Engaging in pelvic floor workout (PEFLOW) during pregnancy appears to reduce the risk of postpartum stress urinary incontinence (SUI), according to a study.
At 6 weeks postpartum, SUI occurred in 8.7 percent of participants who consistently performed a PEFLOW between 28 weeks of gestation and delivery (exercise group) and in 13.9 percent of those who received usual medical care alone (control group) (risk difference, 5.17, 95 percent confidence interval [CI], 0.36–10.03; p=0.03). [JAMA Netw Open 2026;9:e267132]
The incidence of SUI was consistently lower in the exercise group than the control group across all time points: 37 weeks of gestation (22 percent vs 25.7 percent) and 3 months (11 percent vs 17.8 percent), 6 months (13.1 percent vs 18.8 percent), and 12 months (19.4 percent vs 29.8 percent) postpartum. The difference was significant across all postpartum time points (p=0.007, p=0.03, and p<0.001) but not at 37 weeks of gestation (p=0.23).
More participants in the exercise group vs the control group had good-to-strong contraction of the pelvic floor muscles at 6 months postpartum (Modified Oxford Scale score of ≥4: 17.8 percent vs 7.9 percent; p<0.001).
“Pelvic floor muscle training (PFMT) is recommended as the first-line treatment for SUI,” and the findings from the study provide evidence on the effectiveness of prenatal PFMT combined with global postural exercise, the investigators said.
PFMT plus global postural exercise
“PFMT emphasizes the voluntary contraction and relaxation of the pelvic floor muscle surrounding the urethra, vagina, and rectum. It instructs exercisers to synchronize the contraction and relaxation of the pelvic floor muscle with their breathing, specifically through exhalation and inhalation, while avoiding engagement of the abdominal muscles,” the investigators noted.
In the study, the investigators developed a training program that integrated PFMT into global postural exercise at various intensities, which they called PEFLOW.
“Rehabilitation training methods for SUI need to be based on a global postural exercise, involving overall core muscle strength, core stability, and balance of the pelvis and spine. The PEFLOW program was developed to promote in-pregnancy PFMT to prevent postpartum SUI,” they said.
During global postural exercises, exercisers are required to maintain normal posture over time to restore muscular strength. The aim is to correct postural misalignments by stretching muscle chains.
In previous research, both global postural exercise and PFMT were found to be effective for treating SUI, with global postural exercise providing substantially greater benefit. [Rev Assoc Med Bras 2008;54:17-22; Eur J Obstet Gynecol Reprod Biol 2010;152:218-224]
“Based on our findings, the intensity of PEFLOW is directly associated with immediate and sustainable improvements in both SUI and pelvic floor muscle strength, and continuing postpartum PEFLOW appears necessary to achieve the anticipated sustainable improvements in pelvic floor muscle status and to reduce the incidence of SUI in the long term,” according to the investigators.
Study details
Conducted across nine hospitals in China, the study included 764 primiparous women aged 20–40 years (median 29 years) who had a singleton pregnancy of <16 weeks of gestation. Primiparous women with severe complications, SUI or pelvic organ prolapse, and/or a history of cervical insufficiency, recurrent miscarriage, or induced labour were excluded.
The participants were randomly allocated to the exercise group (n=382) or the control group (n=382).
PEFLOW consisted of daily PFMT and two sessions of global postural exercises per week. Participants in the exercise group performed the overall PEFLOW programme in four episodes: 28–30, 31–33, 34–36, and 37–40 weeks of gestation. In each episode, the participants were instructed to begin the PEFLOW session in postures at level 2 intensity. The intensity levels were increased or decreased based on the Rating of Perceived Exertion, with the aim of activating the required muscle contraction while maintaining the current posture.
In terms of safety, “we found no evidence of any adverse effects of PEFLOW during midpregnancy and later pregnancy on the mother or foetus,” the investigators noted.
Premature rupture of membranes occurred in 17.6 percent of participants in the exercise group and in 23.5 percent of those in the control group. Postpartum haemorrhage was documented in 0.3 percent and 3.8 percent of participants in the respective groups. Foetal distress was observed only in one participant in the control group.
The investigators acknowledged the inability of blinding the participants in the control group about the intervention. “In addition … we did not include postpartum PEFLOW and relevant observations in the protocol. For this reason, further study is required.”