Urinary Incontinence Screening Quiz Question Title Please provide us with your full name and email address. Name Email Address Question Title Have you experienced urine leakage with coughing, sneezing, exercise, etc.? Yes No Question Title Have you experienced increased urgency and/or frequency of urination? Yes No Question Title Have you experienced urine or fecal leakage due to inability to make it to the bathroom in time? Yes No Question Title Does the problem affect your function or social life (e.g. sports, home life, relationships, etc.?) Yes No Question Title Have you tried other treatment options (drugs, exercise, surgery, etc.) without full recovery? Yes No Question Title Would you like some help with your current situation? Yes No Next
