Constipation Problems Questionaire - Cauda Equina web site - www.oldcity.org.uk/cauda_equina/
To evaluate your problem please print and complete this questionnaire and show it to your doctor, continence advisor, or nurse (adapted from Agachan et al., 1996).

1. Evacuation frequency:
 1-2 per 1-2 days
 2/week
 1/week
 less than 1/week
 less than 1/month
2. Painful bowel motions:
 never
 rarely (less than 1/month)
 occasionally (1/week - 1/month)
 often (1/day - 1/week)
 always (at least 1/day)
3. Feeling of incomplete evacuation:
 never
 rarely (less than 1/month)
 occasionally (1/week - 1/month)
 often (1/day - 1/week)
 always (at least 1/day)
4. Abdominal pain:
 never
 rarely (less than 1/month)
 occasionally (1/week - 1/month)
 often (1/day - 1/week)
 always (at least 1/day)
5. Time spent on a toilet during attempted bowel motion:
 less than 5 min
 5-10 min
 10-20 min
 20-30 min
 more than 30 min
6. Methods used to assist bowel emptying:
 no assistance
 laxative/suppository
 help with finger or enema
7. Number of episodes of failure to empty the bowel in 24 hrs:
 never
 1-3
 3-6
 6-9
 more than 9
8. Duration of constipation (in years, either predating or following the onset of CES):
 0
 1-5
 5-10
 10-20
 more than 20
Page Last Updated: 05 May 2004