Saturday, November 24, 2012

Pouchitis in Pregnancy: Our First Trip to Labor & Delivery

Complications. They love me. Anaphylaxis, dysplastic nevi, kidney damage, abscess, Portal Vein Thrombosis, small bowel obstruction, thrush. And that's the short list. Now it's premature contractions. I  found myself hospitalized once again on Tuesday after being sent there by my OB. I had pretty bad cramps, but didn't think much of it. Thankfully, I have slightly more paranoid family members. After being blackmailed by the hubby, I called the doc, went to Labor and Delivery and, sure enough, discovered that I was having contractions 1-2 minutes apart. After receiving some terbutaline injections, IV fluids and several hours of monitoring, I was discharged home on indomethacin to be taken for the following 48 hours. Both terbutaline and indomethacin are used to stop early contractions from developing into premature labor.

This was all very frustrating. I finally called the GI doc and my surgeon the next day, per the request of my OB, as apparently it is not "normal," even for a J-Poucher, to be using the RR 25 times/day. I guess the bleeding was also of some concern to them. As a J-Poucher, I very honestly thought it was just the pressure of the baby causing the bleeding and frequency. It's just become such an unexceptional part of my existence over this past decade. Unfortunately, I do have pouchitis, a bacterial infection of the J-Pouch. Symptoms are very similar to UC, I would say only that the bleeding is not as severe and pain is very minimal with pouchitis, both welcome attributes of the infection. They believe that this infection is causing inflammation, and possibly dehydration at times, that could have led to these premature contractions. The problem? Treatment.

The antibiotics used to treat pouchitis are more or less off the table for we preggers ladies. They have put me on Canasa to try and minimize the inflammation, knowing that it will not treat the infection. Antimicrobials are the answer, but anti-inflammatories are the only safe treatment for now. The indomethacin, an NSAID, has also aggrevated the pouchitis, but after conferring with the GI ward at the hospital, it was decided that preventing labor at 28+ weeks was more of a priority than exacerbating the pouchitis symptoms. Nothing is ever straight-forward.

For now, just trying to get these symptoms under control as to avoid another onset of contractions. Between the lovenox monitoring, the pouchitis and the high-risk pregnancy, my trips to the doctors are becoming quite frequent! If any of you J-Pouchers out there have any au naturale treatments for pouchitis, dietary advice (I was put on a low-residue diet), or any comments at all I would love to hear. I do trust my doctors, but I believe sometimes as patients we can gain important insights.

Hoping Baby P can stay cooking for quite a bit longer! 29 weeks now and hoping to give this little girl a healthy start….


  1. Katie, I had my full proctocolectomy in 2001 and oleo for 6 weeks after that. Afterwards I felt a million times better and ignored many symptoms simply because I thought I was better. It is all relative! Anyway, about 2 years ago after an intense bit of work I went to a eastern medicine doctor and she ultimately said I had food intolerances, gluten and dairy + a few other random foods. As soon as I removed these from my diet all of the post-surgery issues cleared up. No more dehydration, no more headaches, a lot fewer trips to the toilet, no more UTIs, the list goes the moral of this story is to get a full food intolerance test. Mine was a blood test for over 300 food items. Since then I have been able to get pregnant and we're at 10 weeks now. Yay!! Today though I have a liver scan as my levels are elevated. There's always something I guess. I live in the UK and the first doctor I have seen said we had to try our best for a vaginal delivery but I'm going to get a few opinions as you have done. I'll keep in touch. Thanks so much for the blog. Be well. Emily

    1. Emily,

      Thank you for writing! I have been meaning for years to get tested for food intolerance and I think I will finally get around to doing just that. It is a very good idea! I feel like I have a good idea of what foods aggravate me at this point, but I think it doesn't hurt to know what allergies you have as well.

      A BIG congrats on your pregnancy! That is so very exciting! I would definitely get other opinions about the C-Section vs. vaginal delivery. I found that every doctor I went to that was not very familiar with J-Pouch surgery told me "we just have to make sure you don't need a C-Section" as they assumed that we would want to avoid another abdominal surgery at all costs. However, my surgeon and other doctors that were more familiar with my surgeries/condition were adamant about C-Section over vaginal delivery as the risk for a tear/rupture/damage to your anus during delivery is too great, and that would result in loss of pouch and end ileostomy. :( Perhaps even other complications.

      Anyway, best of luck to you! And please do keep in touch on the progress of your pregnancy. You are one of the few I have been in touch with that is pregnant with pouch! Best, Katie

  2. I am 7 weeks pregnant. I am 26 years old and had my surgeries for ulcerative colitis when I was 8. I often get pouchitis and usually treat it with ciprofloxacin and flagyl. I am now suffering with a particularly bad bout of pouchitis and am also wondering what there is I can do to treat it and if it is harmful to my baby? If either one of us finds an answer we should keep in contact!

    1. Hi Courtney!

      Sounds like we're in the same boat. I have actually been meaning to update my blog with a new post as it has been several weeks since my last and I've had some new updates with the pouchitis. It was decided that Cipro is for sure off the table because of the possible harm to the fetus, but they did put me on Flagyl which has been working wonders. That said, they tried to taper me from the Flagyl a couple of days ago and the pouchitis is acting up again, so I am not too hopeful about getting off of the Flagyl in near-term. I am almost certain that my doctor told me they will not prescribe Flagyl until after 14 weeks or so, because even Flagyl can do damage to a fetus/embryo at the early stages, but it will certainly be an option for you soon. They also have me on a probiotic called Florastor, which would definitely be worth asking your doctor about. It's hard to say if it's making a difference because I am on the Flagyl as well, but I am feeling much better so it's worth a try.

      I hope they can find something to treat your pouchitis earlier than 14 weeks! And I could be wrong about that even, I just think my doctor did say in passing that Flagyl can't be used early on. It is a Category B drug for pregnancy though, so it is certainly safe to take later.

      Best of luck and keep in touch with the progress of your pregnancy! You're one of few with a J-Pouch that is pregnant that I have been in contact with, so it's great to get an idea of what normal is for us. :)