Start My Journey Questionnaire Please complete all fields… Start my Journey questionnaire 1. Do you pee when you exercise, laugh, cough, run or pick up something heavy? * Yes No Are your orgasms weaker and less satisfying than they used to be? * Yes No Can you stop the flow of urine once you have started? * Yes No Do you find yourself planning your day according to the availability of toilets? * Yes No Do you use pads regularly? * Yes No Do you find that you are unable to hold on when you get the urge to go to the toilet? * Yes No Do you get up often during the night to pass urine or go to the loo every couple of hours during the day? * Yes No If you answered yes to some of these questions then you may have weak pelvic floor muscles that are causing stress incontinence with some urgency or frequency – most of us have a bit of each. If you would like to discuss this with a Women’s Health Physiotherapist please complete the contact form below or if you would like to find more about incontinence due to weak pelvic floor muscles please sign up for the Pelvic Floor Weakness Program. 2. Does it sometimes feel as if something is restricting your ability to empty the bladder or bowel? * Yes No Do you sometimes feel as though there is a heaviness or something dropping down into the vagina? * Yes No Can you feel a lump or swelling inside or at the entrance to the vagina? * Yes No When you cough or pick up something heavy do you feel a bulge in the vagina? * Yes No Do you notice a heavy feeling or bulge at the end of the day or if you are on your feet for long periods? * Yes No If you answered yes to any of these questions you may have a prolapse. I would recommend that you speak to your GP or consult a local Women’s Health Physiotherapist, as a vaginal examination is necessary to confirm the type and severity. If you have already taken medical advice and have been told that it is safe for you to begin to exercise, sign up for the Prolapse Recovery Programme. 3. Do you experience pain in the pelvis or perineum? * Yes No Do you have difficulty or experience pain when using a tampon or during a medical examination? * Yes No Is vaginal penetration painful? * Yes No Do you sometimes feel as though you haven’t completely emptied your bladder or bowel? * Yes No Do you suffer from constipation? * Yes No Does it sometimes take a little while to relax enough to start the flow of urine or empty your bowels? * Yes No Can you feel the difference between contracting and relaxing the pelvic floor muscles? * Yes No If you have answered yes to some of these questions you may have overactive or high tone pelvic floor muscles. Please consult a local Women’s Health Physiotherapist, as it is advisable to have a vaginal examination before beginning an exercise programme. Get in touch Name (optional): Age: * E-mail address: * Message: * This form collects your details (including your answers to the above questions) in line with our privacy policy and only for the purpose of responding to your enquiry. reCAPTCHA If you are human, leave this field blank. Submit View and book courses Start My Journey Video
