REF-1711 · Cristóvão et al., 2026 · International Urogynecology Journal · Paper · PubMed

App- and web-based pelvic-floor training went with less urinary incontinence in pregnancy, but after birth the pooled effect was not significant: a mixed-methods review of 18 studies (4,916 participants) reports reduced incontinence during pregnancy (no effect size in the abstract) and, postpartum, a mean difference of −1.45 (95% CI −3.17 to 0.27, scale not named) with substantial heterogeneity; women's knowledge and confidence, life demands, contact with clinicians, culture and app usability shaped whether they kept training

Main caveat: The authors': mixed evidence and substantial heterogeneity postpartum.
limited evidenceMeasured on non-athletes and recreational peopleRead from the abstract only

Cristóvão and colleagues asked how well digital pelvic-floor muscle training (apps and web-based programmes) prevents and manages pelvic-floor dysfunction in pregnancy and after birth, and what makes women stick with it.

They searched three databases to March 2025, updated in January 2026, and included 18 quantitative and qualitative studies with 4,916 participants, appraised with the Mixed Methods Appraisal Tool. The primary outcome was the severity of pelvic-floor symptoms: incontinence, prolapse symptoms, sexual dysfunction and perineal pain.

Digital training was associated with less urinary incontinence during pregnancy. After birth, results were mixed and the pooled estimate was not significant (MD −1.45, 95% CI −3.17 to 0.27) with substantial heterogeneity.

The qualitative studies yielded five determinants of adherence: knowledge and confidence, emotional and contextual demands, communication with healthcare staff, sociocultural influences and programme usability.

Read through the COM-B model, the authors judge that the variable effectiveness likely reflects differences in women's capability, opportunity and motivation more than programme content, and conclude that digital training may support pelvic-floor outcomes when it addresses these.

Participants

18 studies, 4,916 participants, pregnant or postpartum; how many were in the quantitative and the qualitative studies, and their age, parity and symptoms at entry, are not in the abstract.

Protocol

Search: PubMed, CINAHL, Scopus from inception to March 2025; updated January 2026.
Selection and appraisal: two reviewers screened, extracted and appraised quality with the Mixed Methods Appraisal Tool.
Outcomes: primary, pelvic-floor dysfunction symptom severity (incontinence, prolapse symptoms, sexual dysfunction, perineal pain); adherence determinants from qualitative studies.
Synthesis: meta-analysis where possible, otherwise narrative; qualitative meta-aggregation; integration through COM-B and the behaviour change wheel.
Not in the abstract: study designs and how many were randomised, comparators, the programmes, the quality results, the scale behind the postpartum mean difference, results for prolapse, sexual function and perineal pain, and funding.

Key Results

OutcomeResult
Urinary incontinence during pregnancyDigital PFMT associated with reduced incontinence (no effect size, interval or study count in the abstract)
Pelvic-floor outcome after birthMixed; MD −1.45 (95% CI −3.17 to 0.27), not significant; substantial heterogeneity (scale and outcome not named)
Adherence determinants (qualitative)Knowledge and confidence; emotional and contextual demands; healthcare communication; sociocultural influences; programme usability

Practical Application

An app or web programme went with less leaking in pregnancy; after birth its benefit was not shown. In 18 studies digital training went with less leaking during pregnancy (no size given), while the postpartum pooled estimate was not significant (MD −1.45, −3.17 to 0.27) and varied widely between studies.
Consistent with [SYNTH-95]'s pelvic-floor line, which keeps pelvic-floor training from pregnancy on and gives the programme to a pelvic-health physiotherapist: this review adds that how the training is delivered and supported matters. Knowing how to do it, confidence, time and life demands, contact with a clinician and an easy-to-use app shaped whether women kept going. It does not show that an app replaces a physiotherapist, and it changes no line of the guide.
Inference, not tested here: for a training athlete in pregnancy or after birth, an app is a reasonable reminder and log alongside a pelvic-health physiotherapist's programme; asking whether she has the time and confidence to do it is part of following it up.
Not treatment advice: leaking, heaviness, pelvic or perineal pain in pregnancy or after birth goes to the obstetric provider or a pelvic-health physiotherapist, who decides on assessment and the programme (SYNTH-95).

Limitations

The authors': mixed evidence and substantial heterogeneity postpartum; effectiveness depends on capability, opportunity and motivation rather than content alone.
Not in the abstract: study designs, comparators, programme features, quality appraisal results, the pregnancy effect size, the postpartum scale, results for prolapse, sexual dysfunction and perineal pain, and funding.
Mixed methods: the qualitative findings explain adherence; they do not measure effect.
Written from the abstract and the PubMed record; full text not read.
How this entry was checked and changed
Why this level

the design reaches B+ at most here (risk of bias not read (abstract only): the abstract names the Mixed Methods Appraisal Tool but not its results), held at B because the review mixes quantitative studies of unstated design with qualitative studies, the one positive effect (pregnancy) is given without a number or interval, and the postpartum estimate's scale is not named