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Prostate BPH Self-Assessment

Please take the time to answer the following questions. These questions are intended to act as a guide, showing how affected you are by the following symptoms. Once you have completed the questionnaire you can print the results page and hand it to your doctor, or nurse. Your answers are completely confidential and are not recorded.

International Prostate Symptom Score
Select one button for each category

Questions to be answered regarding your BPH condition

Not at all Less than 1 time in 5 Less than half the time About half the time More than half the time Almost always
Over the past month, how often have you had a sensation of not emptying your bladder completely after you finished urinating? 0 1 2 3 4 5
Over the past month, how often have you had to urinate again less than 2 hours after you finished urinating? 0 1 2 3 4 5
Over the past month, how often have you stopped and started again several times when you urinated? 0 1 2 3 4 5
Over the past month, how often have you found it difficult to postpone urination? 0 1 2 3 4 5
Over the past month, how often have you had a weak urinary stream? 0 1 2 3 4 5
Over the past month, how often have you had to push or strain to begin urination? 0 1 2 3 4 5
Over the past month, how many times did you most typically get up to urinate from the time you went to bed at night until the time you got up in the morning? (Check the column which best represents the number of times you awake each night, on average.) 0
times
 1
time
 2
times
 3
times
 4
times
 5
times