Introduction and Hypothesis <p>We aimed to investigate the effectiveness of intensive preoperative pelvic floor muscle training (I-PPFMT) in women with stress urinary incontinence (SUI) awaiting mid-urethral sling surgery.</p> Methods <p>Ninety women with SUI scheduled for surgery were randomly assigned to an I-PPFMT group (<i>n</i> = 46) or a control group (CG) receiving only education (<i>n</i> = 44). The intervention group completed 6-week I-PPFMT emphasizing both endurance and strength, whereas the CG received only education about the pelvic floor. All assessments were conducted before and after the intervention. Pelvic floor muscle (PFM) function was evaluated using the Modified Oxford System (MOS) of grading and perineometric measurements, whereas pelvic floor health knowledge was assessed using the Pelvic Floor Health Knowledge Quiz. In addition, pelvic floor symptoms were evaluated using the Global Pelvic Floor Bother Questionnaire and the Incontinence Severity Index (ISI).</p> Results <p>The I-PPFMT group showed significant improvements in MOS (<i>p</i> = 0.001, <i>d</i> = 0.85) and ISI (<i>p</i> = 0.001, <i>d</i> = 0.90) compared with the control group. Pelvic floor health knowledge also increased significantly in the I-PPFMT group (<i>p</i> = 0.038). GPFBQ scores improved in both groups. Importantly, in 43% of participants, the planned surgical procedure was postponed following completion of I-PFMT.</p> Conclusions <p>I-PPFMT significantly enhanced PFM strength and symptom severity. Nearly half of the participants postponed their planned surgical procedure, supporting the integration of structured preoperative PFMT into standard clinical practice as a potentially effective, low-risk, and cost-efficient strategy to optimize continence outcomes and reduce immediate surgical demand.</p>