All women have the risk of future rectal sphincter weakness as they age if they have vaginal deliveries. This is multiplied if there are multiple vaginal deliveries. This does not change if you have a j-pouch. Vaginal deliveries before or after the j-pouch would pose the same risk.

Women who have a j-pouch are more affected by this risk because without a colon, the stool is more loose.

I had both my children before my j-pouch surgery. One was a c-section and the other a complicated vaginal delivery. Yes, I have concerns about my future continence, but I don't dwell on it because there is nothing I can do about it.

Jan

Hey Jan, just wondering, do you think something like pelvic floor PT would ameliorate those issues after vaginal delivery for a j-poucher? Or is it more like mechanical damage due to delivery that you can't exercise away?

I just went to see my GI this past week as I am 16 weeks pregnant and wondering the same thing. He was so knowledgable and said that while they used to advise women with a J-pouch to have a c-section it is less risky and better for everyone to have a vaginal delivery. He said that 30 years ago, csections were recommended because of this loss of control concern but they have done trials and studies since then and the risk is so so minor. He also mentioned that due to the scar tissue that we have, he would only recommend a c-section in a case where it would be the last option.

He is putting me in contact with a high risk OB just in case in a nearby city, but says that it should be no issue to meet with a regular OB. In our town, women don't meet with their OB until 30 weeks and he sent a requisition to my Dr. to have me meet my OB before then. He also said that once I do deliver he'll give me an endoscopy once I'm up to it to ensure that the pouch hasn't been damaged at all.

I think it also makes a difference that my surgery was 7 years ago and I am very healthy now - no pouchitis at all since then! I have tiny amounts of blood here and there (maybe one stool a month) and he was not concerned about me at all in that regard.

He also mentioned that he was really surprised that we were able to get pregnant because of the scar tissue that can occur in the ovaries/tubes. He said he normally recommends women just start trying IVF if they want to start a family. It took my husband and I 11 months to conceive our miracle and I am very regular.

I'd love to compare notes with you more about how your pregnancy is going. It'd be great to talk to another preggo woman who's going through exactly what I am!

All the best!!

To be honest, I really do not know if exercises of the pelvic floor would make that much of an impact. I imagine it would as much as it would for someone who still has their rectum/colon.

This is all pretty much of an unknown, and I am not sure what studies they have done that could prove anything one way or the other, since you need to have had both vaginal deliveries and be elderly with a j-pouch to know what that impact is. All the studies I have seen were short term, not long term.

They already know that rates of incontinence issues rise with age and particularly if you had vaginal deliveries. Much has to do with the size of the baby, if there was obstetrical injury (forceps delivery, rapid delivery, etc.), things like that. If there was tearing, that heals quickly if repaired properly, so that is pretty much of a non issue. It is the stretching and stressing of the sphincters and other pelvic floor structures that are the perceived problems. Look at all the women getting bladder slings and repairs due to cystocele and rectocele. Most of them do not have j-pouches, just vaginal obstetric histories.

So, like everyone else, I am just going to have to wait and see how things go. I am hoping that the tendency toward constipation as we age will actually work in our favor in the weak sphincter department! I should be better about doing kegels, but alas, I am not

I can tell you about me in particular though. It has been 18 years since my j-pouch surgery. I am 58 now and post menopausal. I have both cystocele and rectocele due to a very large vaginally delivered baby (9lbs 15oz), with outlet forceps delivery and 4th degree lacerations. This was after a prior c-section for breech 2 years before that (back then VBAC was popular, not so much these days). I have had no pelvic repair, other than the repair done immediately after the delivery. So far, I am continent, but do get the occasional minor urinary stress incontinence. So, I am hopeful... I don't think there is any one right answer.

FYI, here are a few more recent studies indicating that incontinence/leakage is more common after vaginal deliveries. The last one is from the Cleveland Clinic (2005) and that was the one I was most familiar with:

http://www.ncbi.nlm.nih.gov/pubmed/22275287
http://www.ncbi.nlm.nih.gov/pubmed/16779880
http://www.ncbi.nlm.nih.gov/pubmed/16142432

Jan

Just to add my two cents...My high risk OB was fine with me trying for a vaginal delivery if my babies were under 8 lbs (more for my body type than GI issues). HOWEVER, he did tell me that if I tried for a vaginal delivery and needed an emergency c-section, his first priority would be getting the baby out safely and he would not be able to take extra care with the intestines (of course, he wasn't going to be reckless, but couldn't let that be the priority).

With a planned c-section, he felt he could be extra cautious and work around my intestines in a way that would be least likely to cause disruption.

Given that I chose to have c-sections. Since I have a perm ileo, the continence issue was irrelevant for me.

Again, only time will tell. But after having a baby 5 years ago pre-pouch and another 2 years ago post-pouch, things are still working well down there :-) If it were my first, I'm pretty sure I would have chosen the c-section route since I wouldn't have know what to expect. But with my second, all of my docs (high risk OB, regular OB, GI) agreed that with my personal history that a regular delivery would be best (easy first labor/delivery, smaller babies, and some other factors).

Great info on this thread! I'm 23 weeks along with twins and my OB wouldn't touch the issue, and even my MFM's response was like "huh, I'll have to look into that." 3 months later, we haven't really addressed it. I'm going to print out Jan's studies (above) and bring them to my next appointment. I know the vaginal / C-section issue has been heavily discussed on these boards - any experience with twin pregnancies? btw- don't mean to hijack the thread!

Hey! No problem! I just feel that there's very little information for ladies like us out there and we want to know these things - not just take a chance on our bodies or our babies. The most recent study that I saw (Jan's files) was 2007, which isn't that bad, but not terribly recent...it's would be nice to have some that were within the last couple years and from a variety of sources. Even the studies don't agree I've found, so it's hard to know which way to go.

Well, the REAL problem is that any way you slice it, ANY method of birth exposed you to risks. Some are short term and some are long term. It is impossible to predict where any one person will fall into the risk ratio, particularly since there can be, and often are unpredictable obstetrical issues that crop up during labor and delivery.

I certainly did not anticipate a frank breech presentation during my first delivery. This was not known until labor was well underway. So, c-section was essentially mandatory. With my second delivery, it was not known until a week or two before that this would be a large baby. I was scheduled for induction, before he got any larger, but I went into labor anyway. I did not plan on requiring outlet forceps, it was a decision after 12 hours of labor and 2 hours of pushing.

My point? You can make all the plans you want, but when the time comes, you just do what is best for a healthy baby and mom. It all depends on what risks are acceptable to YOU. I thought having a "natural" vaginal delivery would be more special than my c-section (it wasn't). I got a healthy baby each time, so it made everything else a non-issue.

But, I agree. More recent and long term results would be very nice to have.

Jan