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Postpartum · Recovery

Impact of postpartum exercise on pelvic floor disorders and diastasis recti abdominis: a systematic review and meta-analysis

Beamish NF, Davenport MH, Ali MU, Gervais MJ, Sjwed TN, Bains G, Sivak A, Deering RE, Ruchat SM

Published March 31, 2025 British journal of sports medicine
DOI 10.1136/bjsports-2024-108619 PMID 39694630 PMC PMC12013572

RRM Academy Synopsis

Pelvic floor muscle training cuts postpartum urinary incontinence odds

Pelvic floor muscle training led to 37% lower odds of urinary incontinence after birth, a systematic review found. Seven randomized trials supplied the result. One trial of women with an episiotomy or second-degree tear found training led to 56% lower odds of pelvic organ prolapse. Abdominal muscle training narrowed the gap between the muscles of the abdomen, with low certainty.

Key Findings

  • Pelvic floor muscle training alone led to 37% lower odds of urinary incontinence (seven randomized controlled trials, n=1930; OR 0.63, 95% CI 0.41 to 0.97, I2 72%), with moderate certainty.
  • In one trial (n=123) of women with an episiotomy or second-degree tear, pelvic floor muscle training lowered pelvic organ prolapse odds by 56% (OR 0.44, 95% CI 0.21 to 0.91; moderate certainty).
  • Across five trials (n=173), inter-rectus distance at rest fell 0.52 cm more with abdominal muscle training than with control (MD –0.52, 95% CI −0.99 to −0.05, I2 91%). Certainty was low.
  • During a head lift, inter-rectus distance fell 0.47 cm more with abdominal muscle training than with control (two trials, n=84; MD −0.47, 95% CI −0.92 to −0.02, I2 63%).
  • Evidence was limited for sexual function (two trials, n=118; SMD 0.31, 95% CI −0.96 to 1.58), anal incontinence (three trials, n=694; OR 0.58, 95% CI 0.31 to 1.11) and diastasis recti abdominis.

Interpretation

The study is a systematic review and meta-analysis, which pools results across studies. The 65 studies included 21 334 participants in the first year after childbirth, from 24 countries. Seven randomized controlled trials support the incontinence finding, and the certainty of that evidence is moderate. Pelvic organ prolapse means pelvic organs sinking from their normal position into the vagina. The prolapse result comes from one trial of women who had an episiotomy or a second-degree tear. The authors say it should not be generalized to other postpartum groups.

RRM Context

Restorative reproductive medicine follows a woman's health across her lifespan. Recovery after childbirth belongs to that care. Pregnancy puts prolonged stress on the pelvic floor and abdominal muscles, which may lead to disorders after birth. The review examines how exercise during the first year after birth affects those disorders. The work is part of a series behind a 2025 Canadian guideline on physical activity for that year.

Our editorial summary of this paper, not the article's abstract.

Abstract

Objective

To examine the effect of exercise during the first year postpartum on pelvic floor disorders and diastasis recti abdominis.

Design

Systematic review with random effects meta-analysis.

Data Sources

MEDLINE, EMBASE, CINAHL, SPORTDiscuss, Evidence-Based Medicine Reviews (Ovid), Scopus, Web of Science and ClinicalTrials.gov were searched until 12 January 2024.

Study Eligibility Criteria

Studies of all designs (except case studies) and languages were included if they contained information on the Population (individuals in the first year postpartum), Intervention (subjective or objective measures of frequency, intensity, duration, volume or type of exercise alone ('exercise-only') or in combination with other intervention (eg, biofeedback; 'exercise+co-intervention')), Comparator (no exercise or different exercise measures) and Outcome (symptom severity and risk of urinary incontinence, anal incontinence, pelvic organ prolapse, diastasis recti abdominis and sexual function).

Results

65 studies (n=21 334 participants) from 24 countries were included. 'Moderate' certainty of evidence revealed that pelvic floor muscle training reduced the odds of urinary incontinence by 37% (seven randomised controlled trials (RCTs), n=1930; OR 0.63, 95% CI 0.41 to 0.97, I2 72%) and pelvic organ prolapse by 56% (one RCT, n=123; OR 0.44, 95% CI 0.21 to 0.91) compared with control groups. 'Low' certainty of evidence showed a greater reduction in inter-rectus distance measured at rest and during a head lift following abdominal muscle training compared with no exercise. Evidence on the effect of exercise on the risk of anal incontinence and diastasis recti abdominis, as well as the severity of anal incontinence, urinary incontinence, pelvic organ prolapse and sexual function, is limited.

Conclusion

Evidence supports the effectiveness of postpartum pelvic floor muscle training in reducing the odds of urinary incontinence and pelvic organ prolapse and postpartum abdominal exercise training in reducing inter-rectus distance.

Systematic Review Registration

CRD42022359282.

Topics

By this author

Related research

Postpartum › Recovery › Physical Recovery · Lifestyle and Environment › Physical Activity › Exercise and Ovulation · Uterine and Pelvic Conditions › Pelvic Floor and Prolapse › Pelvic Floor Therapy
Muhammad Usman Ali, Matthew J Gervais, Talia Noel Sjwed, Gyanjot Bains, Allison Sivak, Rita E Deering
M Ali, Matt Gervais, M Gervais, T Sjwed, G Bains, A Sivak, R Deering
PMID 39694630 39694630 DOI 10.1136/bjsports-2024-108619 10.1136/bjsports-2024-108619 Beamish et al. 2025, Beamish 2025

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