A colostomy is a surgical procedure that creates an opening, known as a stoma, on the abdomen to divert the end of the large intestine, allowing bodily waste to exit into an external pouch. Having a colostomy does not prevent conception, nor does it preclude a successful, full-term pregnancy and delivery. While a colostomy introduces unique considerations for maternal care, women with this diversion experience successful outcomes that mirror the general population, provided they receive appropriate, coordinated medical oversight.
Medical Feasibility and Pre-Conception Planning
Successfully navigating a pregnancy with a colostomy begins long before conception with careful planning and coordination among specialists. It is highly recommended to consult a multidisciplinary team, including an obstetrician, a colorectal surgeon, and an Enterostomal Therapy (ET) or Wound, Ostomy, and Continence (WOC) nurse. This team approach ensures all medical aspects of the patient’s health are stable before the pregnancy begins.
The underlying condition that necessitated the colostomy, such as Inflammatory Bowel Disease (IBD) or cancer, should be in a state of remission for at least three to six months prior to attempting conception. This period of stability is associated with better maternal and fetal outcomes throughout gestation.
A comprehensive medication review is a necessary step in pre-conception care. Certain medications used to treat IBD, such as methotrexate, are known to be harmful to a developing fetus and must be discontinued several months before trying to conceive. All prescriptions require clearance from the healthcare team to minimize any potential risks.
Nutritional assessment is also a necessary component of planning, especially if the colostomy involves a significant portion of the large intestine. The stoma may alter the absorption of certain vitamins and minerals, which is further stressed by the increased demands of pregnancy. Proactive assessment can identify potential deficiencies, allowing for the timely introduction of necessary supplements to support both maternal health and fetal development.
Physical Adaptation and Stoma Management During Gestation
The physical changes in the abdomen require adaptation in stoma care and appliance management. The growing uterus begins to exert mechanical pressure on the stoma site, especially moving into the second and third trimesters. This pressure, combined with increased blood flow throughout the body, can lead to changes in the stoma’s physical appearance.
The stoma may swell, increase in diameter, or change in shape, sometimes becoming more flush with the skin or even slightly retracted or prolapsed. This can complicate the seal of the pouching system. Regular measurement of the stoma is necessary, as the barrier opening needs to be adjusted frequently to prevent skin irritation and leakage.
Appliance selection often needs modification during this time, moving toward more flexible wafers and larger pouches to accommodate the changing abdominal shape. A convex barrier, which is firmer and puts gentle pressure on the peristomal skin, may be necessary if the stoma becomes retracted or if creases develop around the site. The ET nurse provides guidance on these product changes and fitting adjustments to maintain a secure seal.
Managing output consistency and avoiding potential intestinal blockages becomes increasingly important as the pregnancy advances. The pressure from the enlarging uterus can narrow the passage of stool, sometimes leading to a decrease in stoma output or a partial obstruction. Maintaining adequate hydration is important, particularly if experiencing morning sickness, to prevent rapid fluid and electrolyte imbalances.
Navigating Labor and Postpartum Recovery
The delivery phase requires coordination between the obstetrics and surgical teams to plan for the best method of birth. For many women with a colostomy, a vaginal delivery is possible and is often the preferred route to avoid the added recovery time and abdominal trauma associated with a C-section. However, a prior history of complex pelvic surgery, extensive scar tissue, or the presence of a J-pouch may necessitate a planned C-section.
The location of the stoma, and any resulting scar tissue near the perineum, are factors the care team will evaluate when deciding on the delivery method. Scarring from previous abdominal surgeries can make an emergency C-section more complicated, so a planned procedure is generally safer if a vaginal delivery is deemed too risky.
During labor, the stoma will continue to function, and the pouch will need to be monitored and emptied by the nursing staff to prevent discomfort or dislodgement. Having a well-stocked supply of ostomy products packed in the hospital bag is advisable, as the physical exertion of labor and the immediate change in abdominal shape will likely require a pouch change soon after birth.
In the immediate postpartum period, the stoma site usually begins to return to its pre-pregnancy size and shape as the uterine swelling resolves. To aid healing, avoid excessive strain, such as lifting heavy objects, including the baby carrier, for several weeks. Ongoing monitoring by the ET nurse during the initial recovery ensures the pouching system continues to fit correctly as the body returns to its non-pregnant state.