Directions: | |||
Circle the appropriate number to indicate whether, during the past 3 days, you have had NO PROBLEM, SOME PROBLEM, or a SEVERE PROBLEM with each of the items listed below. | |||
Item | No problem | Some problem | Severe problem |
1. Abdominal distention or bloating | 0 | 1 | 2 |
2. Change in amount of gas passed rectally | 0 | 1 | 2 |
3. Less frequent bowel movements | 0 | 1 | 2 |
4. Oozing liquid stool | 0 | 1 | 2 |
5. Rectal fullness or pressure | 0 | 1 | 2 |
6. Rectal pain with bowel movement | 0 | 1 | 2 |
7. Small stool size | 0 | 1 | 2 |
8. Urge but inability to pass stool | 0 | 1 | 2 |