Sullivan Physical Therapy

 

 

 

 

 

 

 

Health Questionnaire

  1. Do you have difficulty completely emptying when you urinate?
  2. Does your pain radiate to your lower abdomen, pelvic region or lower back?
  3. Do you have difficulty defecating?
  4. Do you leak urine when you cough, sneeze or lift?
  5. Do you have tailbone or pelvic pain while sitting?
  6. Are you constipated regularly?
  7. Have your pelvic examinations become more painful?
  8. Do you have pain with urination?
  9. Do you leak fecal matter throughout the day?
10. Do you have pain during or after intercourse?
11. Do you strain to have a bowel movement?
12. Do certain foods or drinks make your pain worse?
13. Is your sciatic pain getting worse with the duration of your pregnancy?

If you answered yes to any of these questions, you may be appropriate for physical therapy. Consult with your doctor about getting a prescription for physical therapy for a thorough evaluation and treatment plan. If you have any questions, please feel free to contact our office.