If ostomy	If sphincter-sparing surgery
1.	How many times each day do you empty your pouch?	How many times each day do you have a bowel movement?
2.	How often does your pouch leak?	How often do you get to the toilet too late?
3.	Do you have problems with gas or odor?	How often do you use a pad or diaper?
4.	Do you have abdominal pain or obstruction?	Do you have abdominal pain or obstruction?
5.	Can you eat and drink the foods you want?	Can you eat and drink the foods you want?
6.	Are you satisfied with your appearance?	[Not applicable]
7.	Does your ostomy get in the way of doing the things you like to do?	Does your bowel function get in the way of doing the things you like to do?
	… working	… working
	… interacting with friends and family	… interacting with friends and family
	… traveling	… traveling
	… participating in religious activities	… participating in religious activities
	… participating in community service/volunteer work	… participating in community service/volunteer work
	… participating in recreation and sports	… participating in recreation and sports
8.	Are you satisfied with your sexual and intimate activity?	Are you satisfied with your sexual and intimate activity?
9.	Does your ostomy affect your sleep?	Does your bowel function affect your sleep?
10.	Do you feel embarrassed by your ostomy?	Do you feel embarrassed by your bowel function?
11.	Are you having any problems with the skin around your ostomy?	Are you having any problems with the skin around your anus?
12.	Do you need help with your ostomy, and do you get the help you need?	Do you need help with your bowel function, and do you get the help you need?
13.	Are you having any other problems with your ostomy?	Are you having any other problems with your rectal cancer surgery?
14.	If persistent problems: Would you like to talk to an ostomy nurse?	If persistent problems: Would you like to talk to a surgeon about options for improving control over your bowel function?