Electrical stimulation and biofeedback combined with pelvic floor muscle training for pelvic floor dysfunction in postpartum women: a systematic review and meta-analysis

Background Postpartum pelvic floor dysfunction (PFD) manifests as decreased pelvic floor muscle strength (PFMS), stress urinary incontinence (SUI), pelvic organ prolapse (POP), and impaired sexual function. Pelvic floor muscle training (PFMT) is the first-line therapy but often limited by poor muscle perception and adherence. Electrical stimulation (ES) and biofeedback (BF) may enhance outcomes, yet their combined effect with PFMT has not been systematically quantified. Methods Following PRISMA 2020 guidelines, PubMed, Embase, Web of Science, Cochrane Library, CNKI, WanFang, VIP, and SinoMed were searched to July 9, 2026. Randomized controlled trials (RCTs) comparing ES+BF+PFMT with PFMT alone were included. The population was restricted to women within 12 months postpartum. Outcomes were PFMS, SUI incidence, POP severity, and sexual function. Pooled mean differences (MD) or risk ratios (RR) with 95% confidence intervals (CI) were calculated. Subgroup and sensitivity analyses were performed, publication bias was assessed for outcomes with at least 10 studies, and the certainty of evidence was evaluated using GRADE. Results Twenty-nine RCTs were included. ES+BF+PFMT significantly improved PFMS (MD = 0.85, 95% CI: 0.69–1.01), reduced SUI incidence (RR = 0.36, 95% CI: 0.26–0.49), lowered POP-Q stage (MD=−0.29, 95% CI: −0.39 to −0.20), and enhanced sexual function (MD = 4.38, 95% CI: 3.41–5.34). Exploratory subgroup analyses suggested that Kegel training duration may contribute to PFMS heterogeneity. GRADE assessment indicated moderate certainty for SUI incidence, low certainty for PFMS and sexual function, and very low certainty for POP severity. Conclusions Compared with PFMT alone, ES+BF+PFMT may provide additional benefits for postpartum PFD rehabilitation within the first year, with the most consistent evidence observed for reducing SUI incidence. Potential benefits were also observed for PFMS and sexual function, whereas the POP-Q findings should be interpreted with particular caution because the certainty of evidence was very low. The generalizability of these findings is limited because all included studies were conducted in China. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420251134152 , identifier CRD420251134152.