How to manage Ostomy during pregnancy?

There is nothing to worry about the stoma and your pregnancy. You need not worry about your pregnancy and delivery even though you are having a stoma. Several women experience no complications and risks before and after the delivery, it’s normal and safe. But here are several things you must take care of during your pregnancy and after the birth also.

Changes that occur during the gestation period:

The most prominent changes occur in the stoma. It can change in its:

• Height

• Degree of protrusion

• Diameter

These changes also affect peristomal skin (creases, curves, and dips)

With the passing days as the fetus starts growing and you gain weight; there is a decrease in stomal projection and there may be an increase in its diameter. There are also chances that the skin around the stoma may flatten out. During your gestation period, the stoma may change its color and it may become less visible. But don’t worry its functions will remain the same. You just need to change your stoma appliances to cope up with the increase in stomal height and diameter. The most common example is changing your flange. If you have been using a flat flange, now you need to replace it with a curved flange. In the first trimester, there are not many changes in the stomal orientation. However, during the end of the second trimester and start of the third trimester when you start to gain more weight, changing your products is necessary. If you will not switch to the other products it may develop the risk for skin irritation and stomal laceration.

Post-partum changes:

It is recommended not to shop too many products at a time because the changes in body and stoma are very sudden and dramatic during the last trimesters. So you may need to switch to the different sizes with every coming day. Most of the famous brands offer samples that can be used as a free trial. You can also contact your ET nurse. She can help you to choose the products for you throughout your gestation period. She can also help you with using these products.

They're also the number of changes in your peristomal skin after the delivery. Some common changes are:

• Less taut skin

• More wrinkles around the stoma

• The stoma may begin to protrude again.

After delivering the baby you will lose weight and it will bring changes in your body one after another. That’s why you need to make changes in your pouching system accordingly. Depending on the alteration and variations in your body weight after the delivery, it is hard to decide whether you can use those appliances which you were using before pregnancy. 

Pregnancy and Ileostomy:

Usually, nausea and vomiting that are related to morning sickness can cause problems if you have an ileostomy. Frequent vomiting can cause dehydration due to fluids and electrolyte imbalances. Nausea may affect your appetite, and it can be bad for you and your baby. In this case, you must have regular checkups by the physician so that she can introduce intravenous nutrients into your body. This shows how dehydration and other weaknesses can be avoided.

Pregnancy and colostomy

In case if you have a colostomy this can cause constipation with the advancing trimesters. If constipation prolongs then you can consult with your ET. She will prescribe you any medicine or any remedy that will be safe for you and your baby as well. If you are having a colostomy and you are used to performing irrigation, it can be a concern for the later stages of pregnancy. With the advancing days, you may not be able to install an adequate amount of water that is needed for irrigation. This will lead to discontinuous leakages. You will also observe that you are not able to insert the cones properly and ultimately water can’t reach inside your body. You may need to stop irrigation in the last trimesters and use any alternative. But you can start irrigation after some period of delivery.

It has been observed that some women feel difficulty in the irrigation of the pouch during the second and third trimesters. It’s hard for women to place a catheter inside the stoma. This problem can be solved by following the steps mentioned below:

• Use more lubricant

• Lying supine during the insertion of catheters

• Use a relatively smaller catheter

 

Problems related to Ostomy care

If you decide to use a small catheter then you must avoid high fiber foods. This will ensure that the pouch is irrigated and drained properly. You can seek help from a dietitian for this matter.

There is also the possibility that you may not see the stoma because of your weight and large stomach. You may need a perched mirror to perform your Ostomy care. You can also use a longer ouch that will help you to drain the pouch easily in the toilet. Most of the women prefer to drain the pouch in containers placed on the bathroom counter. It prevents them from the extra struggle to visualize their stoma.

Risks 

There are chances of some complications following the delivery. You may develop:

Parastomal hernia (hernia around the stoma)

•  Abnormal lengthening of the stoma (prolapsed stomas)

Your ET can support you to manage the complications after your delivery. If you will stay connected with your health care team it will be good for the health of your baby and it will allow you to enjoy your precious moments.

What is Parastomal Hernia?

If there is an abnormal protrusion or outpouching of the bowel from a feeble area in the abdominal wall, this condition is called a hernia. If you are having a hernia then the weeknd area is around the stoma opening in the abdomen. You can observe a slight bulge to a very large protrusion, depending on the size of the weakened area. Sometimes the prostration is so large that it can be noticed easily under the clothes. There are many things that you should know about how to manage a hernia.

Almost 5- 10 % of people with colostomies have chances to develop hernia and almost 3-10% of patients with ileostomy also develop a hernia. However, it is difficult to know who might be affected by parastomal hernia. Some factors can help you to predict it before its development.

• Location of the stoma: Typically, when a new stoma is created, it must be brought through a muscle present in the abdomen that is referred to as rectus abdominis. If the stoma is placed outside this muscle this may develop a hernia.

• Obesity: People with a lot of fats or obesity have more chances to develop a hernia than others.

• Malnutrition: If you don’t take a well-balanced diet or you have a poor diet after the surgery, this will not only affect the healing time but also weaken your parastomal area.

• Age: Advancing age can be the reason for poor muscle tone. This will develop hernia more easily.

• Increased intra-abdominal pressure: The conditions such as severe coughing, severe sneezing, or lifting a heavy object can also weaken the muscles of the abdomen near the stoma; this will be the reason for the increased pressure within the abdomen that can lead to a hernia.

• Infection following stoma surgery: Any kind of infection can weaken the muscles of the abdominal wall and leads to a parastomal hernia.

When does a hernia develop?

Parastomal hernias may occur just after the surgery and in other cases, it takes many years to happen. Usually, people (80%) don’t experience any complications during hernias and recover without any interventions. The rest of the 20% may notice some symptoms that need to be resolved immediately. In some cases, a hernia can be noticed only in a certain position such as if you are standing or sitting. And this will disappear if you lie on your back. In some cases, a hernia can be noticed in any position.

How to manage parastomal hernia?

Abdominal discomfort can be caused due to parastomal hernias. Many people complain about the tightness, tautness, and weight of the parastomal area which is not painful but the patients become uncomfortable. If you will use a hernia belt or an undergarment such as lycra it can help you to avoid this discomfort. The belt should be according to the size of your abdomen, and it must have a hole that fixes exactly around the stoma and allows the Ostomy pouch to connect with the stoma. In case of severe and continuous pain or discomfort, you should call your doctor without wasting any time. Your ET can help you to choose between a Lycra and belt according to your condition.

Main Concerns

The size and shape of the stoma may also be affected by parastomal hernia. The changes in stomal size and shape are more prominent when you are sitting, standing, or lying on your back. In case of a large hernia, it is hard to examine your stoma and you need to struggle for your Ostomy care. These changes in stoma size and shape can also bring leakages in Ostomy bags and can irritate peristomal skin. You should consult with your ET nurse to cope up with this problem.

When surgery is needed?

This can be a reason for abdominal bloating (distention). There can be a need for surgery, that’s why you should consult with your surgeon if you feel any of these signs. Moreover, a hernia can prevent the normal functioning of the stoma. If this happens with you, there is an immediate need to see your medical expert. Patients who have colostomy along with parastomal hernia, and they use an irrigation method, they need to stop irrigation at this point. If irrigation is not stopped it can cause other complications. You can ask for help from your ET about the regular pouching system.

Some people dislike the bulge that occurs due to the parastomal hernia and they want to fix it through surgery. It’s better to discuss with your surgeon whether surgery will work for you. There are different methods to resolve this issue. For example, the stoma can be shifted to the opposite side, closing the hernia or local repair at the stoma site. If surgery is recommended; then the surgeon will discuss with you the basic risk, complication, and procedure.