Q1. During the last 7 days, how easy or difficult was it to have bowel movement on a scale from 0 to 5.

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Q2. During the last 7 days, how strongly did you feel that you did not empty your bowels completely?

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Q3. During the last 7 days, how would you rate how constipated you felt?

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Q4. During the last 7 days, how many bowel movements have you had?

Q5. Tick the stool, which most closely resembles your own.

Separate hard lumps, like nuts (hard to pass)

Sausage-shaped but lumpy

Like a sausage but with cracks on the surface

Like a sausage or snake smooth and soft

Soft blubs with clear-cut edges

Fluffy pieces with ragged edges, a mushy stool

None

Q6. During the last 7 days, have you taken anything to help bowel movements?

Q6i. Please specify how regularly you are taking your laxatives, fibre supplements or medicines:

Q6ii. Were any laxatives, fibre supplements or medicines recommended or prescribed by your doctor?

Q6iii. How satisfied are you with your treatment(s) in helping you have a bowel movement?

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Q7. Have you ever missed, decreased or stopped taking your current pain medicine to make passing a bowel movement easier?

Q8. Since you started taking your current pain medicine have you had more difficulty passing a bowel movement?

Q9. Has constipation, related to taking your current pain medicine, affected your quality of life or overall well-being?

Q10. How old are you?

Q11. Select gender

Select your gender by clicking on the symbol below and next to proceed:

Congratulations, you have finished the survey.

You may like to print your survey results and take them to your doctor.