Biofeedback electrical stimulation combined with pelvic floor muscle training on postpartum stress urinary incontinence: A meta‐analysis

BACKGROUND: Postpartum stress urinary incontinence (PSUI) is common after childbirth, peaking at 30% incidence at 6 months and affecting about 18% overall. It results from weakened pelvic floor muscles and affects quality of life, with some cases persisting beyond the first postpartum year. OBJECTIVES: To clarify the therapeutic effect of biofeedback electrical stimulation (BFES) combined with pelvic floor muscle training (PFMT) on PSUI through a meta-analysis of relevant studies. SEARCH STRATEGY: PubMed, Web of Science, Cochrane Library, Embase, CNKI, VIP Database, and Wanfang Database were searched for studies published up to October, 2024. SELECTION CRITERIA: Randomized controlled trials with adult females diagnosed with PSUI, focusing on clinical efficacy, PFMS, muscle fiber potential, and incontinence frequency were included. Studies were excluded if they involved severe comorbidities affecting intervention or had inaccessible outcomes. DATA COLLECTION AND ANALYSIS: Information was extracted for author, sample size, mean age, publication year, intervention, parity, postpartum time, delivery mode, number of fetuses, and outcome indicators. Risk of bias was assessed using Stata 15.0 and Review Manager 5.4.1, analyzing continuous and binary variables. MAIN RESULTS: Twenty studies with 2421 patients were analyzed, showing that BFES plus PFMT significantly improved PSUI clinical effect, pelvic floor muscle strength, and muscle fiber potential, reduced daily urinary incontinence incidence, and improved other urinary parameters compared with BFES or PFMT alone. CONCLUSIONS: BFES combined with PFMT is more effective than BFES or PFMT alone for PSUI patients. However, high heterogeneity was observed in some outcome indicators (e.g. PFMT, number of urinary incontinence events [NUI]), potentially affecting the results' precision. Furthermore, there was publication bias in the analysis of NUI. The results should be extrapolated with caution. Future large-scale, multicenter studies are needed to validate these findings.