Effects of postpartum diastasis recti abdominis on multisite pelvic floor electromyography and anatomical structure: A cross-sectional study

This study evaluates the effects of postpartum diastasis recti abdominis (DRA) on multisite pelvic floor muscle electromyography (EMG) and pelvic anatomical structures, with the goal of informing targeted postpartum rehabilitation strategies. A total of 157 postpartum women who underwent follow-up examinations between April 2021 and August 2022 were included. EMG characteristics of pelvic floor muscles at multiple anatomical sites and structural changes were analyzed across groups. Additionally, correlations between the maximum inter-rectus distance and pelvic floor EMG parameters were assessed. Although the external anal sphincter showed significantly lower endurance contraction potential (ECP) in the non-DRA group compared to the DRA group (P < .05), multiple linear regression analysis indicated that DRA grouping was not an independent predictor of the ECP. In comparisons between mild and moderate-to-severe DRA groups, the anterior resting potential (ARP) of the puborectalis, pubococcygeus, and urethral sphincter muscles was significantly higher in the moderate-to-severe group (P < .05). Multivariate regression analysis further confirmed that DRA severity independently influenced ARP in the puborectalis (β = 9.344 μV, P = .018, 95% CI: [1.659, 17.030]), pubococcygeus (β = 8.601, P = .035, 95% CI: [0.621, 16.580]), and urethral sphincter (β = 7.903 μV, P = .015, 95% CI: [1.593, 14.213]). Weak correlations were observed between the maximum inter-rectus distance and both the ARP of the vaginal sphincter and the ECP of the external anal sphincter. No significant associations were found between DRA and three-dimensional ultrasound parameters of pelvic floor anatomy (P > .05). The severity of DRA affects EMG parameters related to muscle tone in specific pelvic floor muscles, particularly the ARP of the puborectalis, pubococcygeus, and urethral sphincter. Future rehabilitation strategies should take DRA severity into account and incorporate individualized factors such as delivery mode and parity to develop personalized interventions aimed at achieving more precise and effective postpartum recovery.