A 65-Year-Old Woman Comes to the Office Due to Intermittent

A 65-year-old woman comes to the office due to intermittent leakage of urine.  For the past 3 months, the patient has had to change her undergarments multiple times a day due to urine leakage.  She voids 4 or 5 times during the day and occasionally wakes up at night to void.  The patient has type 2 diabetes mellitus and was recently diagnosed with chronic obstructive pulmonary disease after evaluation for a chronic cough.  Her only surgeries were 2 cesarean deliveries in her 20s.  BMI is 30 kg/m².  Pelvic examination shows leakage of urine from the urethra during the Valsalva maneuver.  Postvoid residual volume and urinalysis are normal.  Which of the following is the most likely cause of this patient's clinical presentation?

A) Decreased angle of the urethrovesical junction
B) Fistula formation between the bladder and vagina
C) Increased bladder sphincter sympathetic activity
D) Reduced detrusor parasympathetic activity
E) Weakened pelvic floor muscle support

Correct Answer:

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