Bladder Questionnaires - Oklahoma Physical Therapy






Female NIH-Chronic Prostatitis Symptom Index (NIH-CPSI)

Center for Urologic and Pelvic Pain

Pain or Discomfort

1. In the last week, have you experienced any pain or discomfort in the following areas?





2. In the last week, have you experienced:


3. How often have you had pain or discomfort in any of these areas over the last week?

4. Which number best describes your AVERAGE pain or discomfort on the days that you had it, over the last week?

NO PAIN
PAIN AS BAD
AS YOU CAN
IMAGINE

Urination

5. How often have you had a sensation of not emptying your bladder completely after you finished urinating, over the last week?

6. How often have you had to urinate again less than two hours after you finished urinating over the last week?

Impact of Symptoms

7. How much have your symptoms kept you from doing the kinds of things you would usually do, over the last week?

8. How much did you think about your symptoms, over the last week?

Quality of Life

9. If you were to spend the rest of your life with your symptoms just the way they have been during the last week, how would you feel about that?

Scoring the NIH-Chronic Prostatitis Symptom Index Domains

Adapted from Litwin et al. J Urol. 1999;162:369-375

Urogenital Distress Inventory (UDI-6 Short Form): UDI-6

Not at allSomewhatModeratelyQuite a bit

No= 0, Not at all= I, Somewhat= 2, Moderately= 3, Quite a bit= 4

Add all scores and multiply by 6 then multiply by 25 for the scale score

Missing items are dealt with by using the mean from the answered items only

Higher score = higher disability

Also see scoring of PFDI-20.

Uebersax JS, Wyman JF, Shumaker SA. McClish DK, Fantl AJ. Short forms to assess life quality and symptom distress for urinary incontinence in women: the incontinence impact questionnaire and the urogenital distress inventory. Neurourol and Urodynam 1995;14:131-139.

Grade A rating for symptoms of UI for women
Donavan J. et al Symptom and quality of life assessment. In Incontinence vol I Basics and Evaluation eds Abrams P, Cardozo L, Khoury S, Wein A. Health Publications Ltd Paris France 2005.

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