A 42-year-old woman presents to the gynecology clinic with complaints of involuntary urine leakage over the past year. She notices leakage when she coughs, sneezes, laughs, or engages in physical activities such as jogging. She denies any urinary urgency, frequency, nocturia, or pain. The condition has started affecting her confidence, leading to avoidance of social gatherings and exercise. The patient has a history of three vaginal deliveries, with no significant complications. She is otherwise healthy, with no history of urinary tract infections or pelvic surgery. Her weight is 85 kg, with a BMI of 30. Pelvic Exam reveals mild anterior vaginal wall laxity but no significant pelvic organ prolapse. Urine leakage is observed during a cough with a moderately full bladder. Post-Void Residual (PVR) is measured via ultrasound and is within normal limits. What is the primary cause of this patient’s incontinence?
