Fu Feifei, Zhang Shuang, Zhang Hongyun, Xuan Zhangbiao, Zhang Na, Xie Zhenwei
Department of Gynecology, Affiliated Hospital of Shaoxing University, Shaoxing, Zhejiang, China.
Pelvic Floor Disease Diagnosis and Treatment Center, Women's Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang, China.
Medicine (Baltimore). 2025 Jun 27;104(26):e43067. doi: 10.1097/MD.0000000000043067.
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.
本研究评估产后腹直肌分离（DRA）对多部位盆底肌肉肌电图（EMG）和盆腔解剖结构的影响，旨在为有针对性的产后康复策略提供依据。纳入了2021年4月至2022年8月期间接受随访检查的157名产后女性。分析了多组不同解剖部位盆底肌肉的肌电图特征和结构变化。此外，还评估了腹直肌最大间距与盆底肌电图参数之间的相关性。尽管与DRA组相比，非DRA组的肛门外括约肌耐力收缩电位（ECP）显著降低（P < 0.05），但多元线性回归分析表明，DRA分组并非ECP的独立预测因素。在轻度与中度至重度DRA组的比较中，中度至重度组耻骨直肠肌、耻骨尾骨肌和尿道括约肌的静息前电位（ARP）显著更高（P < 0.05）。多元回归分析进一步证实，DRA严重程度独立影响耻骨直肠肌（β = 9.344 μV，P = 0.018，95% CI：[1.659，17.030]）、耻骨尾骨肌（β = 8.601，P = 0.035，95% CI：[0.621，16.580]）和尿道括约肌（β = 7.903 μV，P = 0.015，95% CI：[1.593，14.213]）的ARP。腹直肌最大间距与阴道括约肌ARP和肛门外括约肌ECP之间均观察到弱相关性。未发现DRA与盆底解剖结构的三维超声参数之间存在显著关联（P > 0.05）。DRA的严重程度会影响特定盆底肌肉中与肌张力相关的肌电图参数，尤其是耻骨直肠肌、耻骨尾骨肌和尿道括约肌的ARP。未来的康复策略应考虑DRA的严重程度，并纳入分娩方式和产次等个体化因素，以制定个性化干预措施，实现更精准有效的产后恢复。
