Pregnancy with an Ostomy
Question:
My wife has an ostomy. We are hoping to have children soon. Are there any concerns about pregnancy and ostomies?
Answer:
Having a stoma is not a contraindication to pregnancy and delivery. Most women with ostomies do very well during their pregnancy and experience no complications before or after the birth. There are, however, several things your wife will need to consider during the course of her pregnancy and after delivery.
The most significant changes that will occur during pregnancy are to the stoma (usually its height, degree of protrusion, and diameter) and to the peristomal skin contours (dips, creases, and curves). As the fetus grows in the uterus and your wife begins to gain weight, the stoma may begin to protrude less, the diameter may increase, and the skin around the stoma may start to flatten out. The stoma may, in fact, become flush or retracted during the latter part of gestation, though its function will not likely alter. Changes in the stomal height and diameter and in the peristomal contours usually mean a change in the type of appliance your wife will need to use. Changes in the type of flange are most typical: for example, switching from a flat flange to a convex one. Switching to an alternate product is usually not required in the first trimester and the early parts of the second trimester; however, as the fetus begins to grow and your wife begins to noticeably gain weight (in the latter part of the second trimester and throughout the third trimester), alternate products may be required. If the pouching system is not addressed and altered during the pregnancy, then complications such as skin irritation or lacerations to the stoma can occur.
The changes to the stoma and the peristomal skin can be quite dramatic as the pregnancy progresses. Therefore, it is best not to buy large quantities of product as your wife’s needs may change rapidly and she may require several product changes. Major ostomy supply companies have sampling programs, so you may be able to obtain small quantities of product for free. Regular visits to an Enterostomal Therapy Nurse (ET) can help your wife determine which products are best suited to her needs throughout the pregnancy. The ET can also help you access the sampling programs.
After delivery, your wife’s stoma and peristomal skin will go through changes again: the birth of the baby may make the skin less taut, with more wrinkles/creases than previously, and the stoma may begin to protrude again. As your wife loses the weight associated with the pregnancy, those changes may continue, once again necessitating alterations in her pouching. Given variations in the degree and amount of post-partum weight loss, it is difficult to predict if she will be able to return to the pouching supplies that she used prior to pregnancy.
The nausea and vomiting associated with morning sickness can be problematic if your wife has an ileostomy. Fluid and electrolyte imbalances can occur rapidly under these conditions, causing dehydration. Nausea may interfere with her desire to eat, compromising nutrition for her and the fetus. If morning sickness is a concern, then your wife must be closely monitored by her doctor and assessed for intravenous (fluid given through a vein) and nutrition support, so that dehydration and malnutrition can be prevented.
If your wife has a colostomy, she may have difficulty with constipation in the latter stages of the pregnancy. If constipation does become a concern, your wife should discuss this with her doctor and ET to determine a remedy that is safe for her and the fetus. If your wife has a colostomy and irrigates, she may find that irrigation becomes problematic as the pregnancy progresses. She may only be able to instill smaller amounts of fluid, making the irrigation less effective and causing intermittent leakages. She may also find that she cannot insert the irrigation cone adequately, preventing her from instilling the fluid. She may need to consider stopping irrigations during the latter parts of the pregnancy and resuming at some point post-partum.
Some women with continent ileostomies (e.g. Kock or Barnett pouches) may find that irrigations of the pouch become difficult in the second and third trimesters. Women may have a difficult time inserting the catheter into the stoma. Use of more lubricant; lying supine while inserting the catheter (which decreases the pressure on the pouch/valve); or smaller catheters may be required. Temporary dietary changes (e.g. avoidance of any insoluble fibre products) may also be required if a smaller catheter is used, to ensure that the pouch can be adequately irrigated and drained. A dietitian will be able to help her with any diet changes.
The stoma may also fall away from your wife’s field of view as she gains weight. She may need to use a mirror perched on the bathroom counter to help her perform her ostomy care. She may also want to switch to a longer pouch to help facilitate emptying into the toilet. Some women find it easier to empty the pouch into a container set on the bathroom counter, rather than trying to struggle with a large abdomen and poor visualization while sitting on a toilet.
Some complications can occur after delivery. Parastomal hernias (hernias around the ostomy) and prolapsed stomas (abnormal lengthening of the stoma) have been described in the literature. An ET can help to assess and manage any problems or concerns your wife may have after delivery. Staying in contact with your healthcare team will help make the whole experience of adding to your family more enjoyable and manageable for you and your wife.