Bay Area Medical Information (
Overactive Bladder

Assessment Tool

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Answer the following questions using this scale then calculate your total score:
0=Not at all, 1=A little bit, 2=Somewhat, 3=Quite a bit, 4=A great deal, 5=A very great deal
How bothered have you been by...
1) Frequent urination during the daytime hours? _____
2) An uncomfortable urge to urinate?_____
3) A sudden urge to urinate with little or no warning?_____
4) Accidental loss of small amounts of urine?_____
5) Nighttime urination?_____
6) Waking up at night because you had to urinate?_____
7) An uncontrollable urge to urinate?_____
8) Urine loss associated with a strong desire to urinate?_____
9) For male patients add 2 points to score

Total Score
If the score is 8 or greater, you may have an overactive bladder and further medical evaluation is recommended.  Print this form out and take the completed form with you to your first appointment with your doctor or health care provider.

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