Leaky Urine and Pelvic Floor Problems Support Tool Startpress Enter Over the last year, how often have you been bothered by the following problems? Needing to wee right away and/or had a leak or accident * Never Sometimes (1 – 3 times per month) Often (4 – 14 times per month) Frequently (more than 15 days a month) Bladder problems that affect or interfere with your ability to work * Never Sometimes (1 – 3 times per month) Often (4 – 14 times per month) Frequently (more than 15 days a month) Plan your activities around your bladder problems * Never Sometimes (1 – 3 times per month) Often (4 – 14 times per month) Frequently (more than 15 days a month) Experience heaviness or bulging in the vagina and / or lower back pain * Never Sometimes (1 – 3 times per month) Often (4 – 14 times per month) Frequently (more than 15 days a month) Low mood, mood swings, irritability, anger, crying spells, nervous tension/anxious, social withdrawal * Never Sometimes (1 – 3 times per month) Often (4 – 14 times per month) Frequently (more than 15 days a month) Poor concentration, confusion, memory problems, clumsiness * Never Sometimes (1 – 3 times per month) Often (4 – 14 times per month) Frequently (more than 15 days a month) Difficulty falling asleep and/or staying asleep * Never Sometimes (1 – 3 times per month) Often (4 – 14 times per month) Frequently (more than 15 days a month) Submit If you are human, leave this field blank. ContinueSubmit Use Shift+Tab to go back