IBS Consumer Survey

1. Are you:

Male

Female

2. Do you suffer from abdominal pain associated with Irritable Bowel Syndrome (IBS)?
(If you experience abdominal pain and are not sure whether it is associated with IBS, please click here for more information)

Yes

3. If yes, has your IBS been medically confirmed by a doctor?

Yes

4. How old are you?

	Under 16
	16 - 24
	25 - 34
	35 - 44
	45 - 54
	55 - 64
	65 +

5. In which region do you live?

	North West
	North East
	South East (not London)
	South West
	London
	East
	The Midlands
	Wales
	Scotland

Please specify your nearest town:

6. Which one of the following industry sectors do you work in?

	HR
	IT and telecoms
	Finance
	Sales, media & marketing
	Retail, catering & leisure
	Healthcare
	Manufacturing & Utilities
	Architecture, Engineering & Building
	Travel & Transport
	Education
	Not currently employed
	Other

7. What is your current marital status?

	Married
	Engaged
	Living with partner
	Casual relationship
	I am not currently in a relationship

8. Does your partner know you have IBS?

Yes

9. How much do you agree or disagree with the following statements
(please rate from 1 to 5 where 1 = Strongly agree, 2 = Agree, 3 = Neither agree nor disagree, 4 = Disagree, 5 = Strongly disagree)

IBS Impacts	Strongly Agree				Strongly Disagree
	1	2	3	4	5
IBS has had an impact on my ability to have a relationship
IBS can sometimes make me feel unattractive
Having an IBS attack can dictate the clothes I wear
Having IBS has affected my self-confidence
IBS can be a lonely condition
Having IBS affects the food and drink I can choose in restaurants

10. Have you ever had to cancel a date or romantic plans as a result of your IBS?

Yes

11. Have you/or your partner ever had to end a relationship as a direct result of your IBS?

Yes

12. Which symptom of IBS do you find to be the most disruptive in terms of the impact it has on your personal life?

	Abdominal pain & cramps
	Constipation
	Diarrhoea
	Bloating
	Other

13. CASE STUDY SUBMIT

If you would like to submit your story click here: SUBMIT MY STORY

Many thanks for taking the time to answer this survey, your feedback is extremly valuable to us and will help us to better understand the experiences of people suffering from IBS.