Which of the following is an established risk factor for a patient presenting with a vaginal bulge and urinary incontinence?

A BMI of 32 kg/m² is considered to be in the obese range, which is an established risk factor for various pelvic floor disorders, including pelvic organ prolapse and urinary incontinence. In women, increased body weight can lead to increased intra-abdominal pressure, which can contribute to weakening of the pelvic support structures. This, in turn, can cause symptoms such as a vaginal bulge and urinary incontinence.

While cigarette smoking, diabetes mellitus, and unopposed oral estrogen may have associations with pelvic health issues, the direct link between obesity and the mechanical stress it places on the pelvic floor makes a high BMI a more established risk factor for these conditions. Therefore, the presence of obesity serves as a critical contributing factor when evaluating patients with pelvic floor symptoms.