Stress Urinary Incontinence
The most likely diagnosis is stress incontinence (option c). This patient presents with the classic hallmark of stress urinary incontinence: involuntary urine leakage coincident with increased abdominal pressure during activities like jogging, coughing, and sneezing, without urgency symptoms or inability to reach the bathroom in time 1.
Clinical Reasoning
The diagnosis is straightforward based on the symptom pattern:
Leakage occurs specifically with physical exertion (jogging) and increased intra-abdominal pressure (coughing, sneezing), which defines stress urinary incontinence as involuntary urine loss from the urethral meatus coincident with increased abdominal pressure 1
She can make it to the bathroom in time, which excludes urgency incontinence where patients experience a sudden compelling desire to void with inability to delay 2, 3
Small volume leakage is characteristic of stress incontinence, as opposed to the larger volume losses typical of detrusor overactivity 4, 5
Normal post-void residual rules out overflow incontinence, which would show elevated residual volumes indicating incomplete bladder emptying 1
Negative urinalysis excludes infection or other pathology that might cause urgency symptoms 1
Why Not the Other Options
Overflow incontinence (option a) is excluded because:
- Post-void residual is normal (overflow requires excessive residual urine volume) 1
- She has no symptoms of incomplete emptying, straining, or weak stream 1
- The leakage pattern is activity-related, not continuous dribbling 4
Mixed incontinence (option b) is excluded because:
- She reports no urgency symptoms (no sudden compelling desire to void) 2, 3
- She has no frequency or nocturia 1
- The leakage occurs exclusively with physical stress, not preceded by urgency 2, 3
- Mixed incontinence requires both stress and urge components to be present 3, 4
Supporting Clinical Context
Her risk factors align with stress incontinence:
- Vaginal deliveries contribute to pelvic floor weakness and loss of anatomical urethral support 1, 2
- Perimenopausal status (irregular cycles every 3-4 months) suggests declining estrogen, which affects urethral tissue integrity 4, 6
- The gradual progression over one year is typical of stress incontinence development 1, 5
Critical Diagnostic Confirmation
According to the American Urological Association, the definitive diagnosis requires witnessing involuntary urine loss from the urethral meatus coincident with increased abdominal pressure (positive stress test) in a patient who complains of stress incontinence 1. This patient's history provides the clinical diagnosis, though a cough stress test during examination would provide objective confirmation 4, 5.