Table S2: Questionnaire

Table S2: Questionnaire

Stool frequency

1. How often do you pass stool?

More than 2-3 time daily / 2-3 times daily / 1 time daily / Ever 2-3 days / Less frequent / Large variation (diarrhea to obstipation)
If large variation, please specify……..
Appearances and quality of faeces

1. General Quality

Hard / Soft / Pasty or watery / Can`t tell , varies a lot

1. Do you sometime have to clear out stool manually?

Always / Mostly / Sometimes / Rarely / Never

1. Do you suffer from constipation? Def.: infrequent bowel movements (three times or fewer per week) or difficulties during defecation (straining during more than 25% of bowel movements or a subjective sensation of hard stools), or the sensation of incomplete bowel evacuation

Always / Mostly / Sometimes / Rarely / Never
Do you use blistered / laxative agents?
Always / Mostly / Sometimes / Rarely / Never
If yes, which type and quantity …………
Do you use agents against constipation?
Yes / Sometimes / No
If yes, which type and quantity …………
Are those methods successful?
Yes / Sometimes / No

1. Do you have diarrhea? Def.: three or more loose or liquid stools per day, or as having more stools than is normal the patient

Always / Mostly / Sometimes / Rarely / Never
Do you use agents against diarrhea?
Always / Mostly / Sometimes / Rarely / Never
Do you use conservative methods for treating diarrhea?
Yes / Sometimes / No
If yes, which type and quantity …………
Are those methods successful?
Yes / Sometimes / No
Stool Incontinence

1. Do you suffer from stool incontinence?

Always / Mostly / Sometimes / Rarely / Never
If stool incontinence…….
What kind of stool incontinence do you suffer from?
Always / Mostly / Sometimes / Rarely / Never
Incontinence for solid stool
Incontinence for liquid stool
Incontinence for gas
Amount of stool incontinence?
Stool smear / Loss of small amount / Loss of larger amounts
Which methods do you use to cope with faecal incontinence? (select one or more answers)
Frequent change of underwear: ………….. times per day
Pads (or toilet paper-“pads”)
Always / Mostly / Sometimes / Rarely / Never
If yes, average pads per day ………..
Diapers
Always / Mostly / Sometimes / Rarely / Never
If yes, average pads per day ………..
Is incontinence an impairment of your quality of life?
Always / Mostly / Sometimes / Rarely / Never

1. Are you content with your present situation of bowl control?

Yes / No
Which problems do you have considering bowl movement at present?
Diet

1. Are you a vegetarian?

Yes / No
Drink and Tobacco

1. Do you smoke?

Yes / No

1. How many cigarettes do you smoke daily ………..

How many glasses of beer do you drink daily ………..
How many glasses of wine do you drink daily ………..
Do you drink hard liquor, too?
Yes / No
General data

1. Please fill in your weight and height

Weight ………………………..kg Height ………………………….cm
History of disease

1. Do you suffer from one of the following bowel disease?

Hemorrhoids / Diverticulitis / Polyps / Colitis ulcerosa / Crohn`s Disease

1. Do you suffer from other disease of the stomach, bowel or esophagus?

1. Do you suffer from one of the following metabolic disorders?

Diabetes / Yes / No
If yes, do you have to inject insulin? / Yes / No
Thyroid hyperfunction / Yes / No
Thyroid hypofunction / Yes / No
Medication and Operations

1. Which medication do you take at present?

Medication / Yes / No / Time / Frequency
Cholestyramine
Quantalane
Loperamide
Acetolyt
Nephrotrans
Uralyt U
Other (please name)

1. Did you ever take any medication over a longer period? If yes, which and for how long?

1. Did you have any other operation after your urinary diversion?

Date / Type of operation
Comparison to the time before the urinary diversion

1. If you look back, did you experience any change in bowel movement (habits) after the urinary diversion? (select one or more answers)

No
Yes in frequency
If yes, currently:
More frequent / Less frequent
Yes in quality:
If yes, currently:
More harder / Less softer / more watery
Other changes: ……………………………………………………………

1. Did you change your diet after the operation?

If yes, what did you change? …………………………………………………….
Quality of life

1. How would you rate your quality of life regarding bowel habits after the operation?

Delighted (+3)
(Very satisfied) / Pleased(+2)
(satisfied) / Mostly satisfied (+1) / Mixed (0) / Mostly dissatisfied (-1) / Unhappy (-2) / Terrible (-3)

1. How would you rate your quality of regarding bowel habits before the operation?

Delighted (+3) / Pleased(+2) / Mostly satisfied (+1) / Mixed (0) / Mostly dissatisfied (-1) / Unhappy (-2) / Terrible (-3)
If you have any question about the survey or the urinary diversion please write it down here. We are happy to call you back.