Bay Area Medical Information (BAMI.us)
Overactive
Bladder
Assessment
Tool
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Answer the following
questions using this scale then calculate your total score:
0=Not at all, 1=A little bit, 2=Somewhat, 3=Quite a bit,
4=A great deal, 5=A very great deal |
| How bothered have
you been by... |
| 1) Frequent urination
during the daytime hours? _____ |
| 2) An uncomfortable
urge to urinate?_____ |
| 3) A sudden urge to
urinate with little or no warning?_____ |
| 4) Accidental loss of
small amounts of urine?_____ |
| 5) Nighttime
urination?_____ |
| 6) Waking up at night
because you had to urinate?_____ |
| 7) An uncontrollable
urge to urinate?_____ |
| 8) Urine loss
associated with a strong desire to urinate?_____ |
9) For male patients
add 2 points to score
Total Score _____ |
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If the score is 8 or
greater, you may have an overactive bladder and further medical evaluation is
recommended.
Print this form out and take the
completed form with you to your first appointment with your doctor or health
care provider. |