Distress Inventory 8 (CRAD-8)7. Do you feel you need to strain too hard to have a bowel movement?*0 = not present1 = not at all2 = somewhat3 = moderately4 = quite a bit8. Do you feel you have not completely emptied your bowels at the end of a bowel movement?*0 = not present1 = not at all2 = somewhat3 = moderately4 = quite a bit9. Do you usually lose stool beyond your control if your stool is well formed?*0 = not present1 = not at all2 = somewhat3 = moderately4 = quite a bit10. Do you usually lose stool beyond your control if your stool is loose?*0 = not present1 = not at all2 = somewhat3 = moderately4 = quite a bit11. Do you usually lose gas from the rectum beyond your control?*0 = not present1 = not at all2 = somewhat3 = moderately4 = quite a bit12. Do you usually have pain when you pass your stool?*0 = not present1 = not at all2 = somewhat3 = moderately4 = quite a bit13. Do you experience a strong sense of urgency and have to rush to the bathroom to have a bowel movement?*0 = not present1 = not at all2 = somewhat3 = moderately4 = quite a bit14. Does part of your bowel ever pass through the rectum and bulge outside during or after a bowel movement?*0 = not present1 = not at all2 = somewhat3 = moderately4 = quite a bitUrinary Distress Inventory 6 (UDI-6)15. Do you usually experience frequent urination?*0 = not present1 = not at all2 = somewhat3 = moderately4 = quite a bit16. Do you usually experience urine leakage associated with a feeling of urgency, that is, a strong sensation of needing to go to the bathroom?*0 = not present1 = not at all2 = somewhat3 = moderately4 = quite a bit17. Do you usually experience urine leakage related to coughing, sneezing or laughing?*0 = not present1 = not at all2 = somewhat3 = moderately4 = quite a bit18. Do you usually experience small amounts of urine leakage (that is, drops)?*0 = not present1 = not at all2 = somewhat3 = moderately4 = quite a bit19. Do you usually experience difficulty emptying your bladder?*0 = not present1 = not at all2 = somewhat3 = moderately4 = quite a bit20. Do you usually experience pain or discomfort in the lower abdomen or genital region?*0 = not present1 = not at all2 = somewhat3 = moderately4 = quite a bitScoring the PFDI-20 SCALE SCORES: Obtain the mean value of all of the answered items within the corresponding scale (possible value 0 to 4) and then multiply by 25 to obtain the scale score (range 0 to 100). Missing items are dealt with by using the mean from answered items only. PFDI-20 SUMMARY SCORE: Add the scores from the 3 scales together to obtain the summary score (range 0 to 300). CAPTCHAEmailThis field is for validation purposes and should be left unchanged.