A 75-year-old patient comes to the clinic accompanied by her…
A 75-year-old patient comes to the clinic accompanied by her three adult children because of a three-month history of intermittent incontinence episodes occurring both at home and in public. These tend to occur when she rises from a chair, laughs, or sneezes. She denies pain, burning, fevers, or chills. Medical history is significant for diabetes, hypertension, mild obesity (BMI of 32), arthritis in her hips and knees, constipation, and a remote history of breast cancer treated with lumpectomy and radiation. Medications are lisinopril, insulin, and ibuprofen. Temperature, pulse, and respiratory rate are all normal. Her blood pressure is 139/86. Weight is 100 kg (220 lbs). Height is 175 cm (5 ft 9 in). Body mass index is 32 kg/m2. Physical examination shows a well-groomed female who appears younger than stated age and in no acute distress. Normal cardiac and lung exam. Abdomen soft, non-distended, and with mild suprapubic tenderness. Pelvic exam deferred at this time. Neurologically intact. Laboratory and diagnostic studies have not been completed yet. What is the most likely cause of this patient’s incontinence?