Ostomy and Pregnancy

     Women of childbearing age with severe Crohn’s disease or ulcerative colitis occasionally face the prospect of having ostomy surgery. When these women contemplate pregnancy, they may continue to suffer with pain for fear that having an ostomy will make a pregnancy dangerous or high-risk. This simply is not true. In fact, women who had a child before the ostomy claim that pregnancy was easier after having their surgery performed. In addition, no increase in infertility has been noted for women who have had bowel surgery and are attempting to conceive. The normal rate of needing assistance from an infertility specialist is no different than the general population of women trying to conceive.

     Approximately one in 20,000 women with an ostomy become pregnant each year. I have taken care of a number of pregnant women with an ostomy during my career. These women had uneventful pregnancies and healthy babies.

Advice

     Steps can be taken to ensure a good outcome and lessen problems if you do have an ostomy:

•    Your diet should consist of three healthy meals — ie, low in fat and sugar — per day. You should try to keep your weight gain to between 20 and 25 lb if you are of normal weight.
•    You should continue to supplement your diet with iron, calcium, vitamin D, and folic acid.
•    Generally, women should drink extra water to avoid formation of kidney stones. Women with ostomies divert salt output from the bowel to the kidneys, which if not diluted with extra water can produce kidney stones.
•    As the uterus enlarges, the bowel can become blocked, causing intestinal obstruction and requiring dietary changes and medication. Therefore, it is important to see your GI physician as well as a high-risk specialist throughout your pregnancy.
•    Moderate exercise during pregnancy should pose no problems for women with an ostomy. Remember to empty your pouch before exercising.
•    You should clean your skin and change your pouch after any ultrasounds. The jelly used during the scan may make its way under the adhesive tape that holds your pouch in place.

Belly Concerns

     The abdomen of a pregnant woman goes through many changes. Women with ostomies will have changes in the stoma size and shape. You may need to experiment with different pouching systems as your abdomen grows. Additionally, if you have had multiple abdominal surgeries, you may have scar tissue and adhesions. This may cause you some discomfort as your belly expands, but is of no harm to you or the pregnancy.

Delivery

     There is no added risk to having a vaginal delivery even if the rectum has been removed. A vaginal delivery is usually preferred to a Caesarian section because of adhesions and scar tissue that likely formed from prior abdominal surgery. The stoma usually will go back to pre-pregnancy size approximately 4 weeks following your delivery.

Surgery Timing

     Young women with Crohn’s disease or ulcerative colitis should consider definitive treatment (surgery) before having children if the GI physician believes such surgery is inevitable. Most women are healthier following surgery and have a better experience during pregnancy than those who are chronically ill. I recommend a couple wait 6 to 18 months after bowel surgery to try to conceive to allow adequate healing to occur; your physician can advise you on this time interval.

Dr. Charles Hux is a high-risk obstetrician in private practice in New Jersey. For the past 8 years, he has been the current resident “multiples doctor” on The Learning Channel’s A Baby Story and the author of the new book, Nine Healthy Months, the first book in the 21st Century Pregnancy Series. For additional information, please visit: https://huxmd.yourmd.com//