Medical Specialties

Urology

Symptom Checklist

Over 17 million Americans (a very conservative estimate) have an overactive bladder, yet many miss out on treatments that could help reduce symptoms like the strong sudden urge to urinate. Talking candidly with your doctor about your symptoms can insure you get proper diagnosis and treatment.

The National Association for Continence (NAFC) has established several warning signs of bladder problems. You may find yourself limiting your fluid intake or taking other preemptive actions that are not part of a healthy, active lifestyle. There are many treatable conditions that cause these symptoms, so it’s important that you share this information with your physician. That will set you on the path toward accurate diagnosis and appropriate treatment options.

Ratings for symptom severity:
1 – Not at all
2 – Rarely
3 – Sometimes
4 – Often
5 – Always

• Urinating frequently, day or night
  1    2    3    4    5

---

• Leakage of urine
  1    2    3    4    5

---

• Weakness of the urinary stream
  1    2    3    4    5

---

• Inability to urinate or difficulty urinating
  1    2    3    4    5

---

• Needing to run for a toilet
  1    2    3    4    5

---

• Blood in the urine
  1    2    3    4    5

---

• Frequent bladder infections
  1    2    3    4    5

---

• Pain related to urination
  1    2    3    4    5

---

If your answers indicate any of these dysfunctional symptoms, please print out and take this form in to your primary care provider.