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This questionnaire, promoted by the WFIP (World Federation of Incontinence Patients), is aimed exclusively at people who suffer from some sort of incontinence. Its purpose is to better understand their experiences and how incontinence influences their everyday life in order to offer future services to our community of people affected by this problem.

Disclaimer: This survey is strictly confidential and anonymous. No personal data will be compiled from the individuals surveyed and the responses will only be used to obtain global results.

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* 1. Please indicate whether you are a:

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* 4. In general, would you say your state of health is:

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* 5. What type of incontinence do you have?

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* 6. When did the symptoms start?

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* 7. Which healthcare professional did you speak to first about your incontinence?

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* 9. Finally, who diagnosed the incontinence and indicated treatment?

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* 10. Who is currently following the course of your incontinence? (multiple responses can be chosen)

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* 11. What was your main problem in obtaining a correct diagnosis and starting treatment?

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* 12. Have you had problems in receiving diagnosis and treatment for your incontinence for any of the following reasons? (multiple responses can be chosen)

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* 13. Please indicate below how incontinence affects your everyday life in general:

  Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree
I feel my health is poor due to incontinence
I’m embarrassed about having this condition
I feel more socially isolated (friends, family)
I feel poorly understood by others
I’ve lost my self-confidence
I worry in case I smell
I’m worried that incontinence impacts on my sexual relationship
Generally, I feel incontinence impacts adversely on my quality of life

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* 14. Please indicate below how incontinence affects your daily activities:

  Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree
I’ve managed to prevent incontinence from limiting my daily activities
I’m always worried that I will leak
I often feel down or even depressed
Incontinence limits the variety of what I can wear
Incontinence limits my sporting activities and physical exercise
I avoid long journeys on public transport
I avoid going out socially
I watch how much I drink or eat before leaving home
Incontinence has impacted on my sex life

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* 15. Please indicate below how incontinence affects your work:

  Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree
It doesn’t affect my work
I socialize less at work
My work performance is negatively affected due to lack of sleep
I take time off work for fear of leakage
I’m on temporary sick leave due to incontinence
I left my regular job due to incontinence

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* 16. How would you rate the information that you receive about incontinence from different sources (e.g. clinicians, nurses, Google, social media, …)?

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* 17. Please indicate what sources you use to keep up to date on topics related to health and particularly incontinence: (multiple responses can be chosen)

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* 18. Indicate which of the following actions would help you in your everyday life, besides your treatment

  Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree
Being able to share my problem with others
Having “aids” to help me manage accidents
Having easy access to experts to answer my questions
Having accessible psychological support when I need it
Being up to date with the latest advances in treatment options
If my family and friends had more information and training to have a better understanding of my situation
Get adequate information from my doctor to enable me to handle my situation
Thank you for your answers and for helping improve quality of life for all.
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