Background/Objectives: Urinary incontinence (UI) is a prevalent health condition with a negative impact on quality of life (QoL). Exercise therapy (ET), specifically, pelvic floor muscle training (PFMT), is recommended as a first-line conservative treatment for UI during pregnancy, childbirth, and the postpartum period. This study evaluated the effects of ET on the management of postpartum UI. Methods: A systematic search was conducted to identify clinical trials and randomized controlled trials including women over 18 years with postpartum UI. All included studies used ET as the main intervention. Studies were excluded if UI symptoms were attributable to factors outside the urinary tract or if participants had concomitant pathologies. Results: From 298 records screened, four trials were included. Three trials reported statistically significant improvements in UI outcomes, while findings for pelvic floor function and QoL showed greater heterogeneity. One trial found that supervised PFMT was associated with greater improvements in urinary symptoms (BFLUTS), vaginal pressure (18.96 mmHg (SD: 9.08)), and endurance (11.32 s (SD: 3.17)) compared to unsupervised training. Another trial using electromyographic biofeedback with electrical stimulation reported a continence rate exceeding 70% on the 20 min pad test, with improvements in perceived burden (VAS), symptoms (UDI), and QoL (IIQ). A third trial combining PFMT with infrared physiotherapy showed improvements in pelvic floor function (PFIQ-7, PFDI-20), urodynamic parameters, urine loss, and QoL (GQOLI-74). In the remaining trial, within-group improvements were observed, with no statistically significant between-group differences. Conclusions: ET appears to be beneficial for postpartum UI, with a moderate certainty of evidence. While the greatest benefits are observed with supervised PFMT, the diversity of comparators, and the risk of performance bias limit definitive conclusions regarding its superiority. Given the short-term follow-up, it remains unclear whether the results are influenced by the spontaneous recovery trajectory in the postpartum period and if these effects are sustained in the long term.

Background: There are numerous studies that offer us data on the benefits of therapeutic physical activity during pregnancy in terms of health, although in addition to the physical and emotional benefits, it is also important to know in what terms this activity helps to prevent and treat common pathologies in the prepartum and postpartum periods, as well as its influence on the optimal development of the foetus and better adaptation to childbirth. Objectives: To carry out a systematic review of the studies that address the maternal and foetal benefits of physical activity in the aquatic environment during pregnancy and its influence on antepartum and postpartum health and the prevention of pathologies. Method: We analysed all the studies relating therapeutic exercise in the aquatic environment to pregnant women. An analysis of 21 articles was carried out to carry out this systematic review, using the Medline, Scielo, PEDro and Cochrane Library databases. Results: Therapeutic physical activity in the aquatic environment has effects on both mother and child at physiological and antopometric levels, also influencing the type of delivery and evolutionary development of the baby. Conclusions: Therapeutic physical exercise in the aquatic environment not only has no adverse maternal-fetal effects but also helps to prevent and treat pathologies during pregnancy, childbirth and postpartum. Key words: Pregnant woman, aquatic activity, exercise, childbirth.

Background/Objectives: The aim of this diagnostic accuracy study was to evaluate the usefulness of transperineal ultrasound parameters of urethral instability for assessing the severity of stress urinary incontinence (SUI) in women and their relationship with health-related quality of life (HRQOL). Methods: This cross-sectional study included 240 women with symptomatic SUI (mean age 41 years). Severity was classified using the Sandvik Severity Index (reference standard). Transperineal ultrasound (index test) was performed to measure the retrovesical angle (RVA) at rest and during Valsalva manoeuvre, bladder neck descent (BND), and urethral rotation angle (URA). Impact on HRQOL was assessed with the ICIQ-SF and King’s Health Questionnaire (KHQ). Operators were blinded to clinical data and vice versa. Results: The RVA at rest showed the best discriminatory capacity for identifying severe/very severe SUI (AUC 0.83, 95% CI 0.77–0.89; sensitivity 71%, specificity 84%), with an optimal cut-off value of 118.1° (adjusted for age, BMI and miscarriage). RVA values increased progressively with SUI severity both at rest and during Valsalva (p < 0.001). Significant positive correlations were found between RVA and ICIQ-SF scores (ρ² = 0.412 at rest, p < 0.001). In contrast, URA remained within normal limits (<20°) and did not differ across severity groups. Conclusions: Transperineal ultrasound measurement of the RVA at rest is a reliable, non-invasive parameter for grading SUI severity and correlates with its impact on HRQOL. These findings suggest that RVA at rest has good discriminatory capacity for identifying women with severe or very severe SUI and may have potential as an adjunct to clinical assessment. However, given the moderate sensitivity observed and the lack of data on management outcomes, prospective studies are needed to determine its utility in guiding referral or treatment decisions.

Background: Stress urinary incontinence (SUI) is defined as involuntary urine loss during activities that increase intra-abdominal pressure. It is highly prevalent among women and significantly affects physical, emotional, and social well-being. Pelvic floor muscle training (PFMT) is the gold-standard conservative therapy. Second-generation radiofrequency (RF) therapy has shown promise as an alternative. It stimulates collagen synthesis and promotes tissue remodeling. This study will compare the effects of PFMT, RF, and their combination on pelvic floor function, urethral stability, and health-related quality of life (HRQoL) in women with SUI due to urethral hypermobility. Methods/Design: This will be a single-blinded, three-arm, randomized controlled trial conducted at Clínica Traña (San José, Costa Rica). Women aged ≥18 years with clinically confirmed SUI and a retrovesical (β) angle ≥ 140° during the Valsalva maneuver on functional transperineal ultrasound will be randomized (1:1:1) to PFMT (16 weeks, twice-weekly supervised sessions), RF (5 weekly sessions using Capenergy^® C500 Urogyne), or combined RF + PFMT (39 per arm; total N = 117 accounting for 30% attrition). The primary outcome is the change from baseline in pelvic floor muscle strength at 12 months post-intervention, measured by the modified Oxford scale and vaginal manometry. Secondary outcomes will include urethral stability (retrovesical β angle and bladder neck descent on ultrasound), incontinence severity (Sandvik Severity Index), and HRQoL (ICIQ-UI SF and King’s Health Questionnaire). All outcomes will be assessed at baseline, immediately post-intervention, 15 days, 3 months, 6 months, and 12 months follow-up. Assessments will be performed by blinded evaluators. Analysis will follow intention-to-treat principles using repeated-measures ANOVA or non-parametric equivalents (SPSS v.29; p < 0.05). The trial was prospectively registered on ClinicalTrials.gov (NCT07095283, registered on 24 July 2025), prior to the recruitment of the first participant. Expected outcomes: This study will provide comparative effectiveness data on whether the addition of RF to PFMT offers additional benefits over PFMT alone in the management of SUI.