II. Questions

  1. During the past 3 months, have you leaked urine (even a small amount)?
    1. Yes
    2. No - Stop Questionnaire
  2. During the past 3 months did you leak urine:
    1. When performing Physical Activity (coughing, sneezing, lifting, exercising)?
    2. When felt urge to empty your Bladder, but not able to get to the toilet in time?
    3. Neither of the above circumstances
  3. During the past 3 months did you leak urine MOST often:
    1. When performing Physical Activity (coughing, sneezing, lifting, exercising)?
      1. Stress Incontinence predominant
    2. When felt urge to empty your Bladder, but not able to get to the toilet in time?
      1. Urge Incontinence predominant
    3. Neither of the above circumstances
      1. Other cause (neither Urge Incontinence nor Stress Incontinence)
    4. Both of the above circumstances equally as often
      1. Mixed Urinary Incontinence

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