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

Marci Marshall is a blessing to our community. Women’s pelvic floor problems have been known and documented for many years, but western medicine has been unable to adequately address this area. Physical Therapy has been making in-roads over the last ten years and the Frederick area is very fortuna…

Judy MoriartyCRNP, CNM