The following is a questionnaire about the symptoms of overactive bladder, stress incontinence, mixed incontinence and urinary tract infection. This simple quiz will help your doctor determine which condition you might have.

To complete this questionnaire, fill in the answers by clicking on the "Yes" or "No" box or choosing the appropriate answer from the list. Press "Submit" when you are finished.

If you answer "Yes" to any of these questions, print this page and take it with you when you go to see your doctor.

Symptoms of an Overactive Bladder	Yes		No
Do you frequently have a strong, sudden urge to urinate?
Do you sometimes not make it to the bathroom in time?
Do you frequently go to the bathroom 8 or more times per 24 hours?
Do you get up 2 or more times during the night to go to the bathroom?
How long have you had these symptoms?	Select One < 1 year 1 - 4 years 4 years Don't Know
Symptoms of Stress Incontinence	Yes		No
Do you experience a loss of urine when you are doing physical activities, such as lifting heavy objects or exercising?
Do you sometimes have a slight loss of urine when you sneeze, cough or laugh?
Mixed Incontinence	Yes		No
Do you have symptoms of both an overactive bladder and stress incontinence?
Symptoms of a Urinary Tract Infection	Yes		No
Do you experience a burning sensation when you urinate?
Do you frequently have a strong, sudden urge to urinate?
Do you go to the bathroom 8 or more times per 24 hours?
Did your symptoms come on suddenly?