Review Question - QID 212529

A 49-year-old G4P4 woman comes to the clinic complaining of repeated leakage of fluid from her vagina for the past 5 months. She noticed an increase in episodes following her cold last week when she was coughing and sneezing a lot. Her past medical history is significant for Crohn disease, which is well controlled with sulfasalazine. Her last menstrual period was 1 year ago. She is currently sexually active with multiple partners with inconsistent condom use. She denies any vaginal itching, abnormal discharge, pain, subpubic pressure, urinary urges, or odors. Physical examination is significant for a bulge at the anterior vaginal wall. What is the most likely explanation for this patient’s symptoms?