Bladder Control Questionnaire

If you think you may be experiencing a bladder control problem, try the questionnaire below. It is designed to help you describe any feelings of bladder problems to your doctor as part of a medical consultation. You should always speak with a medical professional about any health concerns you have.

Question
Not at all (0)
A little (1)
Moderately (2)
A great deal (3)

Q1

Is it difficult to hold urine when you get the urge to go?
Is it difficult to hold urine when you get the urge to go?

Not at all

A little

Moderately

A great deal

How much does it bother you?

Q2

How much does it bother you?

Not at all

A little

Moderately

A great deal

Do you have a problem with going to the toilet too often during the day?

Q3

Do you have a problem with going to the toilet too often during the day?

Not at all

A little

Moderately

A great deal

How much does it bother you?

Q4

How much does it bother you?

Not at all

A little

Moderately

A great deal

Do you have to wake from sleep at night to pass urine?

Q5

Do you have to wake from sleep at night to pass urine?

Not at all

A little

Moderately

A great deal

How much does it bother you?

Q6

How much does it bother you?

Not at all

A little

Moderately

A great deal

Do you leak urine?

Q7

Do you leak urine?

Not at all

A little

Moderately

A great deal

How much does it bother you?

Q8

How much does it bother you?

Not at all

A little

Moderately

A great deal

IMPORTANT: If you have blood in your urine, have difficulty passing urine, or pain on passing urine, you MUST talk to your doctor about it.



Questionnaire Outcome

Based on:

Design and Validation of a New Screening Instrument for Lower Urinary Tract (LUT) Dysfunction: The Bladder Control Self-Assessment Questionnaire (B-SAQ), European Urology (2007), doi.org/10.1016/j.eururo.2006.11.0154

Validation of the bladder control self-assessment questionnaire (B-SAQ) in men, Functional Urology (2013), https://doi.org/10.1111/bju.125215

IMPORTANT INFORMATION FOR USE: The Bladder Problem Questionnaire is suitable for adults 18+ years only. It does not constitute a medical device or substitute professional medical advice, professional diagnosis, service, treatment or monitoring of any condition. If you feel any discomfort or have any concerns or questions about your health, you should always consult a healthcare professional.

B-SAQ has been assessed in controlled clinical studies in people who had already identified they may have LUTS and/or urinary incontinence and and sought healthcare advice. In an independent review B-SAQ was found to meet the criterion for use by non-clinical staff and respondents as part of public health activity.6 Differences in results between men and women have been described. The questionnaire, in this setting, has been utilised to help people describe their symptoms and level of bother to a healthcare professional as part of a discussion about bladder health.

No personal data is being stored or shared to third parties.

Questionnaire Results

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