Which of the following are you currently experiencing?
01
/04
Urinary incontinence
(accidental loss of urine)
Urinary incontinence
(accidental loss of urine)
(accidental loss of urine)
Urinary retention
(difficulty emptying all the urine from your bladder)
(difficulty emptying all the urine from your bladder)
Urinary retention
(difficulty emptying all the urine from your bladder)
(difficulty emptying all the urine from your bladder)
What product(s) do you most often use to help manage your urinary incontinence?
02
/04
Adult diapers or briefs
Adult diapers or briefs
Protective underwear
Protective underwear
Disposable pads
Disposable pads
I’m not using anything
I’m not using anything
How frequently do you change your current product(s) in a 24-hour period?
03
/04
2 changes or less
2 changes or less
More than 2 changes
More than 2 changes
What are your concerns with managing urinary incontinence? Please select all that apply.
04
/04
Fall risk from nighttime bathroom visits
Fall risk from nighttime bathroom visits
Interruption of sleep
Interruption of sleep
Multiple changes of bed linens
Multiple changes of bed linens
Moisture-related skin damage
Moisture-related skin damage
Other
Other
I don’t have any concerns
I don’t have any concerns