Objective Based on the previous study that mild moxibustion combined with BMSC transplantation can synergically promote the repair of the structure and function of the injured anal sphincter in rats, further explore the effect of the synergistic repair involves the Wnt/β-catenin pathway and the effect of BMSC-derived exosomes on C212 myoblasts. Methods Sixteen SD rats were randomly divided into 4 groups. All rats were treated with Zutshi rat anal sphincter complex injury model. After modeling, they were treated with mild moxibustion for 30min, BMSC transplantation and normal saline for 14 days. After treatment, the anal sphincter was stripped and the protein expression of Wnt4, Wnt5a and Wnt5b was detected by qPCR and Western blot. After co-culture of BMSC-derived exosomes with mouse myoblasts C2C12, EDU and CCK8 were used to detect the proliferation effect of BMSC exosomes on C2C12 cells, and to explore the difference of BMSC proliferation with different concentrations of exosomes. Flow cytometry was used to detect the effect of BMSC exosomes on C2C12 cell cycle. Results Western blot and qPCR analysis showed that mild moxibustion combined with BMSC transplantation could promote the high expression of Wnt4, Wnt5A and Wnt5B. CCK8 results showed that BMSC-derived exosomes could promote the proliferation of C2C12 cells, and the optimal concentration was 25μg/mL. Co-culture results showed that Cleaved Caspase3 and BAX expression were inhibited by BMSC-derived exosomes, and BCL2 expression was significantly up-regulated. Conclusion Mild moxibustion combined with BMSC transplantation can promote the high expression of Wnt4, Wnt5A and Wnt5B, and BBMSC exosomes can regulate the cell cycle of myoblast C2C12 to promote proliferation and inhibit apoptosis. It is speculated that mild moxibustion combined with BMSC transplantation may promote the repair effect of injured anal sphincter in rats by activating Wnt/β-catenin signaling pathway.