Required fields are marked with an asterisk *.
Do you have urinary urgency? *
Do you urinate often during the hours that you are awake? *
Do you have urinary incontinence? *
Do you urinate at night? *
Do you have problems starting the urinary stream? *
Do you have constipation? *
Do you have diarrhea? *
Do you have occasional incontinence for stools? *
Do you have decreased interest in sexual relations? *
Do you have difficulty reaching an orgasm? *
Do you have decreased sensation in your pelvic area? *
Do you have low back pain? *
Do you have leg pain? *
Do you have numbness under the soles of your feet? *
Do you keep your knees bent at night? *
Do you have low back pain, leg pain, or urinary symptoms while walking up stairs? *
Do you have a history of severe growing pains during childhood and adolescence? *
Do you have difficulty standing longer than 60 minutes? *
Do your symptoms worsen with driving or riding? *
Are your symptoms worse on bumpy roads? *
Have you had an injury to your spine? *
Have you had any surgery on your spine? *
Have you been told you have curvature of the spine (scoliosis)? *
Have you been told you have spina bifida? *

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