Overactive Bladder Assessment Questionnaire
Please select the score that best describes how much you have been bothered by each symptom.
How bothered have you been by the following?
0 = Not at all
1 = A little bit
2 = Somewhat
3 = Quite a bit
4 = A great deal
5 = A very great deal
Frequent urination during the day
0
1
2
3
4
5
An uncomfortable urge to urinate
0
1
2
3
4
5
A sudden urge to urinate with little or no warning
0
1
2
3
4
5
Accidental loss of small amounts of urine
0
1
2
3
4
5
Nighttime urination
0
1
2
3
4
5
Being woken up at night by the need to urinate
0
1
2
3
4
5
An uncontrollable urge to urinate
0
1
2
3
4
5
Urine loss associated with a strong urge to urinate
0
1
2
3
4
5
Are you:
Male
Female
Your score is 0.
This is in the normal range, so you probably don't have an overactive bladder. However, if you are concerned about your bladder and urination, you may want to talk with a health care professional.
Print this questionnaire to take with you the next time you visit your doctor. It will help your doctor to assess your problem and recommend an appropriate course of action.
Print Friendly Version (PDF)
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