May/June 2000

Pregnancy and the Ileostomy

Pregnancy - Before embarking on a pregnancy, it is important to check with your doctor or surgeon as to whether you are now fit to go ahead. You may be asked to visit a gynecologist for pre-pregnancy counseling to discuss any possible difficulties before pregnancy occurs.

Most women with ileostomies sail through their pregnancies with no particular problems, but some commonly asked questions and less common problems will be discussed.

"Will my ileostomy work normally during pregnancy and will I be able to manage it when my tummy gets bigger?"
Usually the ileostomy works perfectly normally, but you may need to increase fluid intake because the developing pregnancy and the changes in your body require extra fluid. Occasionally during pregnancy women get episodes of intestinal obstruction when the enlarging uterus causes a hold-up in the passage of intestinal contents. The ileostomy stops flowing the pouch and the abdomen may become distended and colicky pain is felt. Restricting the diet to fluids only and resting may resolve the problem, but on rare occasions hospital admission and an intravenous will be needed to "rest" the intestine.

During pregnancy, changing of the ileostomy is not usually difficult, but when the abdomen gets very big in the later states of pregnancy, it may be necessary to use a mirror. Sometimes the stoma enlarges due to stretching of the skin and muscle and there may be some prolapse of the intestine into the pouch. That is more of an inconvenience than a danger to health.

What about diet during pregnancy?
Nobody needs to eat for two in pregnancy, but some increase in certain foods may be desirable. Plenty of protein and vitamins are needed, so it may be sensible to eat more meat, eggs or cheese, and some vegetables or salad. Iron tablets will usually be prescribed and possibly some vitamin tablets. Pregnancy women should avoid all but small quantities of alcohol, and of course, smoking can be very harmful for the developing baby.

Is Caesarian section necessary for ileostomates?
Caesarian section is certainly not the rule for ileostomy patients; indeed most obstetricians will try to avoid this because previous surgical scars may make the operation slightly more difficult. The vast majority of people with an ileostomy can have a vaginal birth, but there are a few factors which can affect details of the birth. If the rectum has been removed and there is scar tissue in the perineum (the area between the vagina and the original site of the anus), it may be necessary to do an episiotomy (a small 'cut' to enlarge the vaginal entrance) in order to make the birth easier and prevents an ugly tear. If there has been a lot of damage to the nerve supply, the woman may not get the urge to push her baby out, and so may require a forceps delivery. None of this matters because local anesthetics are used, or an epidural (injection near the spine which takes away all the pain of childbirth). If the midwife or doctor are not familiar with ileostomies, do not worry, they will listen to your knowledge.

"Will I be able to breastfeed?"
There is no reason at all why ileostomies should not breastfeed. Remember that a breastfed baby may drink several pints of milk a day, and so fluids must be taken in greater quantities. There is no evidence that beer is better than any other fluid for breastfeeding mothers! Infertility

There has been much discussion and disagreement as to whether infertility is more common in people with an ileostomy. Approximately 10% of the population have a problem in getting pregnant and it is possible that some causes of infertility are a little more common in people who have had one of the conditions leading to an ileostomy. If women are in a very poor state of health and grossly underweight, as sometimes happens to people before an ileostomy, their periods may stop and they will not ovulate (make an egg). Once health is restored and the weight reaches normal levels, the periods and ovulation resume. Occasionally a drug is required to stimulate ovulation. Sometimes the underlying condition, or the operations for it, cause damage to the Fallopian tubes, either by causing kinking and adhesions, or rarely by blocking the tubes. When this is suspected, tests will be done by x-ray to check the tubes, and it may be necessary to have an operation to improve the tubes. If this is not successful, or if the tubes are very badly affected, test-tube baby treatment, in vitro fertilization (IVF) may be considered. This treatment is perfectly possible for people with an ileostomy nowadays, because the eggs are usually collected through the vagina or bladder and so there is no danger of interfering with the ileostomy. It is, however, important to remember that IVF is still a relatively unsuccessful form of treatment and not everybody gets their "miracle" baby.

Source: Marcus Setchell, FRCS, FRCOG; via Ottawa, ON; Kingston, ON; Metro Halifax News, Jan. 2000, via Inside Out On-line May/June 2000

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