Stress urinary incontinence (SUI) is one of the common pelvic floor dysfunctions that occur in female pregnancy and postpartum. It is defined as wetting while performing physical exercise, lifting, coughing, sneezing and laughing. The pelvic floor and the urinary continence mechanism may be affected by significant anatomical, hormonal and physiological changes during pregnancy and childbirth. The changes include support, strength of the pelvic floor muscles, integrity of the connective tissues and the function of the urethral sphincter, and may lead to leakage of urine during the postpartum period [2]. While often thought of as a temporary after-effect from childbirth, women who suffer from postpartum SUI may find that it negatively impacts their physical comfort, mental health, social interactions and overall quality of life.

Urinary incontinence can develop during pregnancy due to progressive stretching of the structures of the pelvic floor, intra-abdominal pressure, hormone changes, and the increasing weight of the uterus. Moossdorff-Steinhauser et al. conducted a review of the literature and a meta-analysis and found that urinary incontinence increases with the aging of the mother and was most commonly reported as a form of stress incontinence [3]. The mechanical stretching and compression of the pelvic floor muscles, connective tissues and supporting nerves in the process of vaginal delivery may further weaken the mechanism of continence. The levator ani muscle, perineal body, endopelvic fascia and pudendal nerve may all be involved in obstetric pelvic floor trauma, which has the potential to cause impaired urethral closure and urinary leakage following childbirth [4].

Various factors involving the mother and childbirth have been linked to SUI. Known maternal risk factors include: maternal age, elevated body mass index (BMI), excessive gestational weight gain, diabetes mellitus, multiparity and a history of urinary incontinence. In a systematic review and meta-analysis of 73010 participants by Wang et al., they were able to determine 12 risk factors for postpartum SUI. These were vaginal delivery, advanced maternal age, high BMI, diabetes, excessive weight gain during pregnancy, episiotomy, assisted delivery with forceps and urinary incontinence during the pregnancy [5]. A systematic review by Siahkal et al. also showed significant relationships between urinary incontinence and vaginal delivery, urinary leakage during the pregnancy, perineal trauma, instrumental delivery, BMI of the mother and birth weight of the newborn [6]. Other factors such as advanced maternal age, multiparity, neonatal birth weight exceeding 4 kg, perineal laceration, instrumental delivery and prolonged second stage of labour were also found to be significant contributing factors in a more recent metaanalysis by Dai et al. [7].

The type of delivery is an important factor in the development of postpartum SUI. Pelvic floor can be subjected to significant mechanical stresses during prolonged labor, difficult fetal passage and instrumental delivery during vaginal delivery. Other factors that can increase the risk of pelvic floor damage include forceps application, episiotomy, severe perineal tears, and delivery of a macrosomic infant. Cesarean delivery may minimize some pelvic floor trauma associated with childbirth, but it does not have a major effect on the prevention of urinary incontinence since pregnancy can cause changes in the structure of the pelvic floor and urethral function [8,9] as well. In addition, the individual susceptibility, history of pelvic floor dysfunction and magnitude of obstetric damage could play a role in the prevalence and intensity of the postpartum symptoms [10].

Urinary incontinence after birth is an important postpartum health issue, as the prevalence and course of incontinence after childbirth varies significantly over the course of the first few months. In a systematic review and meta-analysis of 35,064 women, Moossdorff-Steinhauser et al. found a prevalence of urinary incontinence in the postpartum period of some 31%, of which stress urinary incontinence had the highest prevalence [11]. Function of the pelvic floor may recover over time after giving birth, but not for everyone. In some women symptoms resolve spontaneously, in others, the women may continue to experience leaking urine for several months or even longer. Initial symptoms, antenatal incontinence, maternal characteristics, delivery complications or PFM function may impact on whether the disease persists.

This is an important time to consider the natural progression and recovery from SUI after birth in order to evaluate it over the six-months postpartum period. In one prospective study, 396 women after their first vaginal delivery were evaluated for the prevalence, severity and risk factors of SUI at 6 months postpartum, with the 6-month postpartum period being specifically identified as a clinically important period to follow [13]. The recovery can be spontaneous and achieved by tissue healing and the restoration of the function of the pelvic floor; or following conservative treatment such as pelvic floor muscle training (PFMT). PFMT is highly suggested to strengthen the pelvic floor muscles and for stress urinary incontinence. Supervised pelvic floor muscle training (PFMT) of at least 3 months has been recommended as a first line conservative treatment in women with SUI [14]. But level of recovery can vary, depending on how well patients stick to treatment, how severe their symptoms are at the start and whether they also have underlying pelvic floor trauma. An objective assessment of urinary leakage frequency, severity, and impact on daily activity can be made using validated assessment instruments, like the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) [15].

Even though the evidence has grown stronger internationally, locally relevant information on the risk factors and 6-month recovery from postpartum SUI is still relevant and needed to enhance the care provided to mothers. Urinary incontinence may be different from one woman to another, depending on the kind of birth, the characteristics of the mother, the quality of the health care received and the postpartum rehabilitation. In addition, pelvic floor dysfunction may not be diagnosed as it is often ignored due to embarrassment to discuss incontinence or as a natural part of childbirth [16]. The present prospective cohort study was therefore aimed at identifying the maternal and obstetric risk factors for the development of postpartum stress urinary incontinence and at evaluating the rate of recovery after 6 months of the women with SUI. The study is also designed to differentiate spontaneous from treatment-mediated recovery, and determine factors related to ongoing symptoms. The results can help to refine the postpartum screening process and provide a timely clue to women at high risk and to implement appropriate preventive and rehabilitative measures that enhance maternal health and quality of life.

A prospective cohort study was carried out in the Department of Obstetrics and Gynaecology of the Ayub Teaching Hospital Abbostabad, Pakistan for a period of six months starting from 10 March 2026 to 11 September 2026. This was done through non-probability consecutive sampling with a total of 90 pregnant women being enrolled. Participants were followed up prospectively to determine the incidence of postpartum stress urinary incontinence (SUI), risk factors for SUI related to the mother and fetus/childbirth, and recovery rate at 6 months among women who developed SUI. Pregnant women that gave consent and met the eligibility criteria were included in the study. Women who had a history of urinary incontinence prior to the index pregnancy, previous urologic surgery, known neurologic disorders that affect bladder function or a previous history of urologic abnormality were excluded to minimize potential confounding factors. Data were gathered using structured interviews and medical records, and baseline demographic and clinical information were obtained. Maternal age, body mass index (BMI), gravidity, parity, previous obstetric history, medical comorbidities and history of urinary incontinence during pregnancy were included as variables. Other pregnancy related factors such as: gestational age, gestational weight gain and antenatal urinary leakage were also recorded. Obstetric data were collected after delivery, such as the type of delivery, spontaneous or instrumental vaginal delivery, duration of the second stage of labour, episiotomy, perineal tears, and birth weight of the neonates. The above variables were evaluated to see if they were associated with developing and maintenance of postpartum SUI. Postpartum stress urinary incontinence was evaluated using a structured clinical interview, which involved having the patient report any urine leakage when she coughs, sneezes, laughs, lifts heavy objects or exercises. Women who complained of leakage during these activities were deemed to have SUI. To avoid misclassification of other urinary incontinence subtypes, the symptoms primarily attributed to a sense of urgency to urinate were distinguished from stress incontinence symptoms of leakage. An International Consultation on Incontinence Questionnaire (ICIQ) – Urinary Incontinence Short Form (SF) was administered to evaluate urinary leakage frequency, volume and effect on daily functioning. The total score of the questionnaire is 0-21, with higher scores representing more severe symptoms. The participants were evaluated at the postpartum stage, and followed up for 6 months to document the development, resolution, improvement, or persistence of urinary incontinence. The main outcomes were the incidence of postpartum SUI, maternal and obstetric risk factors and the percentage of women having full recovery of SUI within six months after childbirth. Recovery was considered as no urinary leakage was observed at the 6-months follow-up assessment. Recovery was further broken down into spontaneous recovery, defined as recovery without treatment, and treatment-assisted recovery, defined as recovery after conservative treatment, such as pelvic floor muscle training (PFMT). Details of the initiation, duration and compliance with pelvic floor muscle training and other recommended conservative therapies was recorded. Stress urinary incontinence was considered to have persisted if women still complained of any stress incontinence even though they had improved. Six-month follow-up assessments were done by scheduled clinical visit or by telephone interview and those who could not be contacted or were unable to participate in a 6-month assessment were noted separately. IBM SPSS Statistics version 27.0 was used to enter and analyze the data. Quantitative variables such as maternal age, BMI, gestational age, duration of labour and neonatal birth weight were presented as mean and standard deviation or median and interquartile range as appropriate for the data distribution. Data for categorical variables such as parity, mode of delivery, presence of postpartum SUI, obstetric complications, and status of recovery were presented as frequencies and percentages. Chi-square or Fisher's exact test was used to test the association of maternal and obstetric risk factors with postpartum SUI. Comparisons of continuous variables between groups were made using independent-samples t-test or Mann–Whitney U test. When appropriate, binary logistic regression analysis was used to determine independent predictors of postpartum SUI and adjusted odds ratios and 95% confidence intervals were generated. Six-month recovery rate: The number of women who actually recovered from postpartum SUI / total number of women diagnosed with postpartum SUI that completed the six-month follow-up, x 100. A p value < 0.05 was deemed statistically significant. The study was approved by the Ethical Review Committee participants gave written informed consent to the study, with the goals, process, benefits, and confidentiality of the research explained. There was no coercion of participation and it was explained that their involvement in the study was voluntary with no impact on their medical care if they chose to withdraw at any point. All the information collected was confidential and would only be used for research.

Baseline demographic and clinical characteristics

In all, 90 women were studied. The mean maternal age was 28.74 ± 4.62 years, while the mean BMI was 26.18 ± 3.71 kg/m². Of all the respondents, 56.7% were multipara while 43.3% were primiparous. Twenty-eight (31.1%) reported urine leakage during pregnancy. Most women did not have any known medical comorbidities (78.9%) (Table 1).

Table 1. Baseline demographic and clinical characteristics of study participants (n=90)

Obstetric characteristics of participants

As far as obstetric features, 58 (64.4%) women delivered vaginally and 32 (35.6%) delivered by cesarean section. Of the vaginal deliveries, 10 (17.2%) were instrumental deliveries. In the 21 (36.2%) vaginal deliveries, where episiotomy was performed, the results were recorded and in 16 (27.6%) a perineal tear was recorded. Of the participants, 12 (13.3%) had a neonatal birth weight of 4 kg or more (Table 2).

Table 2. Obstetric characteristics of study participants (n=90)

Occurrence of postpartum stress urinary incontinence

Of the 90 who responded, 29 (32.2%) experienced postpartum SUI, while 61 (67.8%) said they did not have stress incontinence throughout the assessment. This showed that about one third of the study population were reported to have suffered from SUI after pregnancy (Table 3, Figure 1).

Table 3. Occurrence of postpartum stress urinary incontinence (n=90)

Figure 1. Occurrence of postpartum SUI

Association of maternal and obstetric risk factors with postpartum SUI

The occurrence of postpartum SUI was higher among women aged 30 years or above compared with younger women (51.6% versus 22.0%). Likewise, women who had a BMI of 30 kg/m² or greater had an increased prevalence of SUI compared to women who had a BMI less than 30 kg/m² (58.8% vs. 26.0%). Urinary leakage during pregnancy was strongly associated with the development of postpartum symptoms, 18 women (64.3%) with history of urinary leakage had symptoms compared with 11 women (17.7%) who did not leak. Postpartum SUI was also more common after vaginal delivery as compared to cesarean section (41.4% vs. 15.6%). Multiparity had a higher proportion of SUI as compared to primiparity, but this was not statistically significant (Table 4).

Table 4. Association of maternal and obstetric risk factors with postpartum SUI (n=90)

The analysis showed significant relationships between maternal age, BMI, urinary leakage during pregnancy, and mode of delivery and postpartum SUI, with a statistically significant relationship to each of these variables. The post-partum SUI was not significantly correlated with multiparity (p=0.104).

Risk estimates for postpartum SUI

To estimate the strength of association between maternal/obstetric variables and postpartum SUI, crude odds ratios were calculated. Antenatal urinary leakage was the most strongly associated variable, followed by obesity, maternal age ≥30 years and vaginal delivery (Table 5).

Table 5. Crude odds ratios for selected risk factors associated with postpartum SUI

Six-month recovery rate among women with postpartum SUI

Of the 29 women diagnosed with postpartum SUI, 19 (65.5%) experienced complete resolution of stress urinary leakage within six months following delivery, while 10 (34.5%) maintained stress urinary leakage. The 12 women (41.4% of those affected) recovered spontaneously without any specific care; 7 women (24.1% of those affected) recovered with conservative treatment (mainly pelvic floor muscle training) (Tables 6 and 7).

Table 6. Six-month recovery status among women with postpartum SUI (n=29)

Table 7. Pattern of recovery according to management approach (n=29)

Percentages in Table 7 are based on management groups. The two groups are descriptive, and cannot be regarded as a treatment effect analysis.

The results showed that postpartum SUI was present in 32.2% of the women in the study. Maternal age ≥30 years, BMI ≥30 kg/m², urinary incontinence during pregnancy and vaginal delivery were significantly associated with postpartum SUI. The strongest crude association with postpartum SUI was with ante-natal urinary leakage. There was a trend for urinary incontinence being more common in multiparity, but this was not statistically significant. Of the women with postpartum SUI, 65.5% recovered completely within six months, while 34.5% had persistent SUI at six months.

Postpartum stress urinary incontinence (SUI) is an important maternal health concern that may persist beyond the immediate puerperium and adversely affect women's physical, psychological, and social well-being. The present prospective cohort study was designed to determine the maternal and obstetric risk factors associated with postpartum SUI and evaluate the six-month recovery rate among affected women. In the current analysis of 90 participants, postpartum SUI was identified in 29 (32.2%) women, while 61 (67.8%) did not develop the condition. Among the affected women, 19 (65.5%) achieved complete recovery within six months, whereas 10 (34.5%) continued to experience urinary leakage. The major factors associated with postpartum SUI included maternal age of 30 years or above, BMI of 30 kg/m² or above, urinary leakage during pregnancy, and vaginal delivery. These findings highlight the importance of identifying high-risk women during pregnancy and providing appropriate postpartum assessment and follow-up. The occurrence of postpartum SUI in 32.2% of participants indicates that approximately one-third of the women experienced urinary leakage following childbirth. This finding is consistent with the systematic review by Thom and Rortveit, which demonstrated that postpartum urinary incontinence is a frequent condition, although its reported prevalence varies according to the study population, assessment methods, and duration of follow-up [17]. Giugale et al. also reported considerable urinary incontinence among primiparous women at 12 months postpartum, emphasizing that symptoms may continue beyond the early postpartum period [18]. Similarly, Rajavuori et al., in a prospective cohort study involving 547 women, reported a postpartum urinary incontinence prevalence of 16.1% at three months following delivery [19]. The difference between these findings and the present study may be attributed to variations in follow-up duration, study populations, diagnostic definitions, and the inclusion of different urinary incontinence subtypes. Nevertheless, the findings support the need for routine postpartum screening rather than considering urinary leakage an unavoidable consequence of childbirth. Maternal age was significantly associated with postpartum SUI in the present analysis. Women aged 30 years or above demonstrated a higher frequency of urinary incontinence than younger participants (51.6% versus 22.0%, p=0.004), with a crude odds ratio of 3.77 (95% CI: 1.48–9.62). Increasing maternal age may contribute to reduced pelvic floor muscle elasticity, changes in connective tissue integrity, and diminished functional support of the urethra. These changes may increase susceptibility to urinary leakage following the mechanical stress associated with pregnancy and childbirth. The findings are consistent with the longitudinal EDEN cohort study, which identified increasing maternal age as a significant factor associated with postpartum urinary incontinence [20]. A recent retrospective cohort study by Guo et al. also identified older maternal age as an independent factor associated with persistent postpartum SUI at six months [25]. The association observed in the present analysis suggests that older women may benefit from more focused assessment of pelvic floor function during pregnancy and after delivery. Body mass index was another important factor associated with postpartum SUI. In the present analysis, 58.8% of women with a BMI of 30 kg/m² or above developed SUI compared with 26.0% of women with a BMI below 30 kg/m². The association was statistically significant (p=0.009), with a crude odds ratio of 4.06 (95% CI: 1.35–12.18). Increased body weight may elevate intra-abdominal pressure and place additional mechanical stress on the pelvic floor and urethral supporting structures, potentially compromising the continence mechanism. These findings are supported by the EDEN cohort, which reported a significantly increased likelihood of postpartum urinary incontinence among women with obesity compared with those having a normal BMI [20]. Guo et al. also identified higher BMI as an important predictor of persistent postpartum SUI among women receiving pelvic floor muscle training [25]. These observations emphasize the importance of appropriate weight management and postpartum lifestyle counseling as components of comprehensive maternal care. A particularly important finding was the strong association between urinary leakage during pregnancy and postpartum SUI. Among women who experienced urinary leakage during pregnancy, 64.3% developed postpartum SUI compared with 17.7% of those without antenatal leakage. This association was statistically significant. The mode of delivery also demonstrated a significant association with postpartum SUI. Women who underwent vaginal delivery had a higher frequency of urinary incontinence than those who delivered through cesarean section (41.4% versus 15.6%, p=0.012). The crude odds ratio was 3.81 (95% CI: 1.28–11.31), suggesting increased odds of postpartum SUI following vaginal delivery. Vaginal childbirth may contribute to pelvic floor dysfunction through stretching and injury of the levator ani muscles, connective tissue, and supporting nerves. The extent of these changes may depend on labour duration, fetal size, instrumental assistance, and perineal trauma. The findings are consistent with Guo et al., who reported that vaginal delivery was more common among women with persistent SUI at six months, whereas cesarean delivery was associated with lower odds of symptom persistence [25]. However, cesarean delivery should not be considered completely protective because pregnancy itself can affect pelvic floor function. Furthermore, the association observed in the present study does not establish a causal relationship, as other maternal and obstetric characteristics may contribute to the difference. Multiparity was associated with a higher frequency of postpartum SUI than primiparity (39.2% versus 23.1%); however, the difference was not statistically significant (p=0.104). Repeated pregnancies and vaginal deliveries may expose the pelvic floor to cumulative mechanical stress, potentially increasing the likelihood of impaired continence. The EDEN cohort identified higher parity as an important factor associated with postpartum urinary incontinence [20]. Similarly, Guo et al. reported an association between parity of two or more and persistent postpartum SUI [25]. The absence of statistical significance in the present analysis may be related to the relatively small sample size and limited number of SUI cases. Therefore, the observed difference should not be interpreted as evidence that parity has no relationship with postpartum urinary incontinence. A larger cohort may provide a more precise estimate of this association. An important aspect of the present study was the assessment of recovery within six months after delivery. Among the 29 women diagnosed with postpartum SUI, 19 (65.5%) achieved complete recovery, while 10 (34.5%) continued to experience urinary leakage. The recovery rate indicates that a considerable proportion of affected women may experience resolution of symptoms during the first six postpartum months. However, persistent symptoms in approximately one-third of affected participants demonstrate that spontaneous improvement cannot be assumed in every case. The longitudinal EDEN cohort study reported that 51.9% of women with urinary incontinence at four months postpartum experienced remission by 24 months, although its longer follow-up interval and inclusion of urinary incontinence subtypes limit direct comparison with the present findings [20]. More recently, Guo et al. reported that 826 of 1,538 women with postpartum SUI achieved symptom resolution by six months following basic pelvic floor muscle training, corresponding to a recovery rate of approximately 53.7% [25]. Differences in recovery rates may reflect variations in baseline symptom severity, obstetric characteristics, treatment protocols, adherence, and patient selection. These findings support the importance of longitudinal follow-up to distinguish women with temporary postpartum symptoms from those requiring further evaluation and management. The distinction between spontaneous and treatment-assisted recovery provides additional insight into the clinical course of postpartum SUI. In the present analysis, 12 of 16 women in the spontaneous recovery group (75.0%) achieved complete recovery, compared with 7 of 13 women receiving treatment-assisted management (53.8%). Although the proportion of recovery was numerically higher among women experiencing spontaneous resolution, this difference should not be interpreted as evidence that spontaneous recovery is superior to treatment. Women with more persistent or severe symptoms may have been more likely to receive treatment, introducing potential confounding by indication. Moreover, differences in treatment initiation, duration, and adherence may have influenced the observed outcomes. Woodley et al., in a Cochrane systematic review, demonstrated the preventive benefits of structured pelvic floor muscle training, particularly when initiated during pregnancy, while also highlighting limitations in the evidence concerning postnatal treatment [21]. Chen et al. reported that supervised pelvic floor muscle training and selected conservative interventions were beneficial in reducing urinary incontinence and improving incontinence-related quality of life among postpartum women [22]. These findings support the role of individualized conservative management rather than relying exclusively on spontaneous symptom resolution. Pelvic floor muscle training remains an important component of postpartum rehabilitation because it aims to improve pelvic floor muscle strength, coordination, and functional support of the urethra. Beamish et al., in a systematic review and meta-analysis involving 21,334 postpartum participants, reported that pelvic floor muscle training reduced the odds of urinary incontinence by approximately 37% compared with control interventions [23]. Similarly, Ibáñez-Vera et al. reviewed clinical trials involving 444 primiparous postpartum women and reported improvements in urinary incontinence symptoms following active pelvic floor physiotherapy, although considerable heterogeneity was observed among the included studies [24]. These findings reinforce the importance of structured pelvic floor rehabilitation, appropriate patient instruction, and regular assessment of treatment adherence. In clinical practice, women with persistent urinary leakage should be evaluated for symptom severity and pelvic floor dysfunction, with referral for specialized physiotherapy or urogynecological assessment when indicated. The present findings also have implications for postpartum screening and maternal healthcare delivery. The identification of antenatal urinary leakage, increased BMI, older maternal age, and vaginal delivery as potential risk indicators suggests that postpartum assessment should not be limited to women who spontaneously report urinary symptoms. Healthcare professionals should routinely inquire about urinary leakage during antenatal and postnatal visits, particularly among women with multiple risk factors. Early identification may facilitate timely counseling, appropriate pelvic floor muscle training, weight-management advice, and follow-up assessment. The recent evidence from postpartum exercise research further supports incorporating pelvic floor rehabilitation into routine maternal care during the first postpartum year [23]. Such measures may help reduce the burden of persistent urinary symptoms and improve women's quality of life. The present study has certain limitations that should be considered when interpreting its findings. The relatively small sample size of 90 participants may have limited the statistical power to identify weaker associations, particularly for factors such as parity and delivery-related complications. Furthermore, the study was conducted at a single clinical setting, which may limit the generalizability of the findings to other populations. The assessment of urinary incontinence through patient-reported symptoms may also be affected by recall and reporting bias. Differences in treatment initiation and adherence may have influenced the recovery outcomes, particularly when comparing spontaneous and treatment-assisted recovery. Additionally, the relatively small number of affected women limits the reliability of multivariable risk-factor analysis. Despite these limitations, the prospective cohort design and six-month follow-up provide a useful framework for evaluating the development and recovery of postpartum SUI. Future studies involving larger populations, standardized pelvic floor assessments, and clearly defined rehabilitation protocols are recommended to establish more reliable estimates of recovery and identify independent predictors of persistent disease. Overall, the findings highlight that postpartum SUI affects a substantial proportion of women and that recovery within six months is not universal. Antenatal urinary leakage, increased maternal BMI, advanced maternal age, and vaginal delivery emerged as important associated factors. The observed recovery rate emphasizes the importance of distinguishing spontaneous symptom resolution from treatment-assisted improvement and ensuring appropriate follow-up for women with persistent symptoms. Routine screening, early identification of high-risk women, and access to pelvic floor rehabilitation may contribute to better postpartum continence outcomes.

Postpartum stress urinary incontinence is an important maternal health issue that can last beyond the postpartum period and negatively impact the quality of life for women. Postpartum SUI was seen in 32.2% of the participants in the present study. The factors of maternal age of 30 years or above, BMI of 30 kg/m2 or above, urinary leakage in pregnancy and vaginal delivery were significantly associated with the development of postpartum SUI. Antenatal urinary leakage was the most significant risk factor among the factors analysed. 65.5% of affected women had full recovery (including spontaneous recovery and treatment), and 34.5% still had urinary leakage at the 6-month postpartum timeframe. The results underline the need to identify high-risk women during pregnancy, to perform routine urine incontinence evaluation as part of the postnatal rehabilitation and to offer timely PFR. Prompt recognition and treatment could minimize the likelihood of chronic postpartum SUI and the negative health impacts on mothers.

Recommendations

Pregnant and post-partum women should be routinely screened for urinary incontinence, especially if they've experienced urinary leakage during pregnancy. Special attention should be paid to women at higher risk (such as those at the extremes of maternal age, obesity, multiparity and vaginal delivery) who should be counselled appropriately and monitored more closely after delivery. Pelvic floor muscle training should be emphasized during and after pregnancy and supervised training should be provided for women who have stress urinary incontinence. Urinary leakage should be a matter of active enquiry, especially during the postpartum consultation, by healthcare professionals, particularly obstetricians, gynaecologists and midwives, to enable early diagnosis and treatment. Persistent symptoms should warrant further urogynecological evaluation and/or individualized management. Pelvic floor care needs along with weight management and healthy physical activity should also be highlighted as part of maternal care. In addition, larger multicentre prospective studies with more long-term follow-up are recommended to determine the long-term recovery pattern, to identify independent factors for SUI persistence, and to examine the effectiveness of various conservative treatment strategies.

Authors’ Contributions

Dr. Wajeeha Khurshid contributed to the conceptualization and design of the study, clinical supervision, patient assessment, interpretation of the findings, and critical revision of the manuscript for important intellectual content. Dr. Fauzia Khan contributed to patient recruitment, data collection, follow-up assessments, data entry and analysis, literature review, and drafting of the manuscript. Dr. Fauzia Khan also served as the co-corresponding author and coordinated manuscript preparation and submission. Both authors read and approved the final manuscript and agreed to be accountable for all aspects of the work.