Question Title

* 1. Age

Question Title

* 2. Weight (in pounds)

Question Title

* 5. What dietary or energy supplements do you use, if any?

Question Title

* 6. Do you have/have you been through any of the following (check if yes):

Question Title

* 8. Have you ever had a kidney stone?

Question Title

* 9. How many years have you been participating in CrossFit? (can use 0.5 years)

Question Title

* 10. On average, how many times a week do you do Cross Fit?

Question Title

* 11. On average, how long do you work out for each time?

Question Title

* 12. How much can you lift for the following Cross Fit lifts (in lbs)?

Question Title

* 13. How much are you bothered by pain, pressure, heaviness or dullness in the lower abdomen?

Question Title

* 14. Do you usually have a bulge or something falling out that you can see OR just feel in the vaginal area?

Question Title

* 15. Do you usually have to push on the vagina to start or complete urination?

Question Title

* 16. How much are you bothered by frequent urination?

Question Title

* 17. How much are you bothered by urine leakage with urgency (strong sensation of needing to go to the bathroom)?

Question Title

* 18. How much are you bothered by urine leakage with laughing, coughing, or sneezing?

Question Title

* 19. How much are you bothered by difficulty emptying your bladder?

Question Title

* 20. How much urine do you think you leak?

Question Title

* 21. How often do you leak urine?

Question Title

* 22. If you have urine leakage, how much does this bother you?

Question Title

* 23. Do you usually have to push on the vaginal or around the rectum to have a complete bowel movement?

Question Title

* 24. Do you have any of the following bowel symptoms?

Question Title

* 25. Have you had any of the following treatment/management of urinary leakage?

Question Title

* 26. If you have any of the above symptoms, how much does it affect your ability to do physical activities such as walking, swimming, or other exercises?

Question Title

* 27. If you have any of the above symptoms, how much does it affect your participation in social activities outside the home?

Question Title

* 28. If you have any of the above symptoms, how much does it affect your emotional health (depression, nervousness, etc)?

Question Title

* 29. Overall, how much does leaking interfere with your everyday life?

0 - Not at all 5 10 - Extremely
Clear
i We adjusted the number you entered based on the slider’s scale.

T