Digital pelvic floor muscle training (PFMT) interventions are increasingly used to support prevention and management of pelvic floor dysfunction (PFD). To our knowledge, this is the first mixed-methods systematic review integrating effectiveness and factors influencing adherence to digital PFMT interventions. This review aimed to evaluate the effectiveness of digital PFMT for preventing and treating PFD during pregnancy and the first postpartum year, identify barriers and facilitators to PFMT adherence, and integrate quantitative and qualitative evidence using behaviour change theory to interpret behavioural mechanisms.

A mixed methods systematic review was conducted according to PRISMA guidelines, using the Joanna Briggs Institute convergent segregated approach (1). PubMed, CINAHL, and Scopus were searched from database inception to March 2025, and updated in January 2026. Eligible studies included quantitative, qualitative, and mixed methods studies evaluating digital PFMT interventions delivered during pregnancy or the first postpartum year. Two reviewers independently screened studies, extracted data, and assessed methodological quality using the Mixed Methods Appraisal Tool (2). The primary outcome was PFD symptom severity, including urinary and anal incontinence, pelvic organ prolapse symptoms, sexual dysfunction and perineal pain. Secondary outcomes included pelvic floor muscle (PFM) function, adherence, self-efficacy, quality of life, and knowledge. Quantitative data were synthesised using meta-analysis where appropriate and narrative synthesis otherwise. Qualitative data were synthesised using meta-aggregation. Findings were integrated using the Capability Opportunity Motivation Behaviour (COM-B) model (3).

Eighteen studies involving 4,916 participants were included. Digital PFMT reduced urinary incontinence during pregnancy, while postpartum effects were inconsistent. Improvements were observed in PFM function, adherence, and knowledge, whereas effects on self-efficacy and quality of life were mixed. Meta-aggregation generated five synthesized findings related to adherence, including knowledge and confidence, emotional and contextual demands, healthcare communication, sociocultural influences, and program usability. Integration using the COM-B model indicated that digital PFMT primarily targeted capability and opportunity, consistent with women’s accounts highlighting the importance of these dimensions for adherence. Although motivation emerged qualitatively as an important determinant of adherence, it was not directly measured in trials.

These findings indicate that digital PFMT effectiveness may not solely be determined by access to exercises alone, but arise through interactions with behavioural factors spanning individual, relational, and system levels. Accounting for the unique contextual demands experienced during pregnancy and the first year postpartum when developing digital PFMT interventions may help improve both effectiveness and adherence.

Digital PFMT interventions during pregnancy and the first year postpartum may support pelvic floor health when capability, opportunity, and motivation are addressed, although findings are inconsistent. This review highlights the need for future studies to consider behavioural mechanisms underpinning adherence when developing PFMT interventions.

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Continence 19S (2026) 102813
DOI: 10.1016/j.cont.2026.102813