Clinical outcomes of pelvic floor muscle training, electrical stimulation, and magnetic stimulation in women with postpartum stress urinary incontinence: a retrospective cohort study

BACKGROUND: Postpartum stress urinary incontinence (PSUI) commonly impairs quality of life in postpartum women. Pelvic floor muscle training (PFMT), as a primary foundational treatment, faces challenges such as inadequate adherence and significant individual differences in efficacy. Electrical stimulation (ES) and magnetic stimulation (MS), as passive pelvic floor rehabilitation techniques, are often used in conjunction with PFMT in clinical settings. However, there is a lack of systematic retrospective cohort study evidence comparing the efficacy, safety, and adherence of these three methods. OBJECTIVE: Compare the effects of the three intervention strategies: PFMT, PFMT combined with ES, and PFMT combined with MS, on the recovery of pelvic floor function and the improvement of clinical symptoms in patients with PSUI. METHODS: This retrospective study enrolled patients with PSUI who received systematic treatment at our hospital's plastic surgery department between June 2020 and June 2025. Patients were divided based on their treatment regimens: PF (receiving PFMT guidance), ES (receiving PFMT combined with outpatient ES therapy), and MS (receiving PFMT combined with outpatient MS therapy). A total of 102 patients (n = 34) were ultimately included. All patients received a 12-week course of systematic rehabilitation treatment. Primary indicators were objective measures: the amount of urine leakage during a 1-hour pad test, pelvic floor muscle strength (modified Oxford grading), and urodynamic parameters (maximum urethral closure pressure [MUCP], abdominal pressure leak point pressure [LPP]). Secondary indicators included the overall clinical response rate, International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) scores, Incontinence Quality of Life Questionnaire (I-QOL) scores, and the incidence of adverse events. RESULTS: Baseline characteristics were balanced among the three groups (P > 0.05). After 12 weeks of treatment, the urine leakage volume in all three groups decreased compared to the baseline (P < 0.001). Specifically, the urine leakage volume after MS and ES treatments was lower than after PF treatment (P < 0.01). In terms of pelvic floor muscle strength, both MS and ES treatments resulted in higher Oxford grades compared to PF (P < 0.001). Regarding urodynamic parameters, both MS and ES treatments showed higher MUCP and LPP values than PF (P < 0.001) with MS higher than ES (P < 0.05). In terms of clinical overall effectiveness, PF had a rate of 73.5% (25/34), ES had a rate of 91.2% (31/34), and MS had a rate of 94.1% (32/34). Both ES and MS had higher rates compared to PF (P < 0.05). Both MS and ES showed lower ICIQ-SF scores (P < 0.01) and higher I-QOL scores (P < 0.001) than PF. Moreover, MS had higher I-QOL scores than ES (P = 0.008). CONCLUSION: In this non-randomized study, PFMT combined with ES or MS was associated with greater improvements than PFMT alone, and MS showed more favorable urodynamic and quality-of-life changes. Causal superiority cannot be determined.