Effects of various pelvic floor muscle training forms and combined regimens on muscle strength, function, and recurrence rate in post-vaginal delivery stress urinary incontinence patients.

OBJECTIVE: To investigate the effects of focused PFMT (Kegel exercises), generalized PFMT, and high-intensity combined PFMT on Pelvic Floor Muscle (PFM) strength, functional recovery, and Stress Urinary Incontinence (SUI) recurrence in women with Postpartum Stress Urinary Incontinence (PSUI). METHODS: Ninety-nine PSUI patients were randomly divided into three groups: Focused PFMT group (precise gluteal contractions), Generalized PFMT group (comprehensive PFM training), and High-Intensity Combined group (integrating both). After 4-weeks of treatment, assessments included PFM strength grading, urodynamic parameters (including Maximum Urethral Closure Pressure [MUCP], Maximum Urethral Pressure [MUP], Functional Urethral Length [FUL], Bladder Capacity [BC], and maximum flow rate [Qmax]), Urinary Incontinence Impact Questionnaire (IIQ-7) scores, 1-hour pad test leakage volume, and serum Estradiol (E₂), Follicle-Stimulating Hormone (FSH), and Relaxin (RLX) levels. Recurrence rates were assessed at 3- and 6-months. RESULTS: All groups showed improved PFM strength after treatment, with the Combined Group exhibiting a significantly higher proportion of Grade IV‒V strength. Urodynamic parameters, IIQ-7 scores and leakage volume improved in all groups, with the Combined Group achieving the most significant improvements. The Combined Group showed superior clinical efficacy and a significantly lower 6-month recurrence rate. CONCLUSION: Combining focused and Generalized PFMT effectively enhances pelvic muscle strength, improves urethral and bladder function, and reduces SUI recurrence. The efficacy of PFMT is closely related to training intensity, suggesting that a high-intensity protocol combining focused and comprehensive exercises may be the optimal choice for managing postpartum SUI. The therapeutic benefits may be associated with hormonal modulation.