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Are the incontinence products needed for:

• Urine (Bladder)
• Stool Only or if a urinary catheter is used but there is bowel incontinence (Bowel)
• Both Urine and Stool (Bladder and Bowel)

Urine is lost from the bladder:

• With coughing, sneezing, laughing, lifting objects or exertion a little bit of urine is leaked. In males, sometimes urine dribbles just before or after urinating (Stress)
• An urge is felt and suddenly, there is difficultly holding back the flow of urine. (Urge)
• Urination without awareness and unable to control the flow (Total/Complete)

Describe the bowel incontinence experienced:

• A small amount of staining or smearing after a bowel movement or after gas is passed (Staining)
• Leakage of a small amount of stool (Leakage)
• Formed stool (moderate to large amount) (Formed)
• Liquid, diarrhea-like stool (moderate to large amount)

Describe the "amount" of urine loss (incontinence) typically experienced:

• A trickle or a dribble (Just a couple of tablespoons or ounces)
• A short "gush" (More than a trickle but less than a cup)
• A "flood" (More than a cup)

Measure either the hips or the waist (which ever is larger). Choose the measurement from the ranges below:

• Less than 20" (Y)
• 20" to 31" (S)
• 31" to 44" (M)
• 44" to 58" (R/L)
• 59" to 64" (XL)
• 64" to 68" (XXL)
• 68" to 80"
• Greater than 80"

How frequently is there a need for a fresh incontinence product?

• A few times per week
• 1-3 times over a 24 hour period
• 4-6 times over a 24 hour period
• More than 6 times over a 24 hour period

Does Bowel Incontinence occur overnight?

• Yes
• No
• Sometimes

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