TOPLINE:

A pelvic floor workout program reduced the incidence of stress urinary incontinence at 6 weeks postpartum compared with usual care, with reduced incidence noted up to a year.

METHODOLOGY:

• Researchers conducted a randomized clinical trial across nine hospitals in China, involving 764 first-time mothers (median age, 29 years) with singleton pregnancies of less than 16 weeks’ gestation from 2020 to 2022.
• Participants were randomly assigned to either an exercise group or a control group:
  • The exercise group (n = 367) practiced a pelvic floor workout under physiotherapist supervision from 28 weeks’ gestation to delivery. The workout consisted of daily pelvic floor muscle training (five moderate contractions held for 6-8 seconds followed by relaxation plus eight sets of five maximum quick contractions and relaxations) and two sessions of global postural exercises per week lasting approximately 30 minutes each; these sessions were delivered via a mobile application with online supervision.
  • The control group (n = 360) received usual medical care consisting of obstetric examinations every 2 weeks from 28 weeks’ gestation to delivery.
• The primary outcome was the incidence of stress urinary incontinence — diagnosed via positive stress test results or self-reported urinary leakage during coughing, sneezing, or physical exercise — at 6 weeks postpartum.
• Secondary outcomes were the incidence of stress urinary incontinence at 37 weeks’ gestation and at 3, 6, and 12 months postpartum and pelvic floor muscle strength measured using the Modified Oxford Scale (MOS) at the same timepoints.

TAKEAWAY:

• At 6 weeks postpartum, the incidence of stress urinary incontinence was lower in the exercise vs control group (8.7% vs 13.9%; P = .03).
• The incidence of urinary incontinence remained lower in the exercise vs control group at 3 months (risk difference [RD], 6.81 percentage points; P = .007), 6 months (RD, 5.76 percentage points; P = .03), and 12 months (RD, 10.47 percentage points; P < .001) postpartum.
• The proportion of women achieving a good-to-strong contraction (an MOS score ≥ 4) at 6 weeks postpartum was significantly higher in the exercise group than in the control group (17.8% vs 7.9%; P < .001).
• Participants with an exercise intensity of 80% or more showed a lower incidence of urinary incontinence than those with an intensity ranging from 50% to less than 80% at 37 weeks’ gestation and at 6 months and 12 months postpartum (P < .05 for all). Only one woman in the exercise group compared with 14 women in the control group reported postpartum hemorrhage.

IN PRACTICE:

“The intensity of PEFLOW [pelvic floor workout] is directly associated with immediate and sustainable improvements in both SUI [stress urinary incontinence] and PFM [pelvic floor muscle] strength, and continuing postpartum PEFLOW appears necessary to achieve the anticipated sustainable improvements in PFM status and to reduce the incidence of SUI in the long term,” the authors of the study wrote.

SOURCE:

The study was led by Lei Gao, MD, of the Department of Obstetrics and Gynecology at Peking University People’s Hospital in Beijing, China. It was published online on April 15, 2026, in JAMA Network Open.

LIMITATIONS:

The inability to blind participants in the control group to the intervention may have introduced potential bias in the control group data. 

DISCLOSURES:

The research received support from grants from the National Key Technology Research and Development Program of China. No relevant conflicts of interest were reported by the authors.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.