General Information: Patients with postpartum pelvic floor dysfunction visiting three hospitals in Beijing from January 2021 to December 2022 were recruited. Two hospitals were district-level maternal and child health care centers, and one was a tertiary general hospital. Each hospital recruited 40 patients, evenly falling into the control and experimental groups (n = 20). In total, 60 patients were assigned to the experimental group and 60 to the control group. A single-blind intervention was applied to both groups. A total of 87 medical records were included in the final analysis. Inclusion criteria: (1) provision of informed consent; (2) diagnosis of Pelvic Floor Distress (PFD) according to the textbook Obstetrics and Gynecology, with pelvic floor muscle strength graded 0 to 3; (3) age between 22 and 35 years; and (4) full-term singleton vaginal delivery. Exclusion criteria: (1) history of pelvic floor surgery; (2) reproductive system infections; (3) presence of cardiac pacemakers; (4) neurological diseases; (5) endocrine or hematological disorders; and (6) cognitive, communication, auditory, visual, or motor impairments. All participants were informed of the study procedures and their required cooperation prior to participation. The study protocol obtained the approval of the hospital ethics committee and participants had provided their written informed consent.

Participants received regular health education, including lifestyle modifications such as avoiding prolonged squatting, refraining from lifting heavy objects, and performing regular pelvic floor muscle training (PFMT). A clinical physician developed an individualized treatment plan based on each patient’s condition, including Kegel training, electrical stimulation and biofeedback therapy. Each session lasted 30 minutes, administered twice weekly, with 10 sessions constituting one treatment course. The intervention period commenced 6 weeks postpartum and continued for 3 months.

Data were entered via Microsoft Excel, and statistical analyses relied on SPSS version 17.0 (IBM Corp., Chicago, IL, USA). $\alpha$ = 0.05 represented the significance level. p-values 0.05 indicated statistical significance, while p-value 0.01 reported high significance. Normally distributed quantitative data were in the format of mean $\pm$ standard deviation ($\overline{x}$ $\pm$ s), whereas non-normally distributed data were presented as medians. Evaluation of quantitative data and categorical variables was conducted by virtue of the independent-samples t-test and the chi-square test, respectively.

The two groups were comparable, as evidenced by no significant difference in their baseline characteristics (p $>$ 0.05) (Table 2).

The results of the comparison between the analysis groups (Tables 3,4,5 and Fig. 3): At all three time points (baseline, 1 month, and 3 months), comparisons of each index yielded p-values $>$ 0.05, indicating that total PFDI-20 scores or any subscale scores did not differ significantly in statistical level between the groups at any time point.

Fig. 3.

Evaluation of pelvic floor dysfunction in both groups.

Within the control group: UDI-6 (urinary distress): Scores significantly decreased from baseline to 1 month (p = 0.02), and the mean was higher at 0 months (Before intervention, 0.362 vs. 0.194), indicating symptom improvement. Total score of PFDI-20: A significant reduction was observed from baseline to 1 month (p = 0.05). The total score was higher at 0 months (24.39 vs. 15.625), indicating overall symptom improvement. All other comparisons were not statistically significant.

Within the experimental group: POPDI-6 (POP distress): Scores significantly decreased from baseline to 1 month (p = 0.02), and the mean was higher at 0 months (0.21 vs. 0.09), indicating symptom improvement. CRADI-8 (colorectal and anal distress): Significant reductions were observed between baseline and 1 month (p = 0.05) and between baseline and 3 months (p 0.01). Scores were highest at baseline (0.32) and lowest at 3 months (0.15), indicating continuous improvement. UDI-6 (urinary distress): Significant improvements were noted from baseline to 1 month (p = 0.01) and from baseline to 3 months (p = 0.02). Scores were highest at baseline (0.31), and decreased at 1 month (0.14) and 3 months (0.15), indicating continuous improvement. The total score of PFDI-20: Significant reductions were found between baseline and 1 month (p 0.01) and between 0 months and 3 months (p = 0.01). The total score was the highest at 0 months (21.23), and lower at 1 month (11.26) and 3 months (11.34), indicating continuous improvement.

According to the analysis results of pelvic floor physiological indicators at 6 weeks postpartum, no significant difference was found between the two groups in terms of Type I muscle strength, Type II muscle strength, and fatigue level in statistical level (p $>$ 0.05) (Table 6, Figs. 4,5), indicating good baseline comparability. After the 3-month intervention, both groups exhibited improvements in postpartum pelvic floor muscle recovery. However, when comparing Type I muscle strength, the experimental group outperformed the control group statistically (p 0.05).

Fig. 4.

Evaluation of Class I fibromuscular muscle in the two groups.

Fig. 5.

Evaluation of Class II fibromuscular muscle in the two groups.

At baseline, the severity of UI symptoms did not present an obvious difference in statistical level between the two groups, indicating good baseline consistency. After 3 months of intervention, the frequency of urinary leakage differed a lot (Table 7 and Fig. 6).

Fig. 6.

Evaluation of UI in both groups.

The intergroup comparison showed that t = 4.83 and p = 0.03 (0.05), suggesting that the experimental group achieved remarkably larger improvement in reducing urinary leakage frequency versus the control group. However, no statistically significant differences existed in urine leakage volume (0.80 $\pm$ 1.10 in the control group vs. 0.34 $\pm$ 0.76 in the experimental group; t = 1.41, p = 0.24) or the impact on daily life (0.60 $\pm$ 0.89 in the control group vs. 0.20 $\pm$ 0.63 in the experimental group; t = 1.58, p = 0.22), although both outcomes showed a trend toward lower scores in the experimental group (p values were all $>$0.05).

Holistic postural rehabilitation exercises in combination with electrical stimulation and biofeedback improved the pelvic floor muscle strength in postpartum patients. Baseline comparisons between the two groups demonstrated no significant differences (p $>$ 0.05). After 3 months of intervention, type I muscle fibers demonstrated an obvious intergroup difference (p = 0.00). The pelvic floor muscles are located at the base of the pelvis and consist primarily of the levator ani. These muscles are essential for pelvic floor support and are composed of both type I and type II fibers. The rehabilitation program incorporated abdominal breathing. During inhalation, core muscle contraction was emphasized, followed by antagonistic exercises. The program was progressive, treating the body as an integrated whole, fostering coordination between local and global core muscle groups, and improving both the Class I fibromuscular muscle and Class II fibromuscular muscle of the pelvic floor. Bernardes BT et al. [9] reported that in women suffering POP, the cross-section of the levator ani muscle significantly increased during treatment. PFMT and negative pressure exercises produced comparable improvements in the cross-section of the levator ani. Negative pressure training may also serve as a systemic approach to facilitate postpartum recovery. These findings conform to the present study. Therefore, holistic postural rehabilitation exercises can be considered an effective strategy for comprehensive pelvic floor rehabilitation after childbirth.

Holistic postural rehabilitation exercises combined with electrostimulation and biofeedback reduced the frequency of postpartum urinary leakage. At enrollment, UI-related indicators showed no obvious difference between groups, ensuring reliable comparisons of subsequent intervention effects. After one month, the experimental group showed no significant advantage over the control group. At three months, however, the experimental group significantly outperformed the control group in “urinary leakage frequency”, suggesting that this intervention may require continuous implementation for at least three months to achieve measurable effects. Significant between-group differences were observed only in urinary leakage frequency at 3 months. Improvements in missing urine volume and its impact on daily life did not reach statistical significance. Possible explanations include the intervention being more specifically targeted at leakage frequency, while improvements in leakage volume and quality-of-life impact may require a longer intervention period, or the relatively small sample size (46 and 41 in the control group and experimental group, respectively) may have limited statistical power to detect differences. Globally, the prevalence of SUI in women ranges from 10% to 50% [10, 11], with rates among adult women in China reaching 18.9% [12]. Although variations exist in study populations, survey instruments, and diagnostic criteria, and prevalence differs by country and region, a study indicates a global upward trend in SUI prevalence. Many women with SUI delay seeking medical care due to limited knowledge of the condition or the stigma associated with leakage symptoms, resulting in underestimation of its true incidence in epidemiological surveys [13]. Early identification and effective intervention are of great significance for the recovery of pelvic floor dysfunction.

In 1981, Philippe Souchard empirically developed Global Postural Reeducation (GPR), which is currently used in countries including Brazil, Spain, France, and Portugal [14, 15]. In a randomized controlled trial conducted by Fozzatti et al. [16], both groups showed significant reductions in urinary leakage episodes, with a greater decrease observed in the GPR group. Both groups also showed significant decreases in daily pad use and significant improvements in pelvic floor function, with no significant difference between groups (p = 0.628). The holistic postural rehabilitation program is scientifically robust and has the potential to further improve clinical outcomes, reflecting the principles of contemporary holistic nursing.

Cross-sectional comparisons between the experimental and control groups (0 months, 1 month, and 3 months) and longitudinal analyses within each group show no baseline differences, thereby eliminating potential bias from the initial state and ensuring comparability. Despite the absence of significant differences between groups in statistical level, intra-group trends suggested potential benefits of the intervention. The lack of significant intergroup differences may be attributed to the limited sample size, which resulted in insufficient statistical power to detect potential true differences.

The follow-up duration of 3 months may have been insufficient. If the long-term effects of the intervention measures had not fully manifested, an extended follow-up would be required. Control group: Only short-term improvements in bladder symptoms and overall function were observed at 1 month, followed by complete rebound after 3 months, with no improvement in prolapse or intestinal symptoms. This pattern suggests that the observed changes may reflect natural recovery or a placebo effect, both of which are unsustainable. Experimental group: Prolapse, bladder, intestinal symptoms and overall function improved significantly and were maintained for 3 months without rebound. Notably, intestinal symptoms improved markedly from baseline to 3 months, and overall function showed significant gains from baseline to both 1 and 3 months, demonstrating the characteristics of “effective intervention”. Although no statistical differences were detected between groups, the comparison between the “comprehensive and sustained improvements” in the experimental group and the transient improvements with rebound in the control group suggests that the interventions administered to the experimental group (e.g., pelvic floor rehabilitation training and targeted therapy, though not explicitly detailed) may be superior to conventional treatment. The core principle of holistic postural rehabilitation exercises lies in combining abdominal breathing with activation and training of core muscle groups. By engaging and controlling the core, energy is transmitted from the center to the limbs and peripheral muscles, thereby maintaining stability, enhancing sensitivity, and improving muscle coordination. This process contributes to the alleviation of postpartum pelvic floor symptoms and promotes postpartum pelvic floor recovery.