The effectiveness of Pilates on improving pelvic floor muscle function and sexual function in women with pelvic floor dysfunction and urinary incontinence: a systematic review and Meta-Analysis

Abstract

Objective: To systematically evaluate the effects of Pilates on pelvic floor muscle function, urinary symptoms, and sexual function in women with pelvic floor dysfunction (PFD) or urinary incontinence (UI), providing evidence for rehabilitation programs. Methods: Following PICOS criteria, nine English and Chinese databases, including PubMed, Embase, Cochrane Library, Web of Science, CINAHL, and CNKI, were searched. Two researchers independently screened studies and extracted data. Methodological quality was assessed using the PEDro scale. Random-effects meta-analyses were conducted with RevMan 5.4 and Stata. Results: Nine randomized controlled trials were included. (1) Pilates significantly increased type I pelvic floor muscle fiber potential (SMD = 1.62, 95% CI: 1.35–1.89, P < 0.001); (2) Pilates significantly improved overall sexual function (SMD = 0.68, 95% CI: 0.40–0.96, P < 0.001); (3) Qualitative findings indicated that Pilates alleviated subjective UI symptoms, embarrassment related to urine leakage, and psychological burden; (4) Combining Pilates with conventional pelvic floor muscle training, neuromuscular electrical stimulation, or remote guidance may provide complementary benefits. Conclusion: Pilates improves type I pelvic floor muscle fiber potential and overall sexual function in women with PFD or UI. Integrating Pilates with conventional pelvic floor rehabilitation, instrument-based therapy, and remote guidance may optimize physical and psychological recovery and quality of life.