How often do you open your bowels? (per week/per day) | | |
How often do you try to open your bowels in a day but without any result? | | |
How long do you spend in the toilet on each visit when trying to open your bowels? | | |
During each visit to the toilet, for what proportion of the time do you strain? (%) | | |
Do you pass blood from your back passage? | | |
Do you pass mucus from your back passage? | | |
Do you put a finger into your back passage to help to empty stool? | | |
Do you put a finger into your vagina to help to empty stool? | | |
Do you ever have the feeling that you have not completely emptied your bowels? | | |
Do you ever experience any soiling or leaking from your back passage that you cannot control? | | |
Do you experience any abdominal bloating? | | |
Do you experience any pain around your back passage? | | |
Are you taking laxatives, suppositories or enemas? (If yes please list on the reverse of this sheet) | | |
Are you taking any other medication? | | |