Background: Urinary incontinence (UI), particularly stress UI, significantly impairs quality of life for millions of women globally. Pelvic floor muscle training (PFMT) is recommended as first-line treatment; however, the impact of PFMT on objectively measured continence outcomes remains variably reported. This systematic review evaluated the effectiveness of PFMT interventions—delivered alone or with adjuncts—on objective measures of urinary leakage.

Methods: We conducted a systematic search of PubMed, Scopus, and Web of Science from January 2000 to June 2025, including randomized controlled trials (RCTs) of PFMT in adult women reporting objective UI outcomes (pad-test or urodynamics). Risk of bias was assessed using the Cochrane RoB 2 tool. Results are synthesized narratively due to clinical heterogeneity.

Results: Ten RCTs (n = 1,484) met inclusion criteria. Supervised PFMT significantly reduced leakage by 6–12 grams (g) on pad testing compared to minimal care and increased cure rates (≤2 g) by 13–18%. Biofeedback yielded small additional benefits (~7 g) but was inconsistent across studies; two high-quality RCTs showed no added effect. Mobile app-supported PFMT improved adherence by 25–30% and achieved 8–12 g greater reductions than control groups. Group-based PFMT was non-inferior to one-to-one delivery. A single high-risk trial of functional PFMT suggested a 6 g greater improvement versus conventional PFMT. No serious adverse events were reported.