Birmingham Ibs Symptom Questionnaire Please enable JavaScript in your browser to complete this form. - Step 1 of 2The following questions ask you about your abdominal and bowel symptoms. When we use the word abdomen we mean belly/tummy. Some of the questions ask about passing a stool. By this we mean going to the toilet for a reason other than to urinate (pass water). All of these questions refer to the last 4 weeks. Please tick one box for each statement.1. During the last 4 weeks, how often have you had discomfort or pain in your abdomen? *All of the timeMost of the timeA good bit of the timeSome of the timeA little of the timeNone of the time2. How often have you been troubled with loose, mushy or watery bowel motions during the last 4 weeks? *All of the timeMost of the timeA good bit of the timeSome of the timeA little of the timeNone of the time3. How often during the last 4 weeks have you been troubled with diarrhoea? *All of the timeMost of the timeA good bit of the timeSome of the timeA little of the timeNone of the time4. During the last 4 weeks how often have you been troubled by hard bowel motions? *All of the timeMost of the timeA good bit of the timeSome of the timeA little of the timeNone of the time5. During the last 4 weeks how often have you felt the need to strain to pass a motion (stool)? *All of the timeMost of the timeA good bit of the timeSome of the timeA little of the timeNone of the time6. During the last 4 weeks how often have you been troubled by constipation? *All of the timeMost of the timeA good bit of the timeSome of the timeA little of the timeNone of the time7. During the last 4 weeks how often did you experience pain or discomfort in your abdomen after eating? *All of the timeMost of the timeA good bit of the timeSome of the timeA little of the timeNone of the time8. How often has you abdominal pain prevented you from sleeping, or woken you during the night during the last 4 weeks? *All of the timeMost of the timeA good bit of the timeSome of the timeA little of the timeNone of the time9. During the last 4 weeks how often have you leaked or soiled yourself? *All of the timeMost of the timeA good bit of the timeSome of the timeA little of the timeNone of the time10. How often during the last 4 weeks have you suffered from a feeling of urgency (feeling that you must immediately rush to the toilet to pass a stool)? *All of the timeMost of the timeA good bit of the timeSome of the timeA little of the timeNone of the time11. How often have you passed mucus or slime in your stools over the last 4 weeks? *All of the timeMost of the timeA good bit of the timeSome of the timeA little of the timeNone of the timeNextFull Name *FirstLastEmail *PreviousSubmit8160
