OSW FREE QUESTIONNAIRE
COZEAN PELVIC DYSFUNCTION SCREENING PROTOCOL
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I sometimes have pelvic pain (in genitals, perineum, pubic or bladder area, or pain with urination) that exceeds a ‘3’ on a 1-10 pain scale, with 10 being the worst pain imaginable
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I can remember falling onto my tailbone, lower back, or buttocks (even in childhood)
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I sometimes experience one or more of the following urinary symptoms:

Accidental loss of urine 

Feeling unable to completely empty my bladder 

Having to void within a few minutes of a previous void 

Pain or burning with urination 

Difficulty starting or frequent stopping/starting of urine stream


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I often or occasionally have to get up to urinate two or more times at night
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I sometimes have a feeling of increased pelvic pressure or the sensation of my pelvic organs slipping down or falling out
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I have a history of pain in my low back, hip, groin, or tailbone or have had sciatica
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I sometimes experience one or more of the following bowel symptoms: 

Loss of bowel control 

Feeling unable to completely empty my bowels 

Straining or pain with a bowel movement 

Difficulty initiating a bowel movement


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I sometimes experience pain or discomfort with sexual activity or intercourse
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Sexual activity increases one or more of my other symptoms
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Prolonged sitting increases my symptoms
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