The following questions pertain to bowel health. Although not commonly discussed, bowel health problems are important to recognize because they can interfere with daily living. These questions regarding bowel function will help to understand who experiences these difficulties to better target treatment.
1. Have you ever been diagnosed by a physician as having any of the following conditions?
Colon cancer	YES	NO
Ulcerative colitis	YES	NO
Crohn’s disease	YES	NO
Irritable bowel syndrome	YES	NO
2. In the past 12 months, have you experienced accidental leakage of liquid or solid stool? Do not include problems that occurred as a result of a short-term illness such as the flu or food poisoning.
YES	NO
For the remainder of the questions, consider your health over the past year. Again, do not include problems that occurred as a result of a short-term illness such as the flu or food poisoning.
Choose a number, between 1 and 10 which best reflects your answer to each question. The number “1” indicates that you never or infrequently experience the problem, whereas “10” indicated that you always or frequently experience the problem.
3. I experience abdominal distension or bloating _____
4. I experience abdominal pain or discomfort associated with altered bowel movements _____
5. I have had accidents because of an inability to control the passage of a bowel movement until I have reached a toilet _____
6. After finishing a bowel movement I can be bothered by a sense that I still have more stool left to pass _____
7. After finishing a bowel movement I can be bothered by the inability to finish wiping myself _____
8. When I sense the need to have a bowel movement, usually I can comfortably delay using the toilet until a time which is convenient _____
9. I have experienced an unexpected or embarrassing inability to control my bowel movements _____
10. I have had to use pads to protect my undergarments due to fear of accidental leakage of stool _____