Effects of various exercise interventions for postpartum stress urinary incontinence: a systematic review and network meta-analysis

Background Exercise therapy is the first-line treatment for postpartum stress urinary incontinence (PSUI); however, the optimal regimen remains unclear. Objective This study aimed to compare the effects of different exercise modalities on urinary leakage volume, quality of life, and pelvic floor muscle strength in PSUI patients using a network meta-analysis (NMA). Methods Chinese and English databases were searched for randomized controlled trials (RCTs) from inception to September 2025. Two researchers independently screened studies, extracted data, and assessed the risk of bias. A network meta-analysis was performed using Stata 16.0, with treatment effects ranked by the surface under the cumulative ranking curve (SUCRA). The interventions reviewed included pelvic floor muscle training (PFMT) alone or combined with biofeedback, electrical stimulation, or vaginal weights, as well as aerobic exercise and traditional exercises. Treatment effects were expressed as standardized mean differences (SMDs) or odds ratios (ORs) with 95% confidence intervals (CIs). Results A total of 49 RCTs involving 5,432 patients were included. SUCRA ranking indicated that PFMT combined with vaginal weights yielded the highest efficacy in reducing objective urinary leakage (1-h pad test, 92.1%; SMD vs. conventional care = 4.10, 95% CI: 0.29 to 7.92). For improving the quality of life, as measured by the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), PFMT combined with biofeedback and electrical stimulation (SMD = −4.41, 95% CI: −8.31 to −0.52) and aerobic exercise demonstrated superiority. For enhancing pelvic floor muscle strength, PFMT combined with vaginal weights (OR = 3.97, 95% CI: 2.15 to 5.79) and PFMT combined with biofeedback and electrical stimulation (OR = 4.07, 95% CI: 2.14 to 5.99) showed the most pronounced effects compared with conventional care. Conclusion Among the various interventions, PFMT combined with vaginal weights is the most effective for reducing objective leakage, PFMT combined with biofeedback and electrical stimulation is the most effective for enhancing muscle strength, and aerobic exercise is the most effective for improving quality of life. To further validate these conclusions, large-scale, high-quality RCTs are needed. Systematic review registration https://www.crd.york.ac.uk/prospero/ , identifier CRD420251249264.