Table 2.

Japanese version of Patient Assessment of Constipation Quality of Life

The following questions are designed to measure the impact constipation has had on your daily life over the past 2 weeks. For each question, please check one box.
The following questions ask about your symptoms related to constipation. During the past 2 weeks, to what extent or intensity have you…	Not at all = 1	A little bit = 2	Moderately = 3	Quite a bit = 4	Extremely = 5
1. Felt bloated to the point of bursting?	□	□	□	□	□
2. Felt heavy because of your constipation?	□	□	□	□	□
The next few questions ask about how constipation affects your daily life. During the past 2 weeks, how much of the time have you…	None of the time = 1	A little of the time = 2	Some of the time = 3	Most of the time = 4	All of the time = 5
3. Felt any physical discomfort?	□	□	□	□	□
4. Felt the need to have a bowel movement but not been able to?	□	□	□	□	□
5. Been embarrassed to be with other people?	□	□	□	□	□
6. Been eating less and less because of not being able to have bowel movements?	□	□	□	□	□
The next few questions ask about how constipation affects your daily life. During the past 2 weeks, to what extent or intensity have you…	Not at all = 1	A little bit = 2	Moderately = 3	Quite a bit = 4	Extremely = 5
7. Had to be careful about what you eat?	□	□	□	□	□
8. Had a decreased appetite?	□	□	□	□	□
9. Been worried about not being able to choose what you eat (for example, at a friend’s house)?	□	□	□	□	□
10. Been embarrassed about staying in the bathroom for so long when you were away from home?	□	□	□	□	□
11. Been embarrassed about having to go to the bathroom so often when you were away from home?	□	□	□	□	□
12. Been worried about having to change your daily routine (for example, traveling, being away from home)?	□	□	□	□	□
The next few questions ask about your feelings related to constipation. During the past 2 weeks, how much of the time have you…	None of the time = 1	A little of the time = 2	Some of the time = 3	Most of the time = 4	All of the time = 5
13. Felt irritable because of your condition?	□	□	□	□	□
14. Been upset by your condition?	□	□	□	□	□
15. Felt obsessed by your condition?	□	□	□	□	□
16. Felt stressed by your condition?	□	□	□	□	□
17. Felt less self-confident because of your condition?	□	□	□	□	□
18. Felt in control of your situation?	□	□	□	□	□
The next questions ask about your feelings related to constipation. During the past 2 weeks, to what extent or intensity have you…	Not at all = 1	A little bit = 2	Moderately = 3	Quite a bit = 4	Extremely = 5
19. Been worried about not knowing when you are going to be able to have a bowel movement?	□	□	□	□	□
20. Been worried about not being able to have a bowel movement?	□	□	□	□	□
21. Been increasingly bothered by not being able to have a bowel movement?	□	□	□	□	□
The next questions ask about your life with constipation. During the past 2 weeks, how much of the time have you…	None of the time = 1	A little of the time = 2	Some of the time = 3	Most of the time = 4	All of the time = 5
22. Been worried that your condition will get worse?	□	□	□	□	□
23. Felt that your body was not working properly?	□	□	□	□	□
24. Had fewer bowel movements than you would like?	□	□	□	□	□
The next questions ask about your degree of satisfaction related to constipation. During the past 2 weeks, to what extent or intensity have you been…	Not at all = 1	A little bit = 2	Moderately = 3	Quite a bit = 4	Extremely = 5
25. Satisfied with how often you have a bowel movement?	□	□	□	□	□
26. Satisfied with the regularity of your bowel movements?	□	□	□	□	□
27. Satisfied with the time it takes for food to pass through the intestines?	□	□	□	□	□
28. Satisfied with your treatment?	□	□	□	□	□