Questions on faecal incontinence and impact of bowel symptoms in the postal questionnaire
| Do you ever leak from your bowels when you don't mean to? (During the day or night) | |
| Continuously | □ |
| Several times a day | □ |
| Several times a week | □ |
| Several times a month | □ |
| Several times a year | □ |
| Never/rarely | □ |
| When you leak from your bowels when you don't mean to is there usually: | |
| Soiling of furnishing or bedding | □ |
| Soiling of outer clothing | □ |
| Soiling of underwear | □ |
| Minor staining of underwear | □ |
| Not applicable (NA) | □ |
| Do your bowel symptoms: | |||
| A lot | A little | Not at all/NA | |
| Bother you? | □ | □ | □ |
| Cause you any physical discomfort? | □ | □ | □ |
| Interfere with your daily activities? | □ | □ | □ |
| Interfere with your social life? | □ | □ | □ |
| Affect your relationships with other people? | □ | □ | □ |
| Upset or distress you? | □ | □ | □ |
| Affect your sleep? | □ | □ | □ |
| Affect your overall quality of life? | □ | □ | □ |