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To use Health Tracker for Ulcerative Colitis, simply answer the questions on the form below, click Submit, and receive a Health Score.  You may even print or email your information to yourself if you’d like to have it available to look at later.

Note: All fields, except email address, are required.

Question 1
Have you had abdominal pain (stomach aches, cramps, gas pains) in the last 2 days?
None (I did not have any pain) Mild (I had mild pain that I could ignore) Moderate to severe (I had pain that I could not ignore) 

Question 2
Have you had blood in your poops (rectal bleeding) in the last 2 days?
None (I did not have any blood in my poops) I had blood in less than half of my poops, and there was only a small amount of blood I had blood in most of my poops, and there was only a small amount of blood I had a large amount of blood (more blood than poop) in one or more poops 

Question 3
How solid or loose have your poops been in the last 2 days?
My poops have been formed or solid My poops have been partly formed and partly loose My poops have been completely unformed, loose or liquid 

Question 4
In the last 2 days, how many poops have you had each day on average?
I have had 0 to 2 poops each day I have had 3, 4 or 5 poops each day I have had 6, 7 or 8 poops each day I have had more than 8 poops each day 

Question 5
Have you been awakened at night because you had to go to the bathroom to have a poop?
No Yes 

Question 6
In the last 2 days, has Ulcerative Colitis kept you from your regular activities?
No, there have been no limitations. (I have been able to do what I usually do - go to school, play, do after school activities or sports) Yes, there has been some limitation of my activity (I can go to school but I have not been able to play or do after school activities or play sports at least once in the last week) Yes, there have been severe restrictions of my activity (I had to miss school or could not do other important activities) 

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Email Address
Enter only if you want your results emailed to you. Your email address is used only to email your score to you and is not collected.

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