Pregnancy is generally possible and safe for women with a colostomy bag, provided appropriate medical oversight is maintained. A stoma is a surgically created opening on the abdomen to divert waste, and its presence does not prevent conception or the ability to carry a baby to term. Women who have a colostomy often have underlying conditions such as inflammatory bowel disease (IBD), like Crohn’s disease or ulcerative colitis, or may have had surgery for cancer or trauma. A successful pregnancy relies heavily on the mother’s overall health and the stability of the underlying medical condition that necessitated the stoma. With careful planning and management, women with a colostomy can experience a healthy pregnancy.
Pre-Pregnancy Preparation and Planning
The phase before conception is an important time to ensure the best possible outcome. It is strongly recommended to consult with a multidisciplinary team that includes an obstetrician-gynecologist (OB-GYN), a stoma care nurse, and a gastroenterologist or surgeon. This specialized team can assess the mother’s health and develop a comprehensive plan for monitoring the pregnancy. A primary goal is to ensure the underlying disease, particularly if it is IBD, is in a state of remission for at least three to six months before attempting to conceive. The care team will also review all current medications to confirm they are safe for use during pregnancy, making adjustments as needed. Furthermore, the current stoma site needs evaluation, as prior abdominal surgeries can increase the risk of complications like a parastomal hernia during pregnancy.
Practical Stoma Management During Pregnancy
As the pregnancy progresses, the growing uterus and changing abdominal shape necessitate practical adjustments to stoma care. The stoma itself can change significantly in size and shape due to increased blood flow and fluid retention, which can cause swelling. It becomes necessary to measure the stoma frequently, often at every pouch change, to ensure the appliance barrier is cut to the correct size. Many women find they need to modify their ostomy pouching system, sometimes moving away from a flat barrier to one with convexity, or vice versa, to maintain a secure seal on the expanding abdominal contours. The increasing size of the abdomen, especially in the third trimester, can make seeing the stoma difficult, so using a mirror can assist with appliance changes and skin checks. Maintaining the health of the peristomal skin is also important, as a leaky appliance due to changing body shape can cause irritation.
Addressing Pregnancy-Related Stoma Complications
Pregnancy places physical stress on the abdomen, which can lead to specific stoma complications. One such complication is stoma prolapse, where a section of the bowel pushes out through the stoma opening, often caused by the increased intra-abdominal pressure from the growing fetus. While a small degree of enlargement may not be a major concern, it requires close monitoring for changes in color or excessive protrusion. Another complication is bowel obstruction, which can occur when the enlarging uterus presses against the small intestine, blocking the flow of waste into the stoma bag. Symptoms of a blockage include a noticeable decrease or complete absence of output, abdominal distension, and cramping pain. Stoma retraction, where the stoma pulls inward and becomes flush or recessed with the skin, is a serious issue that can compromise pouch adhesion and lead to severe skin damage. Any sudden, severe pain, a lack of output, or a change in the stoma’s color should be reported to the healthcare team immediately.
Labor, Delivery, and Postpartum Considerations
The method of delivery requires careful consideration, but having a colostomy is not an automatic requirement for a cesarean section (C-section). Vaginal delivery is often possible and preferred, but the decision is based on obstetric factors and the stoma’s location. For instance, if the stoma is located close to the midline or if there is extensive scar tissue in the pelvic area from previous surgery, a C-section may be recommended to avoid potential trauma to the stoma or bowel. During labor, the stoma should be protected by emptying the pouch before active delivery. In the immediate postpartum period, the stoma and abdomen rapidly change shape as the uterus shrinks, often causing the stoma to revert to its pre-pregnancy size. The stoma care nurse should be involved in the postpartum hospital stay to assess the stoma and adjust the pouching system to fit the newly reduced and softer abdomen. The recovery period requires vigilance for complications like parastomal hernia due to the weakened abdominal wall, and women are advised to avoid lifting heavy objects soon after birth.