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Bladder Leakage Quiz

~5 min

The level of burden that incontinence can have on your life can make a difference between just living with it and taking the steps necessary to put an end to it. Complete this short survey to receive your bladder leakage severity score.

  • Which best describes your situation?
  • How long has bladder leakage been an issue?
  • How frequently does the bladder leakage occur?
  • Please estimate how much urine usually leaks during an episode, whether protection is worn or not.
  • Using the scale below, tell us how much bladder leakage interferes with your regular life.
    (0=No Interference, 5=Moderate Interference, 10=Major Interference)
  • When does the bladder leakage occur? Please select all that apply.
  • If you or the person you care for was treated for prostate cancer, which treatment was received? Please select all that apply.
  • If a radical prostatectomy was performed, how long ago was it?
  • Select all treatments that have been tried to manage the bladder leakage.
  • How would the sufferer feel if their current urinary condition was permanent and not treatable?
  • Receive your custom results in your inbox.
    • Why ZIP? So we can give you more customized results like specialists and events near you.

      Providing your phone number is optional and allows a trained Boston Scientific Male Incontinence Education Specialist to get in touch with you and address any questions you may have.

      This form is only intended for users living in the United States.

      By submitting this form, I consent to Boston Scientific sending me a full summary of my quiz results and using all information I have entered on this form to provide me by email and/or phone helpful information about male incontinence products and resources for when I’m ready to talk to a doctor about my treatment options. My submission also is my acceptance of, and consent to, the Boston Scientific Privacy Policy and Terms of Use.

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