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Question 1 of 13
What is your name?
Question 2 of 13
What is your email address?
Question 3 of 13
Have you ever been pregnant or are you currently pregnant?
Question 4 of 13
Did you have any tearing during giving birth?
I never gave birth
Question 5 of 13
Do you have pelvic pain (in you genitals, pubic region, tailbone, or with urination or bowel movement) that exceeds a 3 on a scale of 1-10?
Question 6 of 13
Do you have pain with sex?
Question 7 of 13
Do you pee more than 10 times per day?
Question 8 of 13
Do you pee more than 2 times at night?
Question 9 of 13
Have you experience any of the following:Check all that apply:
Accidental leakage of urine with laughing, sneezing, coughing, running, or jumping
Accidental leakage of urine with a strong and uncontrollable urge- cannot get to the bathroom quick enough
Feeling you cannot empty your bladder fully
Must go to the bathroom only a few minutes after peeing the first time
Pain with urination
Difficulty starting to pee
Frequent starting and stopping of the pee when peeing
None of the above
Question 10 of 13
Have you noticed a separation of your stomach muscles? Bulging with certain exercises?
I think so, but not always
Question 11 of 13
Are you doing kegels properly? (yes, this is a trick question)
Yes, of course.
I think so but now I'm not so sure...
Never really tried them.
Question 12 of 13
Have you ever had a fall or an injury to your tailbone, low back, or sacrum? It does count if it happened when you were a child.
Question 13 of 13
Do you increased pressure in your pelvic region, vagina, rectum, or lower abdomen (stomach)? This goes hand in hand with feeling as if your vagina or your insides are falling out.
Only with certain movements or exercise