Cozean Pelvic Dysfunction Screening Protocol Instructions

If you tick three of more boxes pelvic floor dysfunction is likely:

1. I sometimes have pelvic pain (in genitals, peri neum, pubic, or bladder area, or pain
with urination) that exceeds a ‘3’ on a 1 10 pain scale with 10 being the worst pain
2. I can remember falling onto my tailbone, lower back or buttocks (even in childhood).
3. I sometimes experience one or more of the following urinary symptoms:

  • Accidental loss of urine
  • Feeling unable to completely empty my bladder
  • Having to void within a few minutes of a previous void
  • Pain or burning with urination
  • Difficulty starting or frequent stopping/starting of urine stream

4. I often or occasionally have to get up to urinate two or more times a night.

5. I sometimes have a feeling of increased pelvic pressure or the sensation of my pelvic
organs slipping down or falling out.
6. I have history or pain in my low back, hip, groin, or tailbone or have sciatica.
7. I sometimes experience one or more of the following bowel symptoms:

  • Loss of bowel control
  • Feeling unable to completely empty my bowel movements
  • Straining or pain with a bowel movement
  • Difficulty initiating a bowel movement

8. I sometimes experience pain or discomfort with sexual activity or intercourse.
9. Sexual activity increases one or more of my other symptoms.
10. Prolonged sitting increases my symptoms.