Which physical exam finding is typical of stress urinary incontinence?

• A. Urethral hypermobility
• B. Pelvic organ prolapse
• C. Urethral obstruction
• D. Post-void residual

Answer: (A)

Stress incontinence occurs when increased abdominal pressure causes leakage because the pelvic floor and the urethral support are weakened. The key exam feature is urethral hypermobility: the urethra and bladder neck move more than normal during Valsalva or coughing, reflecting loss of pelvic support. A practical way to assess this is the Q-tip (cotton swab) test, where a notable angle change or elevation of the urethral axis with strain indicates hypermobility. This finding explains why urine leaks with sneezing or coughing, even with a relatively preserved detrusor function.

By contrast, urethral obstruction and a large post-void residual point to retention or overflow issues rather than stress incontinence, and pelvic organ prolapse can coexist but is not the defining exam sign for stress incontinence.