• Check off the statements below that apply to your symptoms and discuss the results with your doctor.


• You normally have a sensation of not emptying your bladder completely after you have finished urinating


• You often need to urinate again less then two hours after you have finished urinating


• You find yourself stopping and starting again after several times when you urinate


• You find it difficult to postpone urination
• Your urinary stream is weak


• You find yourself having to push or strain to begin urination


• You get up to urinate three or more times from the time you go to bed at night until the time you get up in the morning


• You go to the bathroom much more than you used to and start to change your routine to accommodate for extra bathroom trips

Disruption Scale

On a scale of 1 to 5, where 1 is “no disruption at all” and 5 is “very severe disruption,” please
rate the severity of your symptoms when answering the following questions. 

How disruptive to your daily routine, including your sex life, are your urinary problems? 
 

                                              1                            3                            5

How disruptive would you find an interruption to a personal event, such as a wedding or graduation, due to your urinary problems?
 

                                               1                             3                            5

How disruptive would you find an interruption to a professional event such as a business lunch, meeting or seminar?

                                             1                               3                             5

How disruptive to your daily routine would your urinary problems have to be before seeing a doctor about them? 

                                             1                                3                            5

According to a survey by ICR, nearly half (45%) of men over 50 said they would  have to be experiencing urinary problems or complications for several weeks before seeing a doctor.

If you rated your disruption as a three or higher on this scale, you should discuss options with your doctor to reduce your disruptions and get back to your life.