Introduction <p>The efficacy of pelvic floor muscle training (PFMT) in preventing and treating postpartum urinary incontinence remains inconclusive. This systematic review aims to evaluate the efficacy of pelvic floor muscle training (PFMT) in treating postpartum urinary incontinence (PPUI).</p> Method <p>We systematically searched Embase, PubMed, and Cochrane Library for randomized controlled trials (RCT) investigating PFMT for PPUI. Studies published before October 2024 were included. Two reviewers independently screened studies, extracted data, and assessed methodological quality using the Cochrane Risk of Bias Tool (ROB 2.0). Meta-analyses were performed using random-effects models, with effect sizes reported as risk ratios (RR) or standardized mean differences (SMD) with 95% confidence intervals (CI).</p> Results <p>A total of 19 RCTs were included in the analysis. Statistically significant improvements were observed in pelvic floor muscle strength (SMD 0.61, 95% CI [0.10, 1.12], <i>P</i> = 0.02) and endurance (SMD 0.68, 95% CI [0.06, 1.30], <i>P</i> = 0.03). However, no significant differences were found in quality of life (SMD −0.46, 95% CI [−1.18, 0.27], <i>P</i> = 0.22) or urinary incontinence incidence (RR 0.87, 95% CI [0.73, 1.04], <i>P</i> = 0.12). The subgroup analysis demonstrated that supervised PFMT interventions lasting more than 8 weeks were the most effective approach for improving pelvic floor muscle strength.</p> Conclusion <p>Pelvic floor muscle training (PFMT) demonstrates significant efficacy in improving pelvic floor muscle function (strength and endurance) in postpartum women with urinary incontinence (UI), supporting its physiological mechanism of action. However, owing to limitations in the available data and substantial heterogeneity across studies, the direct impact of PFMT on symptom resolution—specifically UI incidence and quality of life—remains less certain and should be interpreted with caution.</p>