Pelvic Congestion Syndrome (PCS)

1. Incomplete Emptying: How often have you had the sensation of not emptying your bladder?

2. Frequency: How often have you had to urinate less than every two hours?

3. Intermittency: How often have you found you stopped and started again several times when you urinated?

4. Urgency: How often have you found it difficult to postpone urination?

5. Weak Stream: How often have you had a weak urinary stream?

6. Straining: How often have you had to strain to start urination?

7. Nocturia: How many times did you typically get up at night to urinate?

1. Walking

2. Stair climbing

3. Nocturnal

4. Rest

5. Weight bearing

1. Morning stiffness

2. Stiffness occurring later in the day

1. Descending stairs

2. Ascending stairs

3. Rise from sitting

4. Standing

5. Bending to floor

6. Walking on flat surface

7. Getting in/out of car

8. Going shopping

9. Putting on socks

10. Lying in bed

11. Taking off socks

12. Rising from bed

13. Getting in/out of bath

14. Sitting

15. Getting on/off toilet

16. Heavy domestic duties

17. Light domestic duties

1. Standing

2. Walking on even ground

3. Walking on even ground without shoes

4. Walking up hills

5. Walking down hills

6. Going up stairs

7. Going down stairs

8. Walking on uneven ground

9. Stepping up and down curbs

10. Squatting

11. Sleeping

12. Coming up to your toes

13. Walking initially

14. Walking 5 minutes or less

15. Walking approximately 10 minutes

16. Walking 15 minutes or greater

17. Home responsibilities

18. Activities of daily living

19. Personal care

20. Light to moderate work (standing, walking)

21. Heavy work (push/pulling, climbing, carrying)

22. Recreational activities

23. General level of pain

24. Pain at rest

25. Pain during your normal activity

26. Pain first thing in the morning