Please complete this survey if you have been diagnosed with pelvic or abdominal adhesions. You consent to the use of these results which will be masked or aggregated with other results. Please check all that apply.
1. I am male (do not check if you are female)
2. I have had at least one full bowel obstruction which was due to adhesions
3. I have had at least one partial bowel obstruction which was due to adhesions
4. I have been diagnosed as having adhesions within the last ONE year
5. I have been diagnosed as having adhesions within the last TWO years
6. I have been diagnosed as having adhesions within the last THREE years
7. I have been diagnosed as having adhesions within the last FOUR years
8. I have been diagnosed as having adhesions within the last FIVE years
9. I have been diagnosed as having adhesions within the last SIX years
10. I have been diagnosed as having adhesions within the last SEVEN years
11. I have been diagnosed as having adhesions within the last EIGHT years
12. I have been diagnosed as having adhesions within the last NINE years
13. I have been diagnosed as having adhesions within the last TEN years
14. I have been diagnosed as having adhesions within the last FIFTEEN years
15. I have been diagnosed as having adhesions within the last TWENTY years
16. I was diagnosed as having adhesions more than TWENTY years ago
17. Since being diagnosed with adhesions, I have had a full or partial bowel obstruction on average at least once every 6 months
18. Since being diagnosed with adhesions, I have had a full or partial bowel obstruction on average at least once a year
19. Since being diagnosed with adhesions, I have had a full or partial bowel obstruction on average at least once every three years
20. Since being diagnosed with adhesions, I have had a full or partial bowel obstruction on average at least once every four years
21. Since being diagnosed with adhesions, I have had a full or partial bowel obstruction on average at least once every five years
22. Since being diagnosed with adhesions, I have had a full or partial bowel obstruction on average less than once every five years
23. Due to my adhesions, I suffer from chronic/severe diarrhea
24. Due to my adhesions, I suffer from chronic/severe constipation
25. Due to my adhesions, I have a malabsorption problem
26. Due to my adhesions I have a special diet
27. I receive adequate counseling regarding proper nutrition
28. I require IV/ Tube feedings
29. I suffer from chronic pain
30. I take medication for chronic pain
31. My chronic pain medication makes my bowel problems worse
32. I have tried physical/ massage therapy for my bowel condition
33. The physical/massage therapy has improved my condition
34. Because of my condition I am unable to work
35. I have been unable to obtain disability benefits related to my inability to work
36. Because of my condition my family relationships have suffered
37. My family/ friends are very supportive of me
38. My current doctor is able to help my condition somewhat
39. My current doctor acknowledges my adhesions problem, but is unable to help
40. My current doctor does not acknowledge that adhesions are a problem, and is unwilling to help
 |