Table 1.
Short form incontinence questionnaire (SFIC)
| Question 1. Do you ever leak urine when you do not mean to? | ||||
| Yes | ||||
| No | ||||
| Question 2. Do your urinary symptoms | ||||
| A lot | A little | Not at all | Number urinary symptoms | |
| (a) Bother you? | 3 | 2 | 1 | 0 |
| (b) Cause physical discomfort? | 3 | 2 | 1 | 0 |
| (c) Interfere with daily activities? | 3 | 2 | 1 | 0 |
| (d) Interfere with social life? | 3 | 2 | 1 | 0 |
| (e) Affect your relationships? | 3 | 2 | 1 | 0 |
| (f) Upset or distress you? | 3 | 2 | 1 | 0 |
| (g) Affect your sleep? | 3 | 2 | 1 | 0 |
| (h) Affect your overall quality of life | 3 | 2 | 1 | 0 |
| Total score | /24 | |||
| Question 3. If you were to spend the rest of your life with your urinary pattern just the way it is now, how would you feel about that? | ||||
| Delighted | 1 | |||
| Pleased | 2 | |||
| Mostly satisfied | 3 | |||
| Mixed—equally dissatisfied and satisfied | 4 | |||
| Dissatisfied | 5 | |||
| Mostly dissatisfied | 6 | |||
| Unhappy | 7 | |||
| Terrible | 8 | |||
| Question 4. Do you ever leak from your bowels when you do not mean to? | ||||
| Never/rarely | 1 | |||
| Several times a year | 2 | |||
| Several times a month | 3 | |||
| Several times a week | 4 | |||
| Several times a day | 5 | |||
| Continuously | 6 | |||
| Question 5. Do you have to use a catheter? | ||||
| Yes | ||||
| No | ||||