In the past month: | Not at All | Less than 1 in 5 Times | Less than Half the Time | About Half the Time | More than Half the Time | Almost Always | Your score |
1. Incomplete Emptying | 0 | 1 | 2 | 3 | 4 | 5 | |
How often have you had the sensation of not emptying your bladder? | |||||||
2. Frequency | 0 | 1 | 2 | 3 | 4 | 5 | |
How often have you had to urinate less than every 2 hours? | |||||||
3. Intermittency | 0 | 1 | 2 | 3 | 4 | 5 | |
How often have you found you stopped and started again several times when you urinated? | |||||||
4. Urgency | 0 | 1 | 2 | 3 | 4 | 5 | |
How often have you found it difficult to postpone urination? | |||||||
5. Weak Stream | 0 | 1 | 2 | 3 | 4 | 5 | |
How often have you had a weak urinary stream? | |||||||
6. Straining | 0 | 1 | 2 | 3 | 4 | 5 | |
How often have you had to strain to start urination? | |||||||
None | 1 Time | 2 Times | 3 Times | 4 Times | 5 Times | ||
7. Nocturia | 0 | 1 | 2 | 3 | 4 | 5 | |
How many times did you typically get up at night to urinate? | |||||||
Total IPSS Score | |||||||
Score: 1 - 7: Mild 8 - 19: Moderate 20 - 35: Severe | |||||||
Quality of Life Due to Urinary Symptoms | |||||||
If you were to spend the rest of your life with your urinary condition just the way it is now, how would you feel about that? | 0 | 1 | 2 | 3 | 4 | 5 | 6 |