How often do you open your bowels? (per week/per day) |
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How often do you try to open your bowels in a day but without any result? |
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How long do you spend in the toilet on each visit when trying to open your bowels? |
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During each visit to the toilet, for what proportion of the time do you strain? (%) |
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Do you pass blood from your back passage? |
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Do you pass mucus from your back passage? |
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Do you put a finger into your back passage to help to empty stool? |
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Do you put a finger into your vagina to help to empty stool? |
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Do you ever have the feeling that you have not completely emptied your bowels? |
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Do you ever experience any soiling or leaking from your back passage that you cannot control? |
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Do you experience any abdominal bloating? |
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Do you experience any pain around your back passage? |
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Are you taking laxatives, suppositories or enemas? (If yes please list on the reverse of this sheet) |
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Are you taking any other medication? |
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