GI Condition Risk Assessment
Gastrointestinal Conditions Risk Assessment
Women can answer the following questions to get a sense of their
likelihood of having or developing a gastrointestinal condition.
| Do you experience stomach, intestinal, or other digestive-system discomfort regularly? | Yes | No |
| Do you have GI symptoms that compromise your quality of life or your ability to participate in activities? | Yes | No |
| Do you experience pain or cramping in your abdomen? | Yes | No |
| Do you often have a feeling of being bloated or distended in your lower belly? | Yes | No |
| Do you experience nausea or vomiting regularly? | Yes | No |
| Do you often have a feeling of burning in your throat, chest, or gut? | Yes | No |
|
Does such burning bother you at nighttime? |
Yes | No |
| Do you feel like you often have a sore throat, hoarse voice, or need to clear your throat? | Yes | No |
| Has there been significant change in your stool habits? | Yes | No |
|
Are your bowel movements or bowel patterns disrupted by diarrhea or constipation, or both? |
Yes | No |
| Do you have bowel movements more than three times per day or less than three times per week? | Yes | No |
| Do you sometimes experience discomfort after a bowel movement? | Yes | No |
| Do you ever notice that your stool is bloody, or often covered with mucus? | Yes | No |
|
Do your digestive symptoms correspond with what you eat? |
Yes | No |
|
Do your digestive symptoms correspond with your eating schedule? |
Yes | No |
|
Do you make significant use of over-the-counter products for nausea, heartburn, constipation, or diarrhea? |
Yes | No |
| Do your digestive symptoms correspond with times of stress? | Yes | No |
|
Do you have a lifestyle that is inactive? |
Yes | No |
| Is your diet low in fiber or high in rich foods? | Yes | No |
| Do you have an immediate family member (parent, sibling, or child) who has suffered from reflux disease, irritable bowel syndrome, or other digestive condition? | Yes | No |
The more often you answered “Yes” to the above questions, the greater your risk for developing or already having a gastrointestinal condition. If you answered “Yes” to questions above, consider discussing gastrointestinal conditions with one of our Women’s Center healthcare providers.
Print this page and bring it with you, filled out, to your appointment.
