Pelvic Health Screening

Based on the Cozean Pelvic Dysfunction Screening Protocol

Answer the following questions to see if pelvic floor physical therapy may help you.

Symptom Checklist

Check all that apply to you.

Do you leak urine when you cough, sneeze, laugh, or exercise?

Do you ever have such a strong need to urinate that you leak urine or wet yourself before reaching the toilet?

Do you have difficulty emptying your bladder?

Do you have recurring bladder infections (more than 3 in a year)?

Do you have difficulty emptying your bowels?

Do you have accidental loss of stool/feces?

Do you have accidental loss of gas (flatulence)?

Do you feel a bulge or something falling out of your vagina?

Do you ever have to push on the vagina or around the rectum to have or complete a bowel movement?

Do you experience pain during or after sexual intercourse?

Do you experience pelvic pain throughout the day?

Do you feel pelvic heaviness or pressure that increases during the day or with activity?

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Cozean Pelvic Dysfunction Screening Protocol

Developed by Nicole Cozean, PT, DPT, WCS — Founder of PelvicSanity

This screening tool is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified healthcare provider.