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Pelvic Dysfunction

Unsure if Pelvic Dysfunction is something for you to worry about or have checked out?

The Cozean Screening Protocol was developed to help patients (and their physicians) screen for pelvic floor dysfunction. Take the questionnaire below; if you score 3 or more pelvic floor dysfunction is highly likely and you'd benefit from an evaluation with a pelvic health physical therapist.

Find out if Pelvic Dysfunction is likely

Check all that apply to you

I sometimes have pelvic pain (in genitals, perineum, pubic or bladder area, or pain with urination) that exceeds a ‘3’ on a 1-10 pain scale, with 10 being the worst pain imaginable.

I can remember falling onto my tailbone, lower back, or buttocks (even in childhood).

Accidental loss of urine Feeling unable to completely empty my bladder.

Having to void within a few minutes of a previous void Pain or burning with urination.

Difficulty starting or frequent stopping/starting of urine stream

I sometimes experience one or more of the following urinary symptoms: • Accidental loss of urine • Feeling unable to completely empty my bladder • Having to void within a few minutes of a previous void • Pain or burning with urination • Difficulty starting or frequent stopping/starting of urine stream

I often or occasionally have to get up to urinate two or more times at night

I sometimes have a feeling of increased pelvic pressure or the sensation of my pelvic organs slipping down or falling out

I have a history of pain in my low back, hip, groin, or tailbone or have had sciatica

I sometimes experience one or more of the following bowel symptoms: • Loss of bowel control • Feeling unable to completely empty my bowels • Straining or pain with a bowel movement • Difficulty initiating a bowel movement

I sometimes experience pain or discomfort with sexual activity or intercourse

Sexual activity increases one or more of my other symptoms

Prolonged sitting increases my symptoms

You indicated you are having some symptoms of Pelvic Dysfunction. How long have you had these symptoms?

Thanks for sharing your answers with us!
We will be in touch if you checked three or more of the above symptoms. You can also request an appointment below.

We can help you

Pelvic Pain

Urinary Urgency

Painful Intercourse

Core Instability

Request an Appointment

CONTACT

CONTACT US

Phone: 832-521-8277

Fax: 832-652-3692

physicaltherapy@awarenesspelvichealth.com

In-office visits

1302 North Shepherd Drive

3rd Floor

Houston, TX 77008

THERAPY SESSION LOCATIONS

OPENING HOURS

Monday 9-330

Tuesday Closed

Wednesday 9-5p

Thursday 10-7p

Friday 9-3p

First Name

Last Name

Phone

Referring Doctor

Referring Doctor Contact Info

Check reason for inquiry

Pelvic pain

Sexual dysfunction

GI symptoms

Bladder symptoms

Other

Briefly discribe problems you're experiencing

Thank you for your inquiry! We'll be in contact soon!

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