Questions 5 to 21 were referred to the last 12 months.
For questions 9 to 14, four answers were offered:
Sometimes (<25% of
Often (>25% of
For questions 16 to 18, four answers were offered:
Fewer than once a
One o more times in a
included in the questionnaire mailed to subjects.
Indicate your age:
Indicate your gender:
Indicate your educational level:
Indicate your job:
5. Indicate the
amount of fiber in your diet: Low / Medium / High
6. How often do you
perform physical exercise? Never / Sometimes / Habitually
7. Indicate which
drugs are you taking:
8. Have you felt
constipated? Yes / No
9. Do you strain
during a bowel movement?
10. Do you feel an
incomplete emptying sensation after a bowel movement?
11. How often are
your stools hard?
12. Do you feel a
blockage in the anus that makes it difficult to pass the stool?
13. Do you need to
press around the anus or vagina to complete bowel movement?
14. Do you spend more
than 10 minutes on the toilet to pass the stools?
15. How many bowel
movements do you usually have each week?
16. Do you take oral
17. Do you need to
use suppositories to have bowel movements?
18. Do you need to
use enemas to have bowel movements?
19. Have you visited
a doctor because of constipation? Yes / No
20. Have you
presented with abdominal pain more than 6 times last year? Yes / No
21. Have you
presented loose or watery stools? Yes / No