Female Questionnaire
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This section covers specific bowel / intestinal problems.


Have you had Ulcerative Colitis?
  • Never / don't know
  • Mild / moderate but in remission
  • Serious, but in remission
  • Yes, currently mildly / moderately active
  • Yes, currently seriously active


Have you had Crohn's Disease?
  • Don't know
  • No, it has been ruled out
  • Moderately, but in remission
  • Seriously, but in remission
  • Yes, currently active


Have you been diagnosed with Diverticular Disease?
  • Don't know
  • No, it has been ruled out within the past 2 years
  • It is suspected
  • Confirmed 1 or 2 pockets
  • Confirmed 3 or more pockets


Have you had Dysentery?
  • Never had it / don't know
  • Single episode in past only
  • Multiple or prolonged episodes in past only
  • Very significant episode within the last 6 months
  • Very significant current problem


Have you been diagnosed with Irritable Bowel Syndrome (IBS)?
  • No / don't know
  • Mild, in the past, now resolved
  • Serious, in the past, now resolved
  • Current minor/moderate problem
  • Current major problem


Have you had any polyps in your colon?
  • Don't know
  • No, none have been found during examination
  • Yes, it/they were removed
  • One or two present
  • More than two present


Have you suffered from Hemorrhoids?
  • Never had one / don't know
  • Probably had one/minor episode(s) now resolved
  • Major episode(s) now resolved
  • Current minor problem
  • Current major problem


Does your anus itch?
  • Never / very rarely / don't know
  • Occasionally - a few times a month
  • Often, mostly at night
  • Often, day and night