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Pelvic Floor Distress Inventory (PFDI - 20)

20- item, short form of the PFDI, to assess quality of life for women with pelvic floor conditions.

Provided by EVAL Foundation
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Pelvic Organ Prolapse Distress

Please answer all of the questions in the following survey. These questions will ask you if you have certain bowel, bladder, or pelvic symptoms and, if you do, how much they bother you. 

  • While answering these questions, please consider your symptoms over the last 3 months.
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The Pelvic Floor Distress Inventory-20 (PFDI-20) is one of the most widely used patient-reported outcome measures (PROMs) for assessing the symptoms of pelvic floor dysfunction (PFD) in women. It is frequently utilized in clinical practice and research to evaluate distress levels and track the effectiveness of treatments like surgery or physical therapy.

 

Clinical Purpose and Significance

Grade-A Tool: The International Consultation on Incontinence (ICI) has highly recommended the PFDI-20 as a reliable criteria for examining the severity and impact of pelvic floor disorders.

Symptom Impact: It measures how symptoms related to the lower urinary tract, lower gastrointestinal tract, and pelvic organ prolapse affect a woman's health-related quality of life.

Responsive to Change: The tool is noted for its excellent reliability and responsiveness to clinical changes, making it ideal for monitoring patient progress over time.

 

The Three Subscales

The 20 questions are divided into three specific inventories, each representing a unique aspect of pelvic floor function:

  • POPDI-6 (Pelvic Organ Prolapse Distress Inventory): Questions 1-6 focuses on sensations of bulging, heaviness, or pressure in the pelvic region.
  • CRADI-8 (Colorectal-Anal Distress Inventory): Questions 7-14 evaluates bowel-related issues such as straining, incomplete emptying, and loss of bowel control.
  • UDI-6 (Urinary Distress Inventory): Questions 15-20 assesses urinary symptoms, including frequent urination and leakage associated with urgency or activities like coughing.

 

Scoring and Interpretation

The PFDI-20 uses a two-step response system for each item:

  • Presence: Patients first answer "Yes" or "No" to whether they experience a specific symptom.
  • Degree of Bother: If "Yes," they rate the impact on a 4-point scale:

            1 = Not at all

            2 = Somewhat

            3 = Moderately

            4 = Quite a bit

 

Results - Calculating the Score

  • Subscale Scores: The mean value of all answered items in a subscale is multiplied by 25, resulting in a score from 0 to 100.
    • POPDI Score 
    • CRADI Score 
    • UDI Score
  • Total Score: Total PFDI-20 Score = POPDI Score + CRADI Score + UDI Score. The three subscale scores are added together for a final total ranging from 0 to 300.
    • Mild Distress: 0–100 points.
    • Moderate Distress: 101-200 points.
    • Severe Distress: 201-300 points.

 

Interpretation

Meaning: A higher score indicates a greater perceived negative impact of pelvic floor dysfunction on the patient's life.

  • A higher score indicates a greater perceived negative impact of pelvic floor dysfunction on the patient's life.
  • A lower score indicates fewer symptoms or symptoms that are less bothersome.

 

The Minimal Clinically Important Difference (MCID) is the smallest change in your score that represents a noticeable improvement (or worsening) in your daily life.

 

If you are tracking your progress over time, look for these specific drops in your 0–300 total score:

  • "Slightly Better": A reduction of approximately 28.6 points.
  • "Moderately Better": A reduction of approximately 34.1 points.
  • "Much Better": A reduction of 45.0 points or more. This is the most widely cited "gold standard" for a successful outcome after surgery.
  • Conservative Treatment: For those with milder symptoms (like starting physical therapy), a smaller drop of 13.5 to 24 points can still be considered a clinically relevant improvement.

 

All questions & possible results

Pelvic Organ Prolapse Distress

Please answer all of the questions in the following survey. These questions will ask you if you have certain bowel, bladder, or pelvic symptoms and, if you do, how much they bother you. 

  • While answering these questions, please consider your symptoms over the last 3 months.
1. Do you usually experience pressure in the lower abdomen?

Select one option:

  • No
  • Yes
1b. How much does this bother you?
  • Pressure in the lower abdomen.

Select one option:

  • Not at all
  • Somewhat
  • Moderately
  • Quite a bit
2. Do you usually experience heaviness or dullness in the pelvic area?

Select one option:

  • No
  • Yes
2b. How much does this bother you?
  • Heaviness or dullness in the pelvic area.

Select one option:

  • Not at all
  • Somewhat
  • Moderately
  • Quite a bit
3. Do you usually have a bulge or something falling out that you can see or feel in your vaginal area?

Select one option:

  • No
  • Yes
3b. How much does this bother you?
  • A bulge or something falling out that you can see or feel in your vaginal area.

Select one option:

  • Not at all
  • Somewhat
  • Moderately
  • Quite a bit
4. Ever have to push on the vagina or around the rectum to have or complete a bowel movement?

Select one option:

  • No
  • Yes
4b. How much does this bother you?
  • Pushing on the vagina or around the rectum to have or complete a bowel movement.

Select one option:

  • Not at all
  • Somewhat
  • Moderately
  • Quite a bit
5. Usually experience a feeling of incomplete bladder emptying?

Select one option:

  • No
  • Yes
5b. How much does this bother you?
  • A feeling of incomplete bladder emptying.

Select one option:

  • Not at all
  • Somewhat
  • Moderately
  • Quite a bit
6. Ever have to push up on a bulge in the vagina area with your fingers to start or complete urination?

Select one option:

  • No
  • Yes
6b. How much does this bother you?
  • Push up on a bulge in the vagina area with your fingers to start or complete urination.

Select one option:

  • Not at all
  • Somewhat
  • Moderately
  • Quite a bit
Colorectal-Anal Distress

While answering these questions, please consider your symptoms over the last 3 months.

7. Do you feel you need to strain too hard to have a bowel movement?

Select one option:

  • No
  • Yes
7b. How much does this bother you?
  • Feeling you need to strain too hard to have a bowel movement.

Select one option:

  • Not at all
  • Somewhat
  • Moderately
  • Quite a bit
8. Do you feel you have not completely emptied your bowels at the end of a bowel movement?

Select one option:

  • No
  • Yes
8b. How much does this bother you?
  • Feeling you have not completely emptied your bowels at the end of a bowel movement.

Select one option:

  • Not at all
  • Somewhat
  • Moderately
  • Quite a bit
9. Do you usually lose stool beyond your control if your stool is well formed?

Select one option:

  • No
  • Yes
9b. How much does this bother you?
  • Usually lose stool beyond your control if your stool is well formed.

Select one option:

  • Not at all
  • Somewhat
  • Moderately
  • Quite a bit
10. Do you usually lose stool beyond your control if your stool is loose?

Select one option:

  • No
  • Yes
10b. How much does this bother you?
  • Usually lose stool beyond your control if your stool is loose.

Select one option:

  • Not at all
  • Somewhat
  • Moderately
  • Quite a bit
11. Do you usually lose gas from the rectum beyond your control?

Select one option:

  • No
  • Yes
11b. How much does this bother you?
  • Usually lose gas from the rectum beyond your control.

Select one option:

  • Not at all
  • Somewhat
  • Moderately
  • Quite a bit
12. Do you usually have pain when you pass your stool?

Select one option:

  • No
  • Yes
12b. How much does this bother you?
  • Usually have pain when you pass your stool.

Select one option:

  • Not at all
  • Somewhat
  • Moderately
  • Quite a bit
13. Do you experience a strong sense of urgency and have to rush to the bathroom to have a bowel movement?

Select one option:

  • No
  • Yes
13b. How much does this bother you?
  • Experience a strong sense of urgency and have to rush to the bathroom to have a bowel movement.

Select one option:

  • Not at all
  • Somewhat
  • Moderately
  • Quite a bit
14. Does part of your bowel ever pass through the rectum and bulge outside during or after a bowel movement?

Select one option:

  • No
  • Yes
14b. How much does this bother you?
  • Part of your bowel ever pass through the rectum and bulge outside during or after a bowel movement.

Select one option:

  • Not at all
  • Somewhat
  • Moderately
  • Quite a bit
Urinary Distress
15. Do you usually experience frequent urination?

Select one option:

  • No
  • Yes
15b. How much does this bother you?
  • Usually experience frequent urination.

Select one option:

  • Not at all
  • Somewhat
  • Moderately
  • Quite a bit
16. Do you usually experience urine leakage associated with a feeling of urgency, that is, a strong sensation of needing to go to the bathroom?

Select one option:

  • No
  • Yes
16b. How much does this bother you?
  • Usually experience urine leakage associated with a feeling of urgency, that is, a strong sensation of needing to go to the bathroom.

Select one option:

  • Not at all
  • Somewhat
  • Moderately
  • Quite a bit
17. Do you usually experience urine leakage related to coughing, sneezing, or laughing?

Select one option:

  • No
  • Yes
17b. How much does this bother you?
  • Usually experience urine leakage related to coughing, sneezing, or laughing.

Select one option:

  • Not at all
  • Somewhat
  • Moderately
  • Quite a bit
18. Do you usually experience small amounts of urine leakage (that is, drops)?

Select one option:

  • No
  • Yes
18b. How much does this bother you?
  • Usually experience small amounts of urine leakage (that is, drops).

Select one option:

  • Not at all
  • Somewhat
  • Moderately
  • Quite a bit
19. Do you usually experience difficulty emptying your bladder?

Select one option:

  • No
  • Yes
19b. How much does this bother you?
  • Usually experience difficulty emptying your bladder.

Select one option:

  • Not at all
  • Somewhat
  • Moderately
  • Quite a bit
20. Do you usually experience pain or discomfort in the lower abdomen or genital region?

Select one option:

  • No
  • Yes
20b. How much does this bother you?
  • Usually experience pain or discomfort in the lower abdomen or genital region.

Select one option:

  • Not at all
  • Somewhat
  • Moderately
  • Quite a bit
Possible results
Total Pelvic Floor Distress Score - Moderate Distress ( 101 to 200 points)
  • A higher score indicates a greater perceived negative impact of pelvic floor dysfunction on the patient's life.
  • A lower score indicates fewer symptoms or symptoms that are less bothersome.

 

The Minimal Clinically Important Difference (MCID) is the smallest change in your score that represents a noticeable improvement (or worsening) in your daily life.

 

If you are tracking your progress over time, look for these specific drops in your 0–300 total score:

  • "Slightly Better": A reduction of approximately 28.6 points.
  • "Moderately Better": A reduction of approximately 34.1 points.
  • "Much Better": A reduction of 45.0 points or more. This is the most widely cited "gold standard" for a successful outcome after surgery.
  • Conservative Treatment: For those with milder symptoms (like starting physical therapy), a smaller drop of 13.5 to 24 points can still be considered a clinically relevant improvement.
Total Pelvic Floor Distress Score - Severe Distress ( 201 to 300 points)
  • A higher score indicates a greater perceived negative impact of pelvic floor dysfunction on the patient's life.
  • A lower score indicates fewer symptoms or symptoms that are less bothersome.

 

The Minimal Clinically Important Difference (MCID) is the smallest change in your score that represents a noticeable improvement (or worsening) in your daily life.

 

If you are tracking your progress over time, look for these specific drops in your 0–300 total score:

  • "Slightly Better": A reduction of approximately 28.6 points.
  • "Moderately Better": A reduction of approximately 34.1 points.
  • "Much Better": A reduction of 45.0 points or more. This is the most widely cited "gold standard" for a successful outcome after surgery.
  • Conservative Treatment: For those with milder symptoms (like starting physical therapy), a smaller drop of 13.5 to 24 points can still be considered a clinically relevant improvement.
Pelvic Organ Prolapse Distress Score
Total Pelvic Floor Distress Score - Mild Distress ( 0 to 100 points)
  • A higher score indicates a greater perceived negative impact of pelvic floor dysfunction on the patient's life.
  • A lower score indicates fewer symptoms or symptoms that are less bothersome.

 

The Minimal Clinically Important Difference (MCID) is the smallest change in your score that represents a noticeable improvement (or worsening) in your daily life.

 

If you are tracking your progress over time, look for these specific drops in your 0–300 total score:

  • "Slightly Better": A reduction of approximately 28.6 points.
  • "Moderately Better": A reduction of approximately 34.1 points.
  • "Much Better": A reduction of 45.0 points or more. This is the most widely cited "gold standard" for a successful outcome after surgery.
  • Conservative Treatment: For those with milder symptoms (like starting physical therapy), a smaller drop of 13.5 to 24 points can still be considered a clinically relevant improvement.
Colorectal-Anal Distress Score
Urinary Distress Score

Citation

Barber, M. D., Walters, M. D., & Bump, R. C. (2005). Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7). American Journal of Obstetrics and Gynecology, 193(1), 103–113. https://doi.org/10.1016/j.ajog.2004.12.025

Literature

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