A STRUCTURED pelvic floor muscle training programme performed during pregnancy significantly reduces the risk of postpartum stress urinary incontinence (SUI), according to a large multicentre randomised clinical trial.
The study evaluated the effectiveness of a novel intervention, the pelvic floor workout (PEFLOW), designed to integrate pelvic floor training with global postural and core stability exercises. A total of 764 primiparous women aged 20–40 years with singleton pregnancies were enrolled across nine hospitals in China and randomly assigned to either the intervention or usual care.
Participants in the intervention group undertook supervised PEFLOW training from 28 weeks’ gestation until delivery, with guidance provided every two weeks. The control group received standard antenatal care without structured exercise input. Women were followed through late pregnancy and up to 12 months postpartum, with the primary endpoint being incidence of SUI at 6 weeks postpartum.
Findings
At the primary timepoint, the incidence of SUI was significantly lower in the PEFLOW group compared with controls (8.7% vs 13.9%; risk difference 5.17 percentage points; P=0.03). In addition, pelvic floor muscle strength, assessed using the Modified Oxford Scale, was improved in the intervention group, with a higher proportion achieving scores of ≥4 (17.8% vs 7.9%; P<0.001).
The authors emphasise that PEFLOW differs from conventional pelvic floor muscle training by incorporating whole-body elements, including core strength, pelvic stability, and postural control. This broader approach reflects the multifactorial nature of pelvic floor dysfunction and may explain the observed benefits.
Importantly, the findings suggest that antenatal pelvic floor interventions can play a preventive role, rather than solely serving as treatment after symptom onset. Given the burden of postpartum SUI on quality of life, early intervention during pregnancy may represent a practical and scalable strategy in routine obstetric care.
The researchers conclude that PEFLOW is an effective, non-invasive intervention for reducing early postpartum SUI in primiparous women. Further research will be needed to assess long-term outcomes and implementation in diverse populations, but the results provide strong evidence supporting structured antenatal pelvic floor training as part of standard maternal care.
Reference
Gao L et al. Pelvic Floor Workout for Preventing Stress Urinary Incontinence in Primiparous Women: A Randomized Clinical Trial. JAMA Netw Open. 2026; 9;(4):e267132.
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