Patient Questionnaires

Bowel, Bladder or Pelvic Symptoms

These two questionnaires will ask you if you have certain bowel, bladder, or pelvic symptoms and, if you do, how much they bother you. Please fill out both tests if you have abdominal, vulvar, pelvic and/or rectal pain with intercourse, with use of a tampon, with getting a pelvic exam at your gynecologist’s office; with urinating or having a bowel movement or with sitting.

Impact to Activities, Relationships and Feelings

Some women find that bladder, bowel, or vaginal symptoms affect their activities, relationships, and feelings. For each question place an “X” in the response that best describes how much your activities, relationships, or feelings have been affected by your bladder, bowel, or vaginal symptoms or conditions over the last 3 months.

Low Back, Sacral or Coccyx Pain

I have been working with Marci Marshall for five years and am very impressed with her ability to successfully treat women with pelvic floor dysfunction. When I refer patients to her I know they are getting the best possible PT to suit their specific gynecological problem. Marci has excellent communi…

Lucy D. TreenePA-C, Vulvar Disease SpecialistWashington D.C.