Jpouch and pregnancy

Hi, so I found out a few weeks ago that I'm about 7weeks pregnant. I recently just had my takedown surgery 4 months ago and since I've had pouchitis. I have concerns bc my doctors have completely stopped all my medications except Metamucil and Imodium. They also are sending me to a high risk OB. I'm just wondering on everyone's experience with pregnancy and jpouch bc I'm kind of freaking out.

Original Post

First of all, congratulations!  The best of times are ahead of you!  You can probably tell by that line that I just became an empty nester, but really, so many fun times ahead, like reliving your childhood but the way you want to!  The surgeon told me it might be difficult to get pregnant and it was. My expectations were low, but I also didn't want to have a family if I was going to be sick all the time. Suffered from UC from the age of 18-26, surgeon couldn't believe I walked around as long as I did with a totally dead colon, I donated it to science it was that bad! After surgery, path tests came back that I had Crohns! So 6 years after my take down my husband guessed my "flu" might be because I'm pregnant and I was. I will never forget; I left the dr's office, went home, got on my knees, and prayed to my God that I just wanted to be a healthy mom who could take of her child - He answered my prayer! Although my pouchitis has slowed down over the years after having children - those first 6 years were like I never had surgery and my UC was back. I definitely had challenges along the way, I have 4 fistulas now and my immune system is pretty low, but my kids don't know me as a being a sick mom.  

Like you, my doctor sent me to a high risk OB, and I went every two weeks. I suffered from severe pouchitis before my pregnancies, but it slowed down quite a bit while I was pregnant. As a matter of fact, I didn't have any bouts with pouchitis until I was 32 weeks pregnant. 20 years ago a J-Pouch was unheard of (to this day I still end up with doctors who are clueless to this surgery) and the OB's didn't know what to do with treating my pouchitis while pregnant and in retrospect, there was probably nothing they could have given me. But I ended up delivering at 32 weeks. Not sure if the stress from the pouchitis broke my water or we J-Pouchers are a high risk because of our new systems. Only bad call by the OB was he thought I could deliver a breach premie baby naturally -because the baby was so small. NOT a good call. Since my file had a c-section required, as soon as I was admitted they gave me a spinal epidural. I couldn't feel anything, I couldn't feel the contractions, I couldn't push. They took him by forceps, ended up black and blue from head to toe, and a dislocated shoulder and hip. No fun delivering a premie, having to leave them at the hospital, but he grew up to be a great kid. After I stopped nursing at 9-10 months, I ended up getting pregnant again!  I delivered at 37 weeks and all was good. My 19 and 20 year old boys are now in college and I have a little more time to pamper myself.

My take away for you, no matter what, premie or not, make sure you have a c-section! I felt great through both my pregnancies, no pain or discomfort in my abdomen or at j-pouch. I got lots of rest, ate good, took a walk every day, and took prenatal vitamins.  

Good luck and DON'T WORRY!  Say a prayer, take a deep breath, enjoy your pregnancy, and take one day at a time. 

 

Hi Eagler123-- I'm just about 9 weeks pregnant with a j-pouch and feel just as worried and anxious as you. I've had my pouch for over a decade and am not on any medications for it, but I totally understand where you're coming from. I'm being treated by a regular ob/gyn but he's considering me "high risk" and I'll have more monitoring. We've already discussed a scheduled c-section with a colo-rectal surgeon on hand. But I'm pretty terrified of pregnancy complications-- I had a partial bowel obstruction this week that thankfully resolved itself, but with a growing uterus I imagine I might be in for more of the same. Good luck and stay in touch!!

Congratulations to you both! I had one of my girls post-pouch operation. I also suffer from pretty chronic pouchitis, but for the most part my pouchitis calmed down during my pregnancy. For times when it flared, I took antibiotics -- there are a number of them you can take safely while pregnant, just ask your doctor. I too had a high risk ob-gyn which was great as I seemed to have greater access to and attention throughout my pregnancy which helped give me piece of mind.

I did have a few partial bowel obstructions during my pregnancy, especially near the end as baby got big, but fortunately I got through them without needing any medical intervention. It is stressful for sure, but take it one day at a time. I tried to be very careful not to eat anything too fibrous towards the end as the bowel obstructions increased in frequency.

In the end I decided to go with a planned c-section and everything went perfectly. I now have a very healthy 2 year old. Good luck, and I'm happy to answer any questions you have.

 

Thanks for replying. I saw my high risk OB last week and he was very helpful in calming most of my nerves and worries. As far as antibiotics my gi doesn’t seem to reccomend anything other than cipro and flagyl which my OB said no to. What antibiotics were you able to take for the Pouchitis? Also my OB said he would not let me deliver vaginal that I would have to be a csection due to my pouch surgery being fairly recent. I had asked him though how soon they would do the csection he would only say we will see when you get farther along. How many weeks were you when they did your csection? Thanks

Hi,

As I recall, my ob-gyn was OK with me taking flagyl and cipro during my pregnancy (I think cipro was only advised against during the first trimester). I also took amoxicillan (which I don't find to be quite as effective as cipro or flagyl for treating pouchitis, but it works OK in a pinch) which is commonly prescribed to pregnant women if necessary for all sorts of infections. 

 Below is a links to an article maintained by Motherisk at Sick Kids Hospital in Toronto that looks at the risks different antibiotics pose to the fetus:

http://www.motherisk.org/prof/...l.jsp?content_id=882

As my ob-gyn explained, there is always a risk in taking any medication, especially while pregnant; however, the risks of taking certain antibiotics while pregnant are very small in proportion to their potential benefit. A pregnant women left sick with untreated pouchitis poses its own, arguably more significant, risks.

Perhaps take the article above to your doctor to discuss your options?

My ob-gyn left it to me to determine whether I wanted to pursue a vaginal delivery or a c-section (although he recommended a c-section, he was comfortable with whichever way I decided to go as evidence shows there is no increased risk to baby of pursuing either option). In the end I decided upon the c-section as I wanted to avoid as much risk to my pouch as possible (there is evidence that pouchers who have c-sections experience less trouble with incontinence long term) and I didn't feel strongly about needing to experience another vaginal birth

I delivered as is typically done for c-section births -- it was scheduled one week before my due date (if I remember right it was at 39 weeks). I have to say a planned c-section is sort of lovely, especially as compared to what I've heard from friends who have had an emergency c-section: my husband and I woke up, read the paper, went in and were joking with nurses and then calmly walked into the delivery room -- 30 min later we had a baby! Recovery wasn't as easy as my previous vaginal birth recovery, but compared to jpouch surgery it was no big deal.

Hope that helps!

 

 

Hi there, Congratulations on your pregnancies! I just wanted to chime in as I have had a j-pouch for 14 years and had a baby a year ago. My doctor considered me higher risk, but my prenatal visits were pretty much the same as a low-risk patient. I did meet with a maternal fetal specialist, who consulted with a colorectal surgeon, and the whole team agreed that the best course of action would be to try for a vaginal delivery. A c-section is another surgery with additional risks, and given that I already have plenty of scar tissue in the area, they didn't want to have to open me up again. (Worth noting that I hope to have several more kids, so we were also considering the fact that it would be several more abdominal surgeries, not just the one, if we went the c-section route.) Long story short, I was able to deliver my son vaginally with no complications or effects on the pouch. It is my understanding that in and of itself, a j-pouch does not have to mean that you should have a c-section (though there are plenty of other pouch-related factors that could steer you in that direction). I think the doctors and hospital you deliver at play a huge role in determining which way you go, and I was at one that works very hard to avoid unnecessary c-sections.

Happy to chat with anyone who is considering a vaginal delivery and share the resources I found while I was considering it myself. I was definitely very nervous about messing anything up pouch-wise, but believed that my best option was to at least try for a vaginal delivery. Good luck!

Thank you everyone for your replies! I have seen a high risk pregnancy doctor for the second time and they said with my last surgery being so recent that a csection is the best option for me. And as far as the pouchitis, my symptoms have kind of slowed down since pregnancy but I still have to continue taking the Imodium and limotil but just lower doses.

Congrats on finding out you are preggo! When I had my pouch done the surgeon informed me that this surgery will make you that you will never be able to conceive. I was like "what". I was so desperate to get rid of this stoma so at the time I did not really care. Well now I do. Did anyone out there experience the same thing?  Also, after the baby is born how is this effecting your j-pouch? 

Thanks ljk

 

By the way I constantly have cramps like I am going to start my cycle. But then nothing happens! As of now I am severely malnourished and I believe that's why I can't have a cycle. Although the docs say I am going through early menopause! For some reason I'm having a hard time believing this info and want to still try to have one. I don't know what you think about not having a cycle, but for me it sucks!!! Like I'm getting old or something!

I'm now 15 weeks pregnant with my little one. I've consulted with the MFM, who is taking my lead and will deliver by c-section at 37 weeks. I need to get in touch with a colo-rectal surgeon, and it's on my to-do list. (I should really make that call today!) If he has a very different viewpoint from my original colo-rectal surgeon, then I'll take his input into consideration as well. I'm not being treated as high risk and my prenatal care is that of an average pregnant woman, but I understand that I'll have more sonos in the third trimester because it will be difficult to measure my fundal height.

 

ljk posted:

Congrats on finding out you are preggo! When I had my pouch done the surgeon informed me that this surgery will make you that you will never be able to conceive. I was like "what". I was so desperate to get rid of this stoma so at the time I did not really care. Well now I do. Did anyone out there experience the same thing?  Also, after the baby is born how is this effecting your j-pouch? 

Thanks ljk

 

I would consider consulting with a reproductive endocrinologist, especially if you aren't getting periods on your own. I was only able to get pregnant through IVF due to scar tissue on my fallopian tubes from the j-pouch surgeries and an irregular cycle from PCOS (unrelated to my GI issues). It's worth visiting the real experts to assess your fertility.  

Unfortunately I have. I have also done IVF, even used an egg donor in which I had 12 embryos and 4  transfers. Each transfer was a negative result! Which ripped my heart out and sobbed for months. this was when i had my stoma, the checked all my levels every time. I think its not about quanity but is all about the quality. I really don't think my donor had the best eggs 30k later I have nothing !

Congratulations on the pregnancy - I assume since this post is a few months old that you're well on your way to either having the baby or will be having it soon. 

For those who have struggled with infertility as a result of surgeries and such - I'm so sorry. 

I recently found out I'm pregnant and am in my third month. I feel like I have the start of an obstruction and I'm not sure what to do. My GI wants me to go to the ER, but I don't know what they would be able to do for me. I'm not as bad as to where I need pain medication - not that they could give me any anyhow. Also, I'm tired of going to the ER and doctors! 

My question is, how do they handle things if you have a partial (or suspected) obstruction if you are pregnant. I assume they can't do an MRI or an x-ray like they would to diagnose you if you weren't pregnant. Is it even worth me going?

Symptoms since Sunday (Tuesday now), severely bloated, can't lay down without curling my legs up bc it feels like someone punched me in the stomach. Decreased appetite bc of stomach pain and bloating, no fever. Dizzy the past 4-5 days. I've also been vomiting (once yesterday and once this morning, but that may be bc of morning sickness which I've had). No fever. I usually have 10-12 bowel movements a day, but I went twice today and it's already 1pm. I was up 5x last night with gas pains and urge to go. 

Any suggestions?

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