TABLE 3.

Symptoms and Impacts Questionnaire for Ulcerative Colitis (SIQ‐UC)

Daily Bowel Movement Report 1. When did you have this bowel movement? – Just now – Earlier today (please enter time) 2. How strong was your urge to use the restroom before this bowel movement? – Not strong at all – Mild – Moderate – Very strong – Extremely strong 3. Were you able to reach the toilet in time with this bowel movement? – Yes, I made it to the toilet on time – No, I had an accident before reaching the toilet 4. How severe was your rectal bleeding with this bowel movement? – No bleeding at all – Mild – Moderate – Severe – Very severe 5. Please select the picture and description that best resembles your stool. Daily Symptom Diary 1. How severe was your worst abdominal cramping during the last 24 hours? – No cramping at all – Mild – Moderate – Severe – Very severe 2. How severe was your worst abdominal pain during the last 24 hours? – No pain at all – Mild – Moderate – Severe – Very severe 3. How severe was your worst joint pain during the last 24 hours? – No pain at all – Mild – Moderate – Severe – Very severe 4. How would you rate your worst feelings of tiredness during the last 24 hours? – No tiredness at all – Mild – Moderate – Severe – Very severe 5. How would you rate the severity of any constipation that you have experienced in the last 24 hours? – No constipation at all – Mild – Moderate – Severe – Very severe 6. How severe was your worst abdominal bloating during the last 24 hours? – No bloating at all – Mild – Moderate – Severe – Very severe 7. How severe was your worst gas during the last 24 hours? – No gas at all – Mild – Moderate – Severe – Very severe 8. During the last 24 hours, how often did you have difficulty telling the difference between gas and a bowel movement? – Never – Rarely – Sometimes – Often – Always 9. How often did you experience low energy during the last 24 hours? – Never – Rarely – Sometimes – Often – Always 10. How often did you feel weak in the last 24 hours? – Never – Rarely – Sometimes – Often – Always 11. How often did you have a poor appetite in the last 24 hours? – Never – Rarely – Sometimes – Often – Always Weekly Impact Assessment 1. Over the last 7 days, how limited were you in the types of food you could eat because of your ulcerative colitis? – Not limited at all – A little limited – Moderately limited – Very limited – Extremely limited 2. Over the last 7 days, how limited were you in the amount of food you could comfortably eat because of your ulcerative colitis? – Not limited at all – A little limited – Moderately limited – Very limited – Extremely limited 3. Over the past 7 days, how limited were your activities because of the need to be near a restroom? – Not limited at all – A little limited – Moderately limited – Very limited – Extremely limited 4. Over the past 7 days, how limited were your social activities because of your UC? – Not limited at all – A little limited – Moderately limited – Very limited – Extremely limited 5. Over the past 7 days, how limited were your leisure activities because of your UC? – Not limited at all – A little limited – Moderately limited – Very limited – Extremely limited 6. Over the past 7 days, how limited was your overall functioning because of your ulcerative colitis? – Not limited at all – A little limited – Moderately limited – Very limited – Extremely limited 7. Over the past 7 days, how difficult was it to complete your responsibilities at work or school because of your UC? – Not difficult at all – A little difficult – Moderately difficult – Very difficult – Extremely difficult – Not applicable: I did not work or attend school in the past 7 days because of my UC – Not applicable: I did not work or attend school in the past 7 days for reasons not related to my UC 8. Over the past 7 days, because of your UC, how difficult was it for you to stay asleep after going to bed? – Not difficult at all – A little difficult – Moderately difficult – Very difficult – Extremely difficult 9. Over the past 7 days, how limited was your participation in exercise or sports because of your UC? – Not limited at all – A little limited – Moderately limited – Very limited – Extremely limited 10. Over the past 7 days, how limited was your ability to travel because of your UC? – Not limited at all – A little limited – Moderately limited – Very limited – Extremely limited 11. Over the past 7 days, how much has UC interfered with your quality of life? – Not at all – A little bit – Moderately – Very much – Extremely 12. Over the past 7 days, how often have you worried about having an accident related to your UC? – Never – Rarely – Sometimes – Often – Always 13. Over the past 7 days, how often has your UC caused you to feel embarrassed? – Never – Rarely – Sometimes – Often – Always