Table 2 Japanese version of Patient Assessment of Constipation Quality of Life
The following questions are designed to measure the impact constipation has had on your daily life over the past 2 weeks. For each question, please check one box. | |||||
|---|---|---|---|---|---|
The following questions ask about your symptoms related to constipation. During the past 2 weeks, to what extent or intensity have you… | Not at all = 1 | A little bit = 2 | Moderately = 3 | Quite a bit = 4 | Extremely = 5 |
1. Felt bloated to the point of bursting? | □ | □ | □ | □ | □ |
2. Felt heavy because of your constipation? | □ | □ | □ | □ | □ |
The next few questions ask about how constipation affects your daily life. During the past 2 weeks, how much of the time have you… | None of the time = 1 | A little of the time = 2 | Some of the time = 3 | Most of the time = 4 | All of the time = 5 |
3. Felt any physical discomfort? | □ | □ | □ | □ | □ |
4. Felt the need to have a bowel movement but not been able to? | □ | □ | □ | □ | □ |
5. Been embarrassed to be with other people? | □ | □ | □ | □ | □ |
6. Been eating less and less because of not being able to have bowel movements? | □ | □ | □ | □ | □ |
The next few questions ask about how constipation affects your daily life. During the past 2 weeks, to what extent or intensity have you… | Not at all = 1 | A little bit = 2 | Moderately = 3 | Quite a bit = 4 | Extremely = 5 |
7. Had to be careful about what you eat? | □ | □ | □ | □ | □ |
8. Had a decreased appetite? | □ | □ | □ | □ | □ |
9. Been worried about not being able to choose what you eat (for example, at a friend’s house)? | □ | □ | □ | □ | □ |
10. Been embarrassed about staying in the bathroom for so long when you were away from home? | □ | □ | □ | □ | □ |
11. Been embarrassed about having to go to the bathroom so often when you were away from home? | □ | □ | □ | □ | □ |
12. Been worried about having to change your daily routine (for example, traveling, being away from home)? | □ | □ | □ | □ | □ |
The next few questions ask about your feelings related to constipation. During the past 2 weeks, how much of the time have you… | None of the time = 1 | A little of the time = 2 | Some of the time = 3 | Most of the time = 4 | All of the time = 5 |
13. Felt irritable because of your condition? | □ | □ | □ | □ | □ |
14. Been upset by your condition? | □ | □ | □ | □ | □ |
15. Felt obsessed by your condition? | □ | □ | □ | □ | □ |
16. Felt stressed by your condition? | □ | □ | □ | □ | □ |
17. Felt less self-confident because of your condition? | □ | □ | □ | □ | □ |
18. Felt in control of your situation? | □ | □ | □ | □ | □ |
The next questions ask about your feelings related to constipation. During the past 2 weeks, to what extent or intensity have you… | Not at all = 1 | A little bit = 2 | Moderately = 3 | Quite a bit = 4 | Extremely = 5 |
19. Been worried about not knowing when you are going to be able to have a bowel movement? | □ | □ | □ | □ | □ |
20. Been worried about not being able to have a bowel movement? | □ | □ | □ | □ | □ |
21. Been increasingly bothered by not being able to have a bowel movement? | □ | □ | □ | □ | □ |
The next questions ask about your life with constipation. During the past 2 weeks, how much of the time have you… | None of the time = 1 | A little of the time = 2 | Some of the time = 3 | Most of the time = 4 | All of the time = 5 |
22. Been worried that your condition will get worse? | □ | □ | □ | □ | □ |
23. Felt that your body was not working properly? | □ | □ | □ | □ | □ |
24. Had fewer bowel movements than you would like? | □ | □ | □ | □ | □ |
The next questions ask about your degree of satisfaction related to constipation. During the past 2 weeks, to what extent or intensity have you been… | Not at all = 1 | A little bit = 2 | Moderately = 3 | Quite a bit = 4 | Extremely = 5 |
25. Satisfied with how often you have a bowel movement? | □ | □ | □ | □ | □ |
26. Satisfied with the regularity of your bowel movements? | □ | □ | □ | □ | □ |
27. Satisfied with the time it takes for food to pass through the intestines? | □ | □ | □ | □ | □ |
28. Satisfied with your treatment? | □ | □ | □ | □ | □ |