At age 40, Ms. Blair could easily be mistaken for a woman in her late 20s.

At age 40, Ms. Blair could easily be mistaken for a woman in her late 20s. She was fit and thin, a committed long-distance runner, and a mother of two boys. She was also embarrassed to describe her reason for coming to her physician. For several months, each time Ms. Blair finished her run, she felt an uncontrollable urge to urinate. This happened as soon as she stopped running. She would try to suppress the urge, but could not, and would void a small amount of urine while still dressed in her running clothes and before she could enter her home. This did not happen at any other times during the day, or at night—it only occurred the moment that she ended a run. In addition to feeling uneasy about discussing the problem, she was anxious, because she thought she might have a tumor. She had no known health problems, took no medications, did not smoke, ate a healthy diet, and assumed that this problem came “out of the blue” because she must have a serious condition such as a tumor in her urinary tract. A cystourethrogram, or X-ray of the bladder, was obtained, along with urinalysis and urine cultures. Physical examination was normal. The main diagnostic aid was the history, particularly the details about exactly when incontinence occurred. Ms. Blair did not have the incontinence risk factors of being overweight, smoking, or other diseases, but she did have two risk factors: female gender and advancing age. In addition, changes resulting from pregnancy can weaken the sphincter muscle. 1. What type of incontinence did Ms. Blair have? Why? 2. The physician decides on a conservative management strategy for Ms. Blair. Which technique would the physician be most likely to use? A. A pessary B. Pelvic floor muscle exercises C. Botulinum toxin type A (Botox) injections into the bladder muscle D. An implanted sacral nerve stimulator.

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