Effects of Pelvic Floor Muscle Training in Pregnant and Postpartum Women: A Systematic Review

Pelvic floor disorders are common in pregnancy and after childbirth. Pelvic floor muscle training (PFMT) is first-line conservative care, but the added value of feedback and the effect of timing (pregnancy vs postpartum) remain unclear. This systematic review evaluated PFMT with and without feedback in pregnant and postpartum women.

Ovid MEDLINE, Ovid Embase, and the Cochrane Library were searched for studies published between January 2005 and December 2025. Trials enrolling pregnant or postpartum women and comparing PFMT (with or without feedback) with usual care or no intervention were included. Two reviewers independently assessed eligibility and risk of bias using the RoB 2 tool. The primary outcome was PFM strength. Meta-analysis was performed using standardized mean differences (SMD).

Twenty-six trials were included. PFMT improved PFM strength (SMD 1.39, 95% confidence interval [CI] 0.74 to 2.05; I² 95%). Effects were significant in pregnancy (SMD 1.10, 95% CI 0.28 to 1.93; I² 92%) and postpartum (SMD 1.74, 95% CI 0.71 to 2.76; I² 96%), with larger gains postpartum. Evidence for improvements in urinary severity and symptoms, quality of life, sexual function and pelvic organ prolapse severity was less consistent, and interventions incorporating feedback tended to show more reliable benefits than PFMT without feedback.

Pelvic floor muscle training improves PFM strength and may reduce urinary symptoms during pregnancy and postpartum. Feedback enhances training accuracy and adherence, supporting structured implementation rather than superior physiological effects.