| Incomplete emptying
Over the last month how often have you had a sensation of not emptying your bladder completely after you finish urinating? |
Never - 0 | Less than 1 time in five - 1 | Less than half the time - 2 | About half the time - 3 | More than half the time - 4 | Almost always - 5 | Your Score |
| Frequency
Over the past month how often have you had to urinate again less than two hours after finishing |
Never - 0 | Less than 1 time in five - 1 | Less than half the time - 2 | About half the time - 3 | More than half the time - 4 | Almost always - 5 | Your Score |
| Intermittency
Over the past month, how often have you found you stopped and started again several times when you urinated |
Never - 0 | Less than 1 time in five - 1 | Less than half the time - 2 | About half the time - 3 | More than half the time - 4 | Almost always - 5 | Your Score |
| Urgency
Over the past month how often have you found it difficult to hold your urine |
Never - 0 | Less than 1 time in five - 1 | Less than half the time - 2 | About half the time - 3 | More than half the time - 4 | Almost always - 5 | Your Score |
| Weak Stream
Over the past month how often have you had a weak urinary stream |
Never - 0 | Less than 1 time in five - 1 | Less than half the time - 2 | About half the time - 3 | More than half the time - 4 | Almost always - 5 | Your Score |
| Straining
Over the last month how often have you had to push or strain to begin urination? |
Never - 0 | Less than 1 time in five - 1 | Less than half the time - 2 | About half the time - 3 | More than half the time - 4 | Almost always - 5 | Your Score |
| Nocturia
Over the past month how many times did you most typically get up to urinate from the time you went to bed at night until the time you got up in the morning |
None - 0 | Once - 1 | Twice - 2 | Three Times - 3 | Four Times - 4 | Five Times - 5 | Your Score |
| Quality of Life due to Urinary Symptoms
If you were to spend the rest of your life with your urinary condition as it is now, how would you feel about that |
Delighted - 0 | Pleased - 1 | Mostly satisfied - 2 | Mixed - 3 | Mostly Dis- satisfied - 4 | Unhappy or Terrible - 5/6 | Your Score |
| Total IPSS Score | |||||||
