A Stoma as an option after Traumatic Childbirth

For many women who are severely damaged during childbirth, either from a 4th degree tear, 3rd degree tear or a fistula, the option of a stoma as a possible solution to faecal incontinence is presented as the last, worst case scenario choice. There are many reasons of course as to why it is presented as a last choice, once repair surgery, physio, sacral nerve simulation or simple time left to heal have been tried without success. The surgery is a big one, although most I have seen are performed via keyhole surgery, which has a faster recovery rate and leaves the patient with a smaller scar on the stomach. It also fundamentally changes the way someone passes their stool, which is now through a hole in their abdomen where the colon is pulled through from the large intestine, faeces passing into a bag which is attached to the abdomen with strong adhesive. The part of the colon which is out of the abdomen is called the stoma, and the bags are replaced each day, or every few days depending on the personal choice of the patient. The patient no longer poos through their rectum.

My own stoma (colostomy) was fitted as an emergency 7 days after the birth of my premature son, as a result of a missed 4th degree tear which caused an enormous abscess and a recto vaginal fistula (where poo comes out of the vagina through an opening between the vaginal wall and rectum). The primary reason it was initially fitted was to divert the faeces from the abscess which was in the perineum, and the tear from the vagina to the rectum. The intention was to allow the area to heal and the infection to be treated with antibiotics. I was initially told that it would only be necessary for 12 weeks, by which time both the abscess and tear would have healed. It was also hoped that the fistula would have healed too.

Prior to my surgery I had extremely limited knowledge of what a stoma was, although a friend of mine who I had met in the previous few months had an ileostomy as a result of Crohns and Colitis. I knew she had struggled hugely with it as it used to activate (ie, when the poo comes out of the colon and into the bag) a lot when she was changing the bag, and as it was an ileostomy the output was liquid and difficult to contain. Ileostomies (where the stoma is created from the lower intestine) are harder to manage than a colostomy, as the output is much more frequent and watery, so if you have the choice I would have a colostomy. She also had an enormous scar all the way down her stomach and abdomen as it wasn’t done through keyhole surgery, and as a young woman in her twenties she felt very self-conscious. I still didn’t fully understand about the bags – how big they were, when they needed to be changed, or anything like that. I thought that the bags hung down your leg, almost like a catheter does.

Prior to the surgery the stoma nurse helped me to decide where to have the stoma – as you don’t want it where you bend over, or on the waistline of your trousers. I didn’t have much time to faff about deciding, and mine makes jeans or clothes with a low waist tricky to wear. Prior to the surgery I lived in jeans, but ever since I have mainly worn leggings or tights. If you want to see what a stoma bag is like, order a sample, or ask a stoma nurse for one, stick it on your stomach and wear some clothes over it!

I feel very fortunate that I wasn’t really given the option of whether to have the stoma or not – the choice was to have the stoma, or to get sepsis and die. A no brainer… I wa