This systematic review and meta-analysis aimed to evaluate the effectiveness of pelvic floor muscle training (PFMT) on urinary incontinence and pelvic floor muscle strength in postpartum women. Additionally, the study sought to compare the effects of different intervention characteristics, including intervention type (PFMT-only vs. PFMT with adjunctive components), intensity (moderate vs. high), and delivery mode (supervised vs. unsupervised), to identify optimal approaches for improving postpartum pelvic floor outcomes.

A systematic literature search was performed across six electronic databases (ASSIA, CENTRAL, CINAHL, Scopus, PubMed, and Web of Science) using predefined Boolean strategies between March 19 and March 31, 2026, restricted to studies published within the last 10 years. Interventions were classified as PFMT-only or PFMT with adjunctive components and compared with usual care or no intervention. Primary outcomes were urinary incontinence and pelvic floor muscle strength. A total of 19 randomized controlled trials were included following a comprehensive database search and independent screening process. Meta-analyses were conducted using RevMan and JASP software, and heterogeneity and publication bias were assessed using standard statistical methods.

The overall meta-analysis demonstrated a statistically significant effect of the interventions (t(18) = 10.90, p < .001), with a moderate positive pooled effect size (SMD = 0.329; 95% CI: 0.265–0.392). Subgroup analyses showed consistent beneficial effects across all domains. Subgroup analyses demonstrated consistent, statistically significant beneficial effects across all domains. For outcome-based analyses, PFMT showed a moderate effect on urinary incontinence and a small-to-moderate effect on pelvic floor function. Regarding intervention type, both PFMT-only and PFMT with adjunctive components yielded comparable beneficial effects. In terms of intervention intensity, high-intensity programs demonstrated a moderate effect, whereas moderate-intensity interventions showed a smaller effect size. Similarly, delivery mode analyses indicated that both supervised and unsupervised PFMT were effective, with slightly greater effects observed in supervised interventions. Overall, findings were characterized by low heterogeneity and largely consistent results across studies, although some variability and potential small-study effects were observed in selected subgroups.

The findings of this meta-analysis provide robust evidence supporting the effectiveness of PFMT in improving urinary incontinence and pelvic floor muscle function in postpartum women. Both standalone PFMT and PFMT combined with adjunctive interventions were beneficial, with no substantial differences between approaches. Higher-intensity and supervised programs demonstrated slightly greater effectiveness, suggesting that structured and intensive interventions may enhance outcomes. Despite generally low heterogeneity, some subgroup variability and potential small-study effects should be considered when interpreting the results.

PFMT should be recommended as a first-line, evidence-based intervention in postpartum care, with emphasis on optimizing adherence, supervision, and program intensity to maximize clinical benefits.

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