How important is the timing and duration of pelvic floor muscle training for preventing postpartum urinary incontinence? a meta-analysis

Abstract

Background

Postpartum urinary incontinence (PUI) is a common condition that significantly impairs the quality of life for women who have given birth. This meta-analysis aimed to systematically evaluate how the timing and duration of pelvic floor muscle training (PFMT) influence the prevention of PUI.

Methods

To identify relevant studies examining the role of PFMT in preventing PUI, a thorough literature search was conducted across multiple databases up to February 20, 2025. These databases included PubMed, Embase, Web of Science, ClinicalTrials.gov, OVID, Cochrane Library, Wanfang, CNKI, and Weipu. The search aimed to locate randomized controlled trials (RCTs) that specifically assessed PFMT’s impact on PUI prevention. The meta-analysis was subsequently performed using RevMan 5.4 software to synthesize and analyze the collected data.

Results

The meta-analysis included 11 RCTs that collectively involved 2778 parturient women, of whom 1495 received PFMT interventions. The pooled results demonstrated that PFMT significantly reduced the incidence of PUI (p < 0.001). Subgroup analyses revealed that PFMT significantly decreased the risk of urinary incontinence at both 3 months (p < 0.001) and 6 months postpartum (p < 0.001). However, PFMT did not significantly affect urinary incontinence immediately after childbirth (p = 0.69). No significant differences were observed in the improvement of urinary incontinence when comparing the initiation of PFMT during mid-to-late pregnancy versus postpartum or when considering PFMT durations of 3 months or less versus more than 3 months (all p > 0.05).

Conclusion

PFMT implemented during pregnancy and the postpartum period effectively reduces the incidence of PUI. Significant benefits of PFMT have been observed at both 3 and 6 months postpartum, indicating its efficacy across different time frames. However, given the limitations in the quality and sample sizes of the included RCTs, further investigation with large-scale, high-quality studies is warranted to more comprehensively elucidate the role of PFMT in managing PUI.

Introduction

The International Continence Society (ICS) defines urinary incontinence as the involuntary leakage of urine reported by the patient [1]. The prevalence of urinary incontinence among adult females ranges from 25 to 45% [2]. This high prevalence significantly impairs the quality of life. The etiology of urinary incontinence is multifactorial, with pregnancy and childbirth being major risk factors. The epidemiology of postpartum urinary incontinence indicates that it is a common condition affecting women after childbirth [3]. Systematic reviews and meta-analyses conducted to assess the prevalence and incidence of urinary incontinence in postpartum women find that the mean prevalence of postpartum urinary incontinence is 31.0% [4, 5]. This prevalence initially decreases at 3 months postpartum but increases again to nearly the same level as in the third trimester of pregnancy at 1 year postpartum (32%) [6]. These findings underscore the substantial impact of postpartum urinary incontinence on women’s health and highlight the necessity for effective interventions.

The physiological urinary continence mechanism in females relies on a well-functioning active continence mechanism, anatomical support, and the urethral mucosal closure mechanism [7]. The active continence mechanism is accomplished through the voluntary contraction of the urethral sphincter and smooth muscles; anatomical support is provided by the pelvic fascia, pubic ligaments, pelvic floor muscles, and the urogenital diaphragm [8, 9]. Any factor that damages the urinary continence mechanism can lead to the occurrence of urinary incontinence. Elevated hormone levels post-pregnancy act on the collagen components between pelvic floor tissues, causing degeneration and thereby impairing the urinary continence mechanism; the enlarged uterus can cause pelvic floor muscle damage, leading to urinary incontinence [10]. Vaginal delivery results in damage to the urethral support structures, weakening the contraction strength of the pelvic floor muscles, causing relaxation of the pelvic floor and peri-urethral muscles, and reducing the supportive effect of the pelvic floor muscles on the urethra, which is also one of the pathogenic mechanisms of postpartum urinary incontinence [11].

With the increasing attention paid to women’s quality of life by society, the issue of urinary incontinence has also gained growing recognition and has become one of the significant risk factors affecting women’s health [12]. Pelvic floor muscle training (PFMT) has been widely proven to be an effective method for the prevention or treatment of urinary incontinence, and numerous specific training guidelines are available for reference [13]. However, there is currently no consensus on the optimal timing for initiating PFMT interventions and the duration of the training. Previous studies have consistently demonstrated that conducting PFMT during pregnancy or postpartum can effectively prevent postpartum urinary incontinence. Although these studies have confirmed the effectiveness of PFMT in preventing postpartum urinary incontinence, specific recommendations regarding the timing of intervention and the duration of training have not been clearly established. Therefore, this study aimed to evaluate the effects of PFMT in preventing or treating urinary incontinence during pregnancy and postpartum, to compare the differences in effects among various intervention start times and training durations, with the goal of providing a scientific reference for the management of postpartum urinary incontinence.

Methods

This meta-analysis was conducted in comply with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement [14]. Clinical trial number: not applicable.

Eligibility criteria

The inclusion criteria for this study were structured in accordance with the PICOS (Population, Intervention, Comparison, Outcome, Study design) framework to enhance clarity and precision. Specifically, the Population of interest comprised pregnant or postpartum women. The Intervention under investigation was PFMT, while the Comparison group consisted of participants receiving no PFMT intervention. The primary Outcome measure was the incidence of postpartum urinary incontinence. Finally, the Study design was restricted to RCTs to ensure methodological rigor. Additionally, a study must have a minimum sample size of 20 participants to ensure adequate statistical power and meaningful results. Studies with smaller sample sizes were excluded due to the potential for higher variability and less reliable outcomes. This criterion was established to maintain the robustness and validity of our meta-analysis. Studies were excluded if the full text or relevant data could not be obtained despite multiple attempts to contact the corresponding authors.

Search strategy

We searched PubMed, Embase, Web of Science, Clinical trials, OVID, Cochrane Library, Wangfang, CNKI, Weipu databases for randomized controlled trials (RCTs) on the role of PFMT in preventing postpartum urinary incontinence. The search was conducted from the inception of the database to February 20, 2025. The search strategies were as following: (OR “antenatal” OR “pregnancy” OR “postpartum” OR “postnatal” OR “post obstetric” AND (“pelvic floor muscle training” OR “PFMT” OR “pelvic floor muscle exercises” OR “pelvic training”) AND (“urinary incontinence”).

Selection and data collection of studies

Literature screening, quality assessment, and data extraction were independently conducted by two reviewers. In the event of discrepancies in their opinions, the reviewers engaged in thorough discussions to reach a consensus. If consensus could not be achieved after discussion, a third researcher was consulted to ensure the objectivity and accuracy of the evaluation results.

Assessment of the methodological quality of studies

In accordance with the quality assessment criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions [15], this study evaluated the quality of RCT. The assessment encompassed several key aspects: the proper generation of random sequences, the implementation of allocation concealment, blinding of participants and personnel, blinding of outcome assessors, completeness of outcome data, selective reporting, and the presence of other potential biases. Each assessment item was categorized into one of three risk levels: low, unclear, or high. The quality evaluation of the literature was independently conducted by two researchers. In the event of disagreements, a third researcher was consulted to reach a consensus on the final evaluation results.

Data analysis

This study employed RevMan 5.4 software for conducting the meta-analysis. Given that the study outcomes were dichotomous variables, the relative risk (RR) was selected as the measure of effect size. The I² statistic was utilized to assess the degree of statistical heterogeneity. When I² was ≤ 50%, heterogeneity was deemed acceptable, and a fixed-effects model was applied for analysis. Conversely, if I² exceeded 50%, a random-effects model was adopted to account for the influence of heterogeneity. To minimize clinical heterogeneity, subgroup analyses were conducted based on the initiation time of the intervention and the duration of training. The objective was to compare the effects of pelvic floor muscle training and routine postpartum care on reducing the incidence of urinary incontinence immediately postpartum, at 3 months postpartum, and at 6 months postpartum. Additionally, publication bias was evaluated using funnel plots and Egger regression analysis. The stability and robustness of the results were assessed by sequentially excluding individual RCTs and observing the changes in the pooled effect sizes. A P-value of less than 0.05 was set as the criterion for statistical significance.

Results

Screening findings

In this study, a total of 2274 relevant articles were initially identified. After removing duplicates, 2265 articles remained. Subsequently, 2217 articles were excluded based on a review of their titles and abstracts, as they did not align with the research topic and objectives. Of the remaining articles, 37 were further excluded after full-text review due to factors such as study design, data completeness, and sample size not meeting the inclusion criteria. Ultimately, adhering strictly to the inclusion and exclusion criteria, 11 RCTs [16–26] were included in this study (Fig. 1).

Fig. 1.

PRISMA flow diagram of study selection

Characteristics of studies and participants

This study included a total of 11 RCTs, encompassing 2778 parturient women. Among them, 1495 women received PFMT interventions, while 1383 received routine care. Regarding the characteristics of the study subjects, 10 RCTs involved primiparous women, and 1 RCT did not specify the parity of the participants. In terms of the timing of intervention initiation, 4 RCTs commenced PFMT during the mid-to-late stages of pregnancy, and the remaining 7 RCTs initiated training postpartum. With regard to the duration of training, 7 RCTs had a training period of no more than 3 months, whereas the other 4 RCTs had a training duration exceeding 3 months (Table 1).

Table 1.

The characteristics of included 11 RCTs

RCT	Sample size		Country	Intervention		Start time of intervention	Duration of intervention	Assessment methods of urinary incontinence
	PFMT group	Control group		PFMT group	Control group
Chiarelli 2002 [16]	370	350		The intervention involves performing the action three times per day, with each contraction being sustained for a duration of 3–6 s	Routine postpartum care	Within 48 h postpartum	3 months	ICS criteria
Geng 2022 [17]	109	55		The postpartum participant assumes a supine position with legs apart and abdominal muscles relaxed. After maintaining a state of calm for 1 min, the participant commences the exercise by contracting the vaginal and anal muscles. During this process, the participant inhales slowly while sustaining the contraction of the pelvic floor muscles for 3–5 s. Subsequently, the pelvic floor muscles are relaxed for 2–6 s. A set consists of 10–15 repetitions, and the training regimen involves 3–8 sets per day, with a frequency of at least 5 sessions per week	Routine postpartum care	7 days postpartum	6 months	ICS criteria
Hilde 2013 [18]	87	88		The exercise protocol entails conducting two sessions per day, with a total weekly training duration of 45 min. Each session consists of 8 to 12 maximal contractions, sustained for a duration of 6–8 s	Routine postpartum care	6–8 weeks postpartum	4 months	ICIQ-UI short form
Ko 2011 [19]	150	150		The prescribed exercise regimen consists of two sessions per day, with each session comprising three sets. In each set, eight contractions are performed, sustained for 6 s each. A 2-min interval is maintained between sets. After the 34th week of gestation, the exercise protocol is modified to include 12 contractions per set	Routine postpartum care	16 ~ 20 weeks of gestation	3 months	ICS criteria
Luo 2022 [20]	100	100		Participants are instructed to contract the perineal muscles for no less than 3 s, followed by a period of relaxation. This sequence is then repeated twice. Subsequently, rapid contractions of the perineal muscles are performed five times	Routine postpartum care	6 weeks postpartum	8 weeks	UDI-6
Mason 2010 [21]	145	141		Two times per day, with 8–12 maximal contractions each time	Routine postpartum care	20 weeks of gestation	8 months	BFLUTS
Qiu 2010 [22]	182	173		The exercise protocol involves performing the activity three times daily. Each contraction is maintained for a duration of 5–8 s, followed by relaxation during exhalation. This cycle is continuously executed for a period of 15–30 min	Routine postpartum care	6 weeks postpartum	6 ~ 8 weeks	ICS criteria
Reilly 2014 [23]	139	129		Perform the exercise twice daily, with each session consisting of 3 sets. Each set includes 8 contractions, sustained for 6 s, with a 2-min interval between sets. After the 34th week of pregnancy, modify the exercise to 12 contractions per set	Routine postpartum care	20 weeks of gestation	5 weeks	ICS criteria
Sigurdardottir 2020 [24]	41	43		The prescribed exercise protocol consists of three daily sessions. Each session involves performing 10 maximal contractions, with each contraction being sustained for 7 s. A 10-s rest interval is maintained between every two contractions	Routine postpartum care	Nine weeks postpartum	3 months	Australian pelvic floor questionnaire
Yang 2008 [25]	90	72		The exercise is performed three times a day. Each contraction is sustained for 5–10 s, followed by a 10-s relaxation period. This sequence is continuously carried out for 15–30 min	Routine postpartum care	The first day postpartum	10 weeks	1-h pad test
Yao 2013 [26]	82	82		The exercise regimen involves two daily sessions. Each session begins with a sustained contraction for no less than 3 s, followed by relaxation. Subsequently, three or four rapid contractions are performed, succeeded by a 6-s relaxation period. This cycle is then repeated continuously for a total duration of 20 min	Routine postpartum care	Two weeks postpartum	8 ~ 12 weeks	ICS criteria

RCT randomized controlled trial, PFMT pelvic floor muscle training, ICS International Continence Society, ICIQ-UI SF International Consultation on Incontinence Questionnaire-urinary incontinence short form, UDI Urogenital Distress Inventory, BFLUTS Bristol Female lower urinary tract symptoms

Quality assessment findings of studies

As shown in Figs. 2 and 3, among the 11 RCTs included in this study, 9 employed scientifically sound randomization methods, while the remaining 2 did not explicitly report the specific methods used for generating random sequences. Due to the inherent characteristics of the intervention protocols in this study, it was practically challenging to implement blinding among the participants, hence blinding was not conducted. Regarding allocation concealment, 2 RCTs provided detailed descriptions of their specific methods for allocation concealment, thereby ensuring the rigor of the study. Furthermore, 7 RCTs appropriately and reasonably managed the handling of lost-to-follow-up data. Upon assessment, no other potential sources of bias that could affect the study outcomes were identified.

Fig. 2.

Risk of bias graph

Fig. 3.

Risk of bias summary

Meta-analysis findings

As shown in Fig. 4, meta-analysis indicated that PFMT was effective to reduce the postpartum urinary incontinence (RR = 0.63, 95% CI 0.53 ~ 0.76, p < 0.001). Subgroup analysis showed that PFMT was effective to reduce urinary incontinence at 3 months postpartum (RR = 0.55, 95% CI 0.39 ~ 0.77, p < 0.001) and 6 months postpartum (RR = 0.62, 95% CI 0.50 ~ 0.76, p < 0.001). PFMT had no effects on the urinary incontinence immediately after giving birth (RR = 1.10, 95% CI 0.69 ~ 1.75, p = 0.69).

Fig. 4.

Forest plot for the incidence of continence

As shown in Table 2, the analysis was stratified into two subgroups based on the timing of intervention initiation: mid-to-late pregnancy and postpartum. The results indicated that PFMT conducted during mid-to-late pregnancy [RR = 0.69, 95% CI 0.51 ~ 0.94), P = 0.02] and postpartum [RR = 0.72, 95% CI 0.58 ~ 0.95), P = 0.01] both significantly reduced the incidence of urinary incontinence at 3 months postpartum. Besides, PFMT conducted during mid-to-late pregnancy was associated with a reduced incidence of urinary incontinence at 6 months postpartum [RR = 0.60,95% CI 0.38 ~ 0.92, p = 0.02]. Similarly, PFMT initiated postpartum also demonstrated a significant reduction in the incidence of urinary incontinence at the same time point [RR = 0.68, 95% CI 0.33 ~ 0.95, P = 0.01]. Subgroup analyses were conducted based on the duration of PFMT, categorizing the studies into two groups: those with a training duration of ≤ 3 months and those with a duration of > 3 months. The findings revealed that PFMT with a duration of ≤ 3 months was associated with a reduced incidence of urinary incontinence at 3 months postpartum [RR = 0.72, 95% CI 0.56 ~ 0.97, p = 0.04]. Similarly, PFMT lasting > 3 months also demonstrated a significant reduction in the incidence of urinary incontinence at the same time point [RR = 0.69, 95% CI 0.51 ~ 0.94, p = 0.02]. Besides, PFMT with a duration of ≤ 3 months was associated with a lower incidence of urinary incontinence at 6 months postpartum [RR = 0.55, 95% CI 0.40 ~ 0.74, p = 0.01]. Similarly, PFMT lasting > 3 months also significantly reduced the incidence of urinary incontinence at this time point [RR = 0.77, 95% CI 0.45 ~ 0.91, p = 0.08].

Table 2.

Subgroup meta-analysis of the impact of different initiation times and durations of pelvic floor muscle training on the prevention of postpartum urinary incontinence

Timepoint for urinary incontinence assessment	PFMT intervention		Number of included RCTs	Heterogeneity (I2)	Model for meta-analysis	RR	95% CI	p
3 months postpartum	Start time of PFMT	Mid-to-late pregnancy	2	14.6%	Fixed	0.69	0.51 ~ 0.94	0.02
		Postpartum	3	5.9%	Fixed	0.72	0.58 ~ 0.95	0.01
	Duration of PFMT	≤ 3 months	3	11.5%	Fixed	0.72	0.56 ~ 0.97	0.04
		> 3 months	2	2.2%	Fixed	0.69	0.51 ~ 0.94	0.02
6 months postpartum	Start time of PFMT	Mid-to-late pregnancy	1	20.3%	Fixed	0.60	0.38 ~ 0.92	0.02
		Postpartum	5	1.6%	Fixed	0.68	0.33 ~ 0.95	0.01
	Duration of PFMT	≤ 3 months	3	18.4%	Fixed	0.55	0.40 ~ 0.74	0.01
		> 3 months	3	25.0%	Fixed	0.77	0.45 ~ 0.91	0.08

PFMT pelvic floor muscle training, RR risk ratio, CI confidence interval

A sensitivity analysis was performed by iteratively removing individual studies from the dataset. The results indicated that there were no substantial alterations in the analysis of various outcome measures, suggesting that the findings of this meta-analysis exhibit a degree of robustness and stability.

As depicted in Fig. 5, the points within the funnel plots were uniformly situated within the confines of the inverted funnel shape, indicating symmetry. The outcomes of Egger’s regression test provided evidence against the presence of publication bias, as all P-values were greater than 0.05, thereby supporting the validity and reliability of the meta-analytic results.

Fig. 5.

Funnel plot for the incidence of continence

Discussion

PFMT involves the conscious, autonomous contraction exercises of the pelvic floor muscle groups, primarily the pubococcygeus muscles, by patients to enhance urethral resistance and thereby strengthen urinary control [27, 28]. Pelvic floor muscle exercises can lead to changes in pelvic floor nerves (such as an increase in effective motor units and excitation frequency), strengthen muscle contraction force and tension, provide structural support for the bladder and urethra, and enhance the strength of the urethral sphincter [29]. The results of this study indicate that implementing PFMT during mid-to-late pregnancy or postpartum can effectively reduce the incidence of urinary incontinence in postpartum women at 3 and 6 months postpartum. However, the observed lack of significant differences in the timing of PFMT initiation suggests that its effectiveness may not be critically dependent on whether it begins during mid-to-late pregnancy or postpartum. This finding may be attributed to the complex recovery process of the pelvic floor muscles following childbirth, which is influenced by factors such as hormonal changes, tissue trauma, and individual healing rates. The inherent delayed recovery and adaptive capacity of these muscles could overshadow the impact of specific timing, leading to similar benefits regardless of when PFMT starts. Additionally, consistent patient compliance with the training protocol may be a more critical factor than the timing of initiation. Future research should focus on elucidating the underlying mechanisms of pelvic floor recovery and optimizing PFMT protocols to provide more tailored recommendations for postpartum women.

PFMT serves as a conservative treatment approach for urinary incontinence and is particularly suitable for patients with mild to moderate incontinence. Variations in the severity of urinary incontinence at the onset of intervention may influence the efficacy of PFMT. Although guidelines have been established to recommend specific PFMT methods, heterogeneity in PFMT protocols persists across the studies included in this analysis. Previous research [30] has compared the effects of PFMT with different single-session durations, training frequencies, and training durations on the treatment of female urinary incontinence. The findings indicated that a regimen of 45-min sessions conducted 7 days per week yielded superior outcomes. However, no statistically significant differences were observed in the intervention effects across varying training durations. This suggests that inconsistencies in PFMT intensity may interfere with the intervention outcomes for postpartum urinary incontinence. The inconsistencies in the severity of urinary incontinence among the baseline populations of the studies, as well as the variations in PFMT intensity, may be the key factors contributing to the lack of statistical significance in the improvement of postpartum urinary incontinence incidence rates when PFMT is initiated during mid-to-late pregnancy or postpartum [31].

Although initiating PFMT during pregnancy or postpartum does not yield statistically significant differences in the improvement of postpartum urinary incontinence, research findings suggest that conducting group-based PFMT for all women during pregnancy offers greater health economic benefits compared to commencing training only after the onset of urinary incontinence postpartum [32, 33]. Furthermore, PFMT initiated during pregnancy not only ameliorates urinary incontinence in the late stages of pregnancy but also has the added benefit of shortening the first and second stages of labor for nulliparous women [34]. Therefore, it is recommended that PFMT be initiated during mid-to-late pregnancy to fully leverage its potential advantages in preventing and improving postpartum urinary incontinence.

The results of this study indicate that there is no statistically significant difference in the incidence of urinary incontinence at 3 and 6 months postpartum when using a 3-month duration of PFMT as a threshold. While relevant guidelines generally recommend that patients with urinary incontinence undergo PFMT for at least 3 months to treat the condition, these guidelines primarily target women with urinary incontinence, including middle-aged and elderly females [35]. This study, however, focuses on postpartum urinary incontinence, with the study population consisting of women in their childbearing years. This group has relatively better pelvic floor muscle strength compared to middle-aged and elderly women, thus requiring a shorter recovery time for their pelvic floor muscles [36]. Nevertheless, a training period that is too short may not effectively enhance the strength of the pelvic floor muscles. In the literature included in this study, all studies had a PFMT duration of over 6 weeks. Furthermore, to enhance the effectiveness of PFMT, various auxiliary methods can be employed, such as utilizing remote supervision applications and group course training [37].

Limitations

In interpreting the results of this study, it is important to consider several limitations inherent in our methodology. Firstly, our study was not registered in PROSPERO due to oversight at the initial planning stage. While PROSPERO registration is a valuable mechanism for ensuring transparency and reducing the risk of bias in systematic reviews and meta-analyses, our study bypassed this step. This omission may affect the comprehensiveness and pre-specified nature of our review process. Future research should prioritize PROSPERO registration to enhance the credibility and reproducibility of meta-analytic studies in this field. Secondly, our search strategy was confined to Chinese and English language publications. This decision was primarily driven by the need to ensure the accessibility and comprehensibility of the sources for our research team, as well as the broader audience of our study. However, we recognize that this approach may have inadvertently resulted in an incomplete collection of relevant studies. By restricting our search to these two languages, there is a possibility that valuable research published in other languages was not included in our analysis. Thirdly, we observed notable heterogeneity within certain subgroups, particularly in the analysis of intervention timings and durations for postpartum urinary incontinence. This heterogeneity suggests variability in the effectiveness of interventions across different study populations and settings. While our current analysis provides valuable insights, the presence of subgroup heterogeneity underscores the need for further investigation to elucidate the optimal intervention strategies. Future research should conduct more high-quality, multicenter, large-sample RCTs to directly compare the effects of different intervention timings and durations on postpartum urinary incontinence outcomes, thereby better guiding clinical applications.

Conclusions

In summary, we have found that PFMT initiated during the mid-to-late stages of pregnancy or postpartum effectively reduces urinary incontinence among postpartum women at 3 and 6 months. However, no significant differences are observed in outcomes based on the timing of PFMT initiation or durations exceeding 3 months. These findings suggest that while PFMT is beneficial, further research is needed to determine the optimal timing and duration of interventions. Given these results, we recommend initiating PFMT with flexibility in timing to accommodate individual needs, but emphasize a minimum duration of over 6 weeks to ensure adequate muscle adaptation and sustained benefits. Additionally, integrating PFMT with digital tools—such as mobile applications providing structured plans, reminders, and feedback—may enhance adherence and long-term effectiveness. Future research should explore these aspects further to develop more targeted and effective interventions for improving postpartum health outcomes.

Clinical guidelines should be updated to provide clear recommendations on the optimal timing, duration, and protocols for PFMT. This will help healthcare providers offer evidence-based interventions to postpartum women. Public health campaigns should also be developed to raise awareness about the benefits of PFMT for postpartum urinary incontinence, encouraging women to engage in pelvic floor exercises as part of their routine postpartum care. Policymakers should consider incorporating PFMT into postpartum care policies and insurance coverage to ensure that women have access to these beneficial interventions without financial barriers. Given the observed heterogeneity and the lack of definitive conclusions regarding the optimal timing and duration of PFMT, future research should prioritize the conduct of standardized, large-scale, high-quality RCTs. Such studies should aim to clarify the optimal timing of PFMT, determine the ideal duration, and standardize PFMT protocols to ensure consistency across studies and clinical practice. This includes defining the frequency, intensity, and type of exercises involved. By addressing these gaps, future studies may provide clearer guidance for clinical practice and policy development, ultimately improving the health outcomes for postpartum women.

Abbreviations

PFMT

Pelvic floor muscle training

RCTs

Randomized controlled trials

PRISMA

Preferred Reporting Items for Systematic reviews and Meta-Analyses

RR

Relative risk

CI

Confidence interval

Author contributions

Y W, Y Z designed research; Y W, Y Z, H Y, R Z conducted research; H Y, R Z analyzed data; H Y, R Z wrote the first draft of the manuscript; Y W, Y Z had primary responsibility for final content. All authors read and approved the final manuscript. All authors contributed to the conception or design of the study or to the acquisition, analysis, or interpretation of the data. All authors drafted the manuscript, or critically revised the manuscript, and gave final approval of the version that was submitted for publication. All authors agree to be accountable for all aspects of the work, ensuring integrity and accuracy.

Funding

This study was funded by the Fujian Provincial Natural Science Foundation of China (2024J011047) and the Fujian provincial health technology project (2024TG013) and the Science and Technology Innovation Start-up Fund of Fujian Maternity and Child Health Hospital (YCXM 20–44).

Data availability

The data associated with the paper are not publicly available but are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

Ethics approval and consent to participate are not necessary since our study is a meta-analysis.

Consent for publication

Not applicable.

Conflict of interest

The authors declare no competing interests.