No symptoms | Worst symptoms | ||||||||||
0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | |
| |||||||||||
Pain, pressure and discomfort associated with your bladder/prostate and/or pelvic region | ❑ | ❑ | ❑ | ❑ | ❑ | ❑ | ❑ | ❑ | ❑ | ❑ | ❑ |
| |||||||||||
Urgency (urge or pressure to urinate) | ❑ | ❑ | ❑ | ❑ | ❑ | ❑ | ❑ | ❑ | ❑ | ❑ | ❑ |
| |||||||||||
Frequency of urination | ❑ | ❑ | ❑ | ❑ | ❑ | ❑ | ❑ | ❑ | ❑ | ❑ | ❑ |
| |||||||||||
Overall urologic or pelvic pain symptoms | ❑ | ❑ | ❑ | ❑ | ❑ | ❑ | ❑ | ❑ | ❑ | ❑ | ❑ |
| |||||||||||
Overall pain symptoms that were not urologic or pelvic pain symptoms (e.g., back pain, headache, etc) | ❑ | ❑ | ❑ | ❑ | ❑ | ❑ | ❑ | ❑ | ❑ | ❑ | ❑ |
|