Self-Report Urinary Incontinence Questionnaire

Original Editor - Ajay Upadhyay

Top Contributors - Ajay Upadhyay  

Objective

To assess and to evaluate urinary function the for patients at different levels of urinary function using 21-item UIQ in patients seeking outpatient physical therapy services due to PFD.

Intended Population

Patients with urinary urgency, urinary frequency.

Method of Use

The UIQ consists of 21 items: 17 related to urinary leakage problems, 2 related to frequency problems, and 2 related to retention problems. Each item has its own Likert rating scale structure and operational definition.

Urinary Incontinence Questionnaire

Urinary Leakage Items

1 How often does urine leak for no obvious reason when you are awake?

1. Never

2. Once or less per week

3. More than once a week

4. Once a day

5. Several times a day

6. Continuously

2 How much urine usually leaks for no obvious reason when you are awake?

1. A few drops

2. Enough to make underpants/pads wet

3. Enough to wet outer clothes

4. Urine runs down legs onto floor

3 How often does urine leak when you are asleep?

1. Never

2. Once or less per week

3. More than once a week

4. Once a day

5. Several times a day

6. Continuously

4 How much urine usually leaks while you are sleeping?

1. A few drops

2. Enough to make pajamas/pads wet

3. Enough to wet all clothes and bedding

5 How often do you leak urine after you thought you had finished urinating?

1. Never

2. Once or less per week

3. More than once a week

4. Once a day

5. Several times a day

6. Every time

6 How much urine usually leaks after you thought you had finished urinating?

1. A few drops

2. Enough to make underpants/pads wet

3. Enough to wet outer clothes

4. Urine runs down legs onto floor

7 How often does urine leak before you can get to the toilet?

1. Never

2. Once or less per week

3. More than once a week

4. Once a day

5. Several times a day

6. Every time

8 How much urine usually leaks before you can get to the toilet?

1. A few drops

2. Enough to make underpants/pads wet

3. Enough to wet outer clothes

4. Urine runs down legs onto floor

9 How often does urine leak when you are physically active, including coughing or sneezing?

1. Never

2. Once or less per week

3. More than once a week

4. Once a day

5. Several times a day

10 Describe the level of activity that causes urine leakage.

1. Vigorous activity, such as running, exercise, coughing, or sneezing

2. Moderate activity, such as household chores or lifting

3. Light activity, such as walking, bending, or rising

4. Leak even without activity

11 How much urine usually leaks when you are physically active or coughing or sneezing?

1. A few drops

2. Enough to make underpants/pads wet

3. Enough to wet outer clothes

4. Urine runs down legs onto floor

12 What type of protection do you use for your urine leakage?

1. None

2. Underpants liners or mini-pads

3. Maxi-pads

4. Incontinence pads

5. Incontinence briefs

6. Diapers

13 Select the number of protective garments for urine leakage you use per day.

1. 1

2. 2

3. 3

4. 4

5. ≥5

14 Overall, how much does leaking urine interfere with your life?

1. Does not interfere with my life

2. Minor inconvenience

3. Slight problem

4. Moderate problem

15 To what extent do you feel your sex life has been affected by urine leakage? 1. Has not affected my sex life

2. A little

3. Somewhat

4. A great deal

16 Describe your level of confidence in your ability to control your urine leakage problem.

1. Complete confidence

2. Moderate confidence

3. Little confidence

4. No confidence

17 How well do you control your urine leakage? (0 being “no control” to 10 being “full control”)

0 (no control)

1. 1

2. 2

3. 3

4. 4

5. 5

6. 6

7. 7

8. 8

9. 9

10. 10 (full control)

Urination Frequency Items

18 What is the frequency of your daytime urination?

1–4 times per day

5–8 times per day

9–12 times per day

≥13 times per day

19 How often do you urinate at night?

1. Do not urinate at night

2. 1 time per night

3. 2 times per night

4. 3 times per night

5. 4 or more times per night

Urinary Retention Items

20 How long can you delay urination from the first time you feel the urge?

1. 1 or more hours

2. 30 minutes

3. 15 minutes

4. less than 10 minutes

5. 1–2 minutes

6. Cannot delay urination

21 After starting to urinate, can you:

1. Stop urine flow completely

2. Maintain a change to the urine stream

3. Partially deflect or change the urine stream

4. Unable to deflect, change, or slow urine stream

Reference

Validity