Category Archives: Pregnancy

Pregnancy post-Pyloric Stenosis

One of the most visited posts on this blogsite deals with how having had infant Pyloric Stenosis (“PS”) affects pregnancy.

This question must be answered by looking at several aspects –

  • Will the scar hold?
  • What do I need to know about adhesions?
  • Could I pass on my PS to my baby?
  • Reliving the past – and the trauma

Will my scar hold?

The short answer is Yes!

Our skin varies, as do our stretch marks, as do our scars.  Your scar may stretch and it may change in appearance, perhaps permanently, perhaps not.  Or it may stay much the same, which will put extra stress on the surrounding skin and underlying tissue of the stretching abdominal wall.  This may create a different pattern of striae (stretch marks caused by the dermis or outer tissue tearing) from the usual.  So there are several unpredictable possibilities, but one thing does not happen: your scar will not rupture.

When a surgical wound is healing it can rupture and need repair. Inadequate repair of the underlying tissue can cause a post-operative hernia which will sometimes heal without further intervention, sometimes not.

C 16w 2010But once scar tissue has matured (losing its redness takes a year or two) it is harder and tougher than normal tissue and far less likely to rupture than the surrounding tissue.  The stretching of pregnancy may cause itching, pain, or a tearing feeling, especially in the scarred area, but this won’t affect your baby, womb, or pregnancy, and your doctor can promise you this!

This is how one mother answered this question –

My niece has similarities to your situation, here is what happened with her.

Nothing bad happened to her baby and he was able to grow just fine – your scars will not affect your bub.

As her baby grew it stretched her scars causing shooting pains, the pains were only every now and then.  They only caused her to worry because she thought it may not be the scars and maybe it was something wrong with her baby.

Her scars are right through stretching right down the middle of her stomach in a T like form: she had an operation when she was born and then again when she was 5 and her scars are attached to her muscles.  Her stomach also didn’t grow very big compared to most pregnancies, so if your belly gets bigger than hers it may cause a bit more pain than ‘every now and then’ (but that’s just a guess based on no medical knowledge).

Hope this sets your mind at ease, both you and your baby will be fine. (– anon)

What do I need to know about adhesions?

All abdominal surgery triggers the growth of adhesions, a web like formation of tough scar tissue that develops between areas that have been exposed, cut or otherwise affected by the operation.  The organs inside our abdomen don’t like the fresh air and drying that occur during open surgery, nor the gas that’s used to inflate the abdomen for keyhole surgery.

A laparoscopic image of adhesions between the right diaphragm and liver

Everybody develops adhesions after surgery: these link different abdominal organs (e.g. the stomach and gall bladder or liver) or they link one or more of these with the inside of the abdominal wall.  This is noticed in only a minority of cases, but when adhesions make their presence known it can be very troublesome, causing pain and snaring, choking or otherwise disrupting the normal working of our abdominal organs in the affected area.  Adhesions are hard to treat, as surgery to remove them in affected people will inevitably trigger the growth of more of these nasty webs. I have written about adhesions several times – use the Categories or Tags search boxes to find them or go to Dr Google!

Pregnancy may make a woman with PS in her history aware of adhesions that had not troubled her before. She may feel pain or tearing in the region of her scar as her body changes; although this is uncomfortable it is a normal process and not hazardous, and will probably be a temporary although added discomfort of pregnancy.

Because each pregnancy has its own unique character in lots of ways, the pain and tearing sensations of adhesions can come with any but not usually all of her pregnancies.

The best advice for dealing with adhesion and scar pain and itching is what is usually recommended for pregnancy anyway: lots of lotion and lots of massage – which will help some and not others. The end result of the 9 months will we trust be well worth the discomfort and pain.

This is how one mother answered this question –

I am a 36 year old female, with 3 children.  I had my pyloric stenosis operation in 1974, at 6 weeks old.  My scar is now about 5 inches long, a cm wide and has 4 ‘stitch’ marks down either side.  It sits off centre to my right side, vertically.  And without a doubt it is attached to my abdomen at the bottom of the scar!  My mum said it was just about two inches long when first done.

Throughout childhood I complained that my ‘scar’ hurt and this was dismissed by the GP as part of growing!  At 18 I had my first pregnancy, and had a dip in my stomach as it swelled, with a feeling I can only compare to being jabbed with a pin.  It wasn’t so bad with my second child a year later, although the dip was there as stomach grew.  I had my third and last pregnancy at 33 years old, and my last baby was bigger than first two.

I collapsed with severe pain in my middle of right side 2½ years ago, and initially was diagnosed with kidney stones, but the urologist did not think the stones were big enough to cause the pain I was in.  (They were smaller than grain of rice.)  I am now awaiting an endoscopy with a gastroenterologist to see if I may have adhesions.

My scar is definitely pulling upwards towards my right ribs and I am rather unhappy that I have had to suffer for this long to get any answers!  I have been back and forwards between the specialists 4 times now as neither would pin-point pain, but if I were able to ‘operate’ on myself, I am convinced I could put my finger exactly where my pain is!  The pain is at best mild, but can get worse, usually 30-45 mins after eating.  It is constant, but I have learnt to recognise, offset and control it with painkillers.

I have been lucky that none of my children inherited the pyloric stenosis.  I am convinced that my life time of constant stomach problems, cramps, constipation, stabbing pains, nausea, etc etc has been a result of this condition, and wouldn’t wish it on anyone!  Good luck to you all on getting it sorted, and insist on help if your child continues to suffer. (– Kaz)

Could I pass on my PS to my baby?

This is indeed quite possible, and because of the quirkiness of genetics a mother who has a PS history is more likely to have a Py-baby than a father.  It is well-known that 4-5 boys have PS to every girl with it, but part of this means that those girls who do have it carry stronger PS-carrying genes.  Not nice…

The risk is unpredictable, as infant PS is “multi-factorial” and can be caused by non-genetic factors – labelled “environmental” in the medical world, although PS is never caused by what most of us think of as “the environment”!  A woman who belongs to a family tree with another (possible) case of PS is at higher risk than one with “one-of” PS.  So the likelihood of a PS mother having a PS baby varies from almost nil to about 20% according to the several studies that are freely available online, and some few mothers have reported passing on their PS to most or all of their offspring – up to 4 children in a few cases I have on file!

The key thing to remember is: everyone (mother or father) who has had PS can and should be better prepared to give prompt and the best possible care for their new-born Py-baby!

This is how one website answered this question –

  • Pyloric stenosis is the most common infant surgery in the United States after circumcision.
  • Pyloric stenosis reports in the United States have shown as few as 1 case per 3,000-4,000 live births to as many as 8.2-12 cases per 1,000 live births.
  • In general, pyloric stenosis affects approximately three out of every 1,000 infants.
  • If a child with pyloric stenosis is female:
    the likelihood of having a future son with pyloric stenosis is one in five.
    the likelihood of having a future daughter with pyloric stenosis is one in 14.
  • If a child with pyloric stenosis is male:
    the likelihood of having a future son with pyloric stenosis is one in 20.
    the likelihood of having a future daughter with pyloric stenosis is one in 40-50.

Reliving the past – and the guilt and the trauma

Sadly you won’t find this information on the PS-pages of our hospitals’ and paediatricians’ websites …

But having followed what not a few new parents have reported on internet social forums such as BabyCenter, Facebook, MedHelp, Patient, and Reddit, it is abundantly clear that some who have PS in their story struggle with guilt and PTSD, although thankfully not in a life-threatening form.  How many and how severely people are affected in this way is impossible to estimate, as this matter has not been given any academic or statistical study that I have seen.

The now adult Py-baby may find during pregnancy that they (father as well as mother) are painfully reliving their own past, fearful of passing their PS on to their new baby.  It is now known that the fears and deep emotions that many parents of a PS baby experience and convey to their growing child in story and emotionally can affect the in many ways exciting months leading up to the birth of a new person.  In times past, the traumatised parents would keep their story to themselves, which will often affect their child even more.  Sensitive and wise openness is far preferable to the old-time “stiff upper lip”.

Several things will help –

While most couples awaiting parenthood have never heard of PS, those who “own” their PS story will be far, far, far better prepared.  All infant surgery runs a high risk of a chain of unhappy events, including:

  • the horror of an eagerly awaited newborn infant vomiting itself to death;
  • insensitive, even haughty doctors who dismiss the fears and homework of new parents and draw out diagnosing their infant’s problem;
  • the hazards of anesthesia and surgery, increased in the very young;
  • post-operative complications and frustrations;
  • worries about long-term effects, usually brushed off by doctors but well-founded despite this.

Having recognised and to some extent worked through most of the fears and uncertainties is a great bonus.

Parents with a PS history also need to face the possibility of misgivings and guilt feelings that won’t be justified and will be unproductive, but may be very real and therefore also need to be processed.

As well as the above reasons, PS survivor parents preparing for the birth of a baby may be stressed by the possibility of bringing another “imperfect and damaged person” into the world, and by memories of the utter powerlessness inevitably associated with submitting one’s long-awaited newborn to a medical team and their procedures.

But PS parents will also know better than other parents that despite the above, PS is recognised throughout the medical world as the least un-desirable of all the conditions of infancy that usually require surgery.  The surgery by today’s standards in minor and routine, and almost always quickly effective. Any immediate after-effects will usually clear up within weeks or months, and any long-term after-effects (although usually not acknowledged) are manageable and never life-threatening.

The bottom line: I survived, and my baby will too!

Here follow four people’s observations on this subject area –

I am not so much nervous about labor as I am about being the best mother I can be and being the mother she needs.  I have a lot going through my mind right now.  My main concern is how horrible I will feel if she inherits pyloric stenosis from me.  Because of it I had to have surgery at 3 weeks old, it caused me to be so weak from not enough nutrients that I no longer had the energy to cry.  I am terrified of having to go through what my mom went through.  I keep trying to tell myself that she will be fine and everything will work out, but I am still scared... (– Jessica)

I used to work on a children’s gastrointestinal ward in London and would often see this. It’s a small op as far as an adult is concerned, but for any mum and little quite major. Make sure any questions you have going round in your head now, you write down. Make sure you ask all you want to ask, don’t be afraid as no question is silly, and they would rather explain to you what’s happening than have you confused and worried. (– Rachel)

I almost died before I was even born.  After my mother’s water broke and she was in labor for several hours, I had a bowel movement inside the womb – gross! – and the doctor said that was sign that I was in distress and not getting any oxygen so he performed an emergency C-section.

Then after I was fed for the first time I vomited it right back up.  And I kept vomiting after every feeding. I was diagnosed with pyloric stenosis… So I had to have surgery when I was just a few days old.

So my parents almost lost me twice before I was even a week old, and it’s easy for me to see why they – my mother especially – became overprotective parents.  And they passed that overprotectiveness on to me.  Even though I don’t have or want kids of my own, whenever I’m around kids I’m hyperaware of what’s going on around them.

I grew up knowing about all of the horrible things that can happen to children – rape, kidnapping, murder, etc. And it wasn’t just “stranger danger either. ( – Holly)

I had the surgery as an infant and asked in my first pregnancy if my baby could have the same problem.  I was basically laughed at so I never thought of it again.  I was definitely agitated over that because I would have always watched out for it.  It was hard just thinking about my baby having an IV/surgery and I really broke down when we got to the children’s part of the hospital and I saw the crib/bed.  After that though I was fine.  My DH and I held him for 2 days straight – we took shifts at night.  The hospital was so thorough and made us feel like Jacob was in great hands. (– anon)

Recommended: my previous post on this subject –  https://whatwewishwedknown.wordpress.com/2017/05/15/an-abdominal-scar-and-pregnancy/

 

A belly scar and pregnancy

Early 2013 I posted my previous report on this subject area: the last of four posts on how an abdominal surgery, its scar and likely adhesions can be expected to affect a woman’s pregnancy.  This 4th post gave readers links to the earlier posts (which are also well read) and #4 quickly became one of the most read posts on this blogsite!

As I wrote then, I feel some hesitation writing about this subject and including a few of the stories and images posted on the web by brave mothers.  My feelings are surely understandable: male, not a doctor.

Yet my reading and the weight of interest confirm my original decision: women who have had abdominal surgery, whether in infancy (like mine for pyloric stenosis) or in adulthood, have reason to be very interested indeed in how that surgery might affect a pregnancy.  This is even more so if that surgery has already given them grief in addition to their scar: usually gastric issues or discomfort from adhesions resulting from their operation.  On the web there seems to be nothing else than pregnancy forum discussions of this subject, and we’re often told that this subject area tends to be brushed aside by medical workers, perhaps because of lack of knowledge of it.

The fact that so many mothers have written about this on forum sites, some even adding a photo, reflects the fact that people who have been through abdominal surgery, possibly its ongoing effects, and then a pregnancy, know how valuable and reassuring it can be to learn how others have found and managed the one-way journey they are on (or are considering).

Interested readers are encouraged to use the above link and the links in that post to access the personal stories, experiences and images I have posted there.  What I want to do here is simply to add some more “stories” and images.

First, some facts and reassurance

  • Every scar is different, as is every pregnancy: expect each pregnancy (your own and others’) to be different in lots of ways.
  • Every pregnancy involves the miracle of bringing a new life to birth, which comes with considerable physical growth and strain.  Because a scar doesn’t have the same flexibility as the damaged tissue it has replaced, expect some discomfort, perhaps pain – and sometimes nothing.
  • Because scar tissue is stronger than the skin tissue we’re born in, it won’t “give” much: the normal abdominal skin will do all the stretching and often develop striae or stretchmarks.
  • In my many years I have never heard or read of an abdominal scar causing serious trouble.

What some mothers have written –

I am a 36 year old female, with 3 children.  I had a pyloric stenosis operation in 1974, at 6 weeks old.  My scar is now about 5 inches long, a cm wide and has 4 ‘stitch’ marks down either side.  It sits off centre to my right side, vertically.  And without a doubt is attached to my abdomen at the bottom of the scar!  My mum said it was just about two inches long when first done.

Throughout childhood I complained that my ‘scar’ hurt which was dismissed by the GP as part of growing!  At 18 I had my first pregnancy, and had a dip in my stomach as it swelled, with a feeling I can only compare to being jabbed with a pin.  It wasn’t so bad with my second child a year later, although the dip was there as my stomach grew.

I had my third and last pregnancy at 33 years old, and my last baby was bigger than the first two.

I collapsed with severe pain in the middle of right my side 2½ years ago, and initially was diagnosed with kidney stones, but the urologist did not think the stones were big enough to cause pain I was in.  (They were smaller than grains of rice.)  I am now awaiting an endoscopy with a gastroentorologist to see if I may have adhesions.

My scar is definitely pulling upwards towards my right ribs and I am rather unhappy that I have had to suffer for this long to get any answers!  I have been back and forwards between the specialists 4 times now as neither would pinpoint pain, but if I were able to ‘operate’ on myself, I am convinced I could put my finger exactly where my pain is!  The pain is at best mild, but can get worse, usually 30-45 mins after eating.  It is constant, but I have learnt to recognise it and control it with painkillers.

I have been lucky that none of my children inherited the pyloric stenosis.  I am convinced that my life time of constant stomach problems, cramps, constipation, stabbing pains, nausea, etc etc!! has been a result of this condition, and wouldn’t wish it on anyone!

Good luck to you all on getting it sorted, and insist on help if your child continues to suffer.

K 2010

I also had Pyloric Stenosis as a baby and it was corrected.  I am now 7 months pregnant with my 1st baby (a boy) and had only noticed occasional stretching pains in my scar.  Doc said it wouldn’t be affected because it had been so long since surgery but I still occasionally feel stretching pains.

T G 2012

My scar gives me problems all the time and until today, I thought I was the only one….  Seeing all this has really helped me out personally!  Pregnancy is a little tough on my scar: the pulling sensation and sharp pains suck to say the least but the little angel in the end makes it all just disappear!

Does anyone have any remedies I could try to help ease the pain?  I’m 27 weeks pregnant today and the pain seems to be a little worse every day and I’m wondering what I can do to be as comfortable as possible.  My scar just feels like it’s going to burst open…. The pulling, burning and stabbing pains are becoming unbearable and any advice is much appreciated!

J D 2011

I had my surgery when I was 4 weeks old.  I am now 26 with 2 kids.  My first was born in 2003 and the second was born in 2007.  I never had any serious issues with my scar.  I did have some pulling of the scar tissue from my expanding belly when I was pregnant with both of my children but it was never painful in any way, it was just a tight pressure feeling.

None of my OBs were ever worried about my scar.

L T 2010

I am 32 weeks now and it has gotten so much worse like stabbing and tearing… I asked the nurses at the hospital and the doc and no one seems to know anything at all… it’s so frustrating.

D C 2010

I too have a large scar on my belly.  I had a pyloric stenosis… I was also worried that it would tear or something.  It was painful during my first pregnancy and itched a lot.  I rubbed a lot of scar cream into the area.  This pregnancy I’ve had no trouble at all.

S 2010

I have a vertical scar on my belly.  It’s not really a very nice scar.  During my pregnancy the scar became much wider and it seemed to sit on top of my skin instead of in it.  I was worried about whether it would ever get back to looking a bit normal again.

I’m glad that after my pregnancy it did get back to what it looked like before and it did not stay all that wide.

So you don’t need to worry.

S 2012

A picture is worth 1,000 words…

As I did when I posted the photos I chose for the earlier posts, I want to say “thank you” to the women who have posted an image of their belly scar taken during their pregnancy.  I have posted these images in support of their original purpose, protected the anonymity of these people, and will withdraw any image on their request.

In these photos notice just two further things –

  • each scar looks very much “together”, and
  • one of the transverse (horizontal) scars seems to have moved to the side.

DS 2011

RJ 2009DJ 2011SP 2009C 16w 2010

Adhesions and pregnancy

Like many who had surgery as a baby, I’ve been left with a few issues as a result.  Abdominal surgery at any age often leaves a bit of collateral damage, and when the surgery happens in infancy, this damage can grow with us.  The harm may be physical, cosmetic, or even emotional.

When I was just 10 days old I had surgery, caused by a stomach blockage, pyloric stenosis.  Discovering that I am not unique in having some “issues” as a result of this, and being in a position to do something about it, I started blogging here just over three years ago.

Adhesions 01One of the most common problems after abdominal surgery is the growth of adhesions, web-like inelastic scar tissue that can develop wherever the surgery went.  Adhesions may connect the abdominal wall to abdominal organs, link one abdominal organ to another, and sometimes obstruct them from working as they should.

Many of us have adhesions without being aware of them.  Virtually everyone who has had abdominal surgery will have adhesions, although in the great majority of people these will also remain unnoticed.  But a minority of former patients will be troubled by adhesions, some to the extent of choosing to have further surgery to get relief, all-too-often only temporary.

Such adhesions will be a special worry for those women who wonder how their already annoying or uncomfortable adhesions will behave when they are carrying a baby.

Will the abdominal surgery I had stop me from having a baby?

Most unlikely if the surgery had something to do with the gastric or food passage.  The scar and/or the adhesions may cause extra grief during a pregnancy, but they won’t stop it or damage the baby.

Will the surgery I had affect my pregnancy?

There is a small chance that adhesions will add to the discomfort and pain that are an expected part of most pregnancies.

The good news:
Good news bad news11)  From the published material it seems that only a small minority find that their surgical scar and/or the adhesions under it become more of an issue during their pregnancy, and those who do have found (as is usual) that every pregnancy is different also in this way.
2)  Although there may be unpleasant but understandable itching, stretching and tearing pain at or under the surgical scar, and some have reported a little bleeding, nothing more serious has been reported.  A mature scar is stronger than the surrounding abdominal wall and won’t tear open.  The stretching and bleeding will heal.
The bad news:
1)  If any of this happens to you it is hardly pleasant and it’s an unwelcome extra challenge during the long months of waiting and wondering.
2)  Count yourself privileged if you have a doctor or obstetrician who pays attention to this aspect of your pregnancy.  Because there is no easy “fix” for adhesion pain most medical people won’t want to hear or say much about it.  Be prepared for a brush-off.  Be content with some pain relief.

What can I do to reduce the discomfort caused by my earlier surgery?

As mentioned, most doctors believe it’s best accepted.  Creams and massaging are worth a try.  There are more costly and specialised therapies advertised online which some have found very good but others not.

Considering mild pain relief as recommended by your doctor, exercising and keeping weight gain to a safe minimum are sensible options.

 *         *        *

Two and a half years ago I wrote a more detailed post about this subject with some fear and trepidation for reasons that will be quite understandable.  How many males untrained in medical science would take it upon themselves to write a post on the effect of abdominal adhesions on a pregnancy?

boy writing1Yet this 2011 post has become by far the most read one of the 160 I have written about some of the issues that can arise from infant surgery later in life.  WordPress, the host of my blog, has encouraged me to revisit the subjects of my most read posts, so with a new year, I offer the above points as a summary and a lead-in.  I have not repeated most of what I wrote in the 2011 post on adhesions and pregnancy.

The 2011 post was the 4th of a series dealing with the problems adhesions can sometimes cause after abdominal surgery.  If this is an “issue” for you (the reader), I suggest you follow the link (click on the highlighted words) above and read all 4 posts and other readers’ valuable first-hand Comments on their subjects.  The “Categories” and “Tags” boxes on the right of this page will help you locate other posts that may be of help.

Communication04Many have found this blogsite to be a good place for getting information about a list of possible issues around infant surgery – especially the treatment and possible effects of infant pyloric stenosis, the most common reason for life-saving infant surgery.

You won’t get personal professional advice about your particular medical problem here, of course.  But this blog wants to continue to give well-informed, responsible, and practical facts and experience-based advice about infant surgery and its possible effects.  I have brought this together from the writing and reports of thousands of not only medical professionals, but also from parents and the survivors of infant surgery who have posted their experiences and stories on the web.

2013’s most visited infant surgery (SIS) posts

This last post for 2013 on the “Surviving Infant Surgery” (SIS) site was written away from home and after a very busy but delightful, Christian, and family Christmas.  I thought if might be of interest to list the most visited posts of this blogsite during the past year.

It is with continual surprise and gratitude that after three years I continue to see the interest in the SIS blog rise each year, so that the total “hits” now number almost 50,000.  Even more gratifying is the feedback from many readers, online and by email.  The message of your comments is, “Thank you, you’re helping people like me (or us) so much with your honesty, careful writing, shared experiences, and by helping me / us to realize that my / our experience is far from a lone or odd one.  Do keep up the good work.”

The post that drew the most interest by quite a margin was about the possible long-term effects of infant pyloric stenosis (“PS”) and the surgery that often follows it, Ramstedt’s pyloromyotomy.

ponderAdhesions after a pyloromyotomy were a frequent and often troublesome concern among those who used this blog during 2013.  Two of the top 10 discussed this, the posts # 2 and # 6.  The 2nd most visited post dealt with the effect of the surgical scar and internal adhesions on a pregnancy, and the subject of #6 was the adhesions that can be expected after any abdominal surgery – with special reference to the trouble adhesions have been found to cause to people after an infant pyloromyotomy.  Sadly, this is one of the subjects raised by PS and its surgical “remedy” that most doctors brush off with a vengeance: there is no prescription, no surgery, and no other easy way of dealing with abdominal adhesions.

The subject that had the next (3rd) most readers’ interest was related to this also: Does an abdominal scar cause trouble during pregnancy?  The short answer is that it can – but usually if any, it is a relatively minor discomfort.

The post with the 4th highest number of “hits” discussed a deep fear and occasional reality: Can PS raise its horrible head again after a pyloromyotomy?   Continued vomiting, although of a less violent form, is quite common, even to be expected, after a pyloromyotomy, although usually only for a short time.  It is very understandable that parents who have just been through the harrowing experience (indeed, traumatic for many) of infant PS will be more than anxious about this possibility.  While most doctors and hospital staff are reported to be very supportive in this situation, many parents are unsettled (to say the least) by the earlier bland and simplistic assurances that “surgery fixes PS immediately, permanently, and without any after-effects”.

Self-exam1The post that came 5th in popularity in 2013 reflects another area of anxiety and emotional pain that has come with the surgery for PS: while some care nothing about their scar, others can tell tall stories about it, and some hardly think about it, there are many “py babies” who grow up to hate their scar with deeply felt hatred and embarrassment and would dearly love to be rid of it.  So one of my posts on scar reduction plastic surgery rated #5 in interest.

Symptoms of post-traumatic stress sometimes result from the anxiety, surgery, and maternal separation that PS can bring, especially from the way the condition and its surgery were handled up to the late 20th century.  This subject was also discussed in many posts, but the one that rated # 8 in 2013 made the top 10.

By using the “Categories” search box (top right of the page) or searching for keywords or “tags”, readers will usually be able to find a number of posts on each of these and other subjects.

The “My Story” page (with its tab at the head of every page) has also rated very well.  Thank you for your interest, encouragement and support!

At the end of another productive year of SIS, I want to thank all my readers and especially those who have given feedback online or by email.

An abdominal scar and pregnancy

How the scars from abdominal surgery will affect women in pregnancy has been outlined in three posts on this blogsite, and all may be accessed via the “Categories” box on the right of this page.

The first post on the effect of an abdominal surgical scar on pregnancy was added here in 2011 when I dealt with adhesions, inflexible strands of scar tissue forming a web between the scar and abdominal tissue, muscle and organs.  Adhesions are most common cause of extra itching and pain during pregnancy, and sometimes even some bleeding.  They can also cause trouble apart from the rigours of pregnancy.

The second post outlined what can be expected and the overview was generally reassuring: surgery scars will quite likely make your pregnancy more eventful in any of several ways, but are very unlikely to be a major problem.

This post was followed a week later by a third one.  My wife of over 40 years and I have parented four  wonderful children, all of them happily married and with their own kids, I have also worked with people of all ages and many situations of life in a church context, and have read widely for 15 years before blogging on the subjects of this site.  Nevertheless, I am a male, and not a family doctor, so that writing about an aspect of pregnancy prompted me to decide it was important to let a careful sample of women “speak” about how their abdominal surgery affected their carrying a baby and giving birth.

One of the things missing from these three posts is what I have done in my previous two blogs.  Here I want to pass on another selection of photos:  images which mothers have posted on their blogsite or a pregnancy forum to reassure interested readers about how their growing belly and scar may be affected.  Most have been able to post their story in a relaxed way, some even with pride or in fun, and perhaps others with some misgivings.  I and I trust many others will be grateful to them all – sharing usually reduces our fears.

The Shape of a Mother is a great blog for you if you are interested or concerned about this issue.  One of the posts there comes from Fiona, who tells readers about her harrowing emergency appendectomy during her first pregnancy; her scar was stretched and keloided somewhat (which it might have done anyway) but thankfully it didn’t rupture or cause major after-griefs.  And here is a link to Fiona’s update.  Audrey’s story and photos (one which is included below) may also be worth reading in full.

What I have written before will become even clearer with these photos, namely that –

  • abdominal scars take on a life of their own as a surgical wound heals;
  • they will be affected by pregnancy but being made of tough, even hard scar tissue they will often stretch less than the surrounding skin and muscle layers;
  • some will do something like shatter, breaking up to some extent; and
  • none show obvious signs of trouble.

I trust that these images and the information and experiences given in earlier posts will clarify and reassure.  Heartfelt thanks are due to the 10 women who have allowed their images to be posted – I am sure to reassure others.  To these women I say:  Thank you!  And if you would like my caption to be altered or your photo withdrawn, please contact me (via the About tab).

Click on an image if you want to enlarge it.

And please consider sharing your own story as a Comment – or send me an email to have it posted.

RUQ PS and glbldr scars

This woman had PS surgery as a baby, and a gallbladder removal as well as several children in her adult years.

Upr transv PS 36w

This transverse pyloromyotomy scar looks good at 36 weeks

Upr transv PS scar 37 wks

Another transverse scar after PS surgery – at 37 weeks and even tidier

Transv scar2

This scar may be relatively new or may have reddened from stretching, but it’s fine

Transv scar1

Pregnancy does not seem to have affected these vertical and transverse scars from more complex surgery

Lwr midline scar

A lower midline scar and one from appendix surgery – the first is very indented but pregnancy does not seem to have widened it

Upr midline inf surg

Unspecified infant surgery and a Cesarian birth left these incision and feeding tube scars – large but not due to pregnancy

Upr midline PS scar

This midline scar from PS surgery has remained tidy

Para-midline PS scar

A para-midline PS scar, looking fine and unchanged by pregnancy

Para-midline PS 28 wks

Finally, another para-midline PS scar, sunken and less tidy but also not obviously affected by pregnancy

Scars that strangle (4): Pregnancy and adhesions

public domain image

One after-effect which I and indeed most of the survivors of infant surgery have had no difficulty escaping is what the adhesions (so common after abdominal surgery) can add to the discomfort and pain of pregnancy.  Many congenital and other infant abnormalities of our bowels affect baby boys more often than the girls.

All of us who have had infant surgery for a bowel complaint like pyloric stenosis (by far the most common culprit) hold their breath for a few months after the birth of our offspring.  My wife and I were certainly on high alert four times for a recurrence of the trauma I visited on my parents two generations ago!  Our fourth (and last) was an enthusiastic puker for a while, but we remain thankful that this never developed into the projectile vomiting and bowel blockage I had.

I have posted three times in recent months about the distress which adhesions bring to some who have had surgery during their infancy.  This time I want to review some of what I have learnt from women who have posted about their experience of pregnancy in the light of their having had pyloric stenosis.

Understandably I’m writing this post with some trepidation… I do so as a male who has been through four pregnancies and births with my married partner of 46+ years, and just as importantly, as one who has seen serious questions raised rather often on internet forums and blogs.  Having learnt so much about the possible long term effects of infant surgery, I am passionate about sharing the issues and some of the material I have read.

So here we go…

Will my surgery and scar stop me from having children?

Certainly not.  Some few people worry about this but there is no connection between the defects of and repairs to our food passage and our ability to carry a baby.

What’s more, the old scar will not tear open or become unsafe.  A surgery scar may affect the surrounding tissue as it is stretched: it is not as supple, but after a year or two, a surgical wound has developed scar tissue which is very tough.  Massaging the scar area with a topical cream may help it become more supple than otherwise.

Will my surgery and scar affect my pregnancy?

It probably won’t – but it may.

I find it telling that I have never come across any research on this and must doubt that this important although passing possibility is given much attention.  I do imagine it must be hard to find the subjects for such a study.

Worse, I have not yet heard of a doctor who actually dealt with a patient’s clear symptoms of adhesions from upper abdominal surgery adding to the discomfort of her pregnancy.  Everybody whose story I’ve read says her doctor ignored, sidelined or brushed off her concern.  Again, I realise doctors have a schedule to maintain and must stay focused on the core reason for the consultation (in this case managing the pregnancy), but from everything I have read and experienced myself, doctors could do much better in dealing with their patients’ expressed concerns – or directing these to others more expert in the area concerned.

Something to watch out for is that several people report their doctor having blamed their pain on an inflammation of the gall bladder or caused by the liver, and I even have several reports of people having gall bladder surgery which proved to be unnecessary!  Wow!  Make sure there is a thorough diagnosis before you go too far down this path.

The good news is that adhesions in the abdomen seem to affect only a small percentage of those pregnant women who have had surgery here.  Almost all mothers with a pyloric stenosis (and other) surgery history report that their pregnancy was not affected by it very much or at all.  Several comment that there was some discomfort around the scar, but elsewhere too.  Adhesions from endometriosis, gynaecological conditions and surgery of the lower abdomen do cause many problems – but that is not within the scope of this blog.

The bad news is that for an unknown but probably small percentage of women, a pregnancy after abdominal surgery brings with it some additional problems.  As well as itching, these may include tearing, jabbing or stabbing feelings, mild or severe pain in the middle to right upper abdomen, and in some cases even some bleeding.  Certainly uncomfortable and distressing, but nothing more serious from a medical point of view.

One sufferer wrote:  The pain is at best mild, but can get worse, usually 30-45 minutes after eating.  It is constant, but I have learnt to recognise, offset and control it with painkillers.

Another mother-to-be has written:  It feels as though the scar is somehow attached to my ribs and my growing belly is pulling on it.  It feels like something is slowly being ripped inside of me, some days it is a slight ache while others it is a throbbing /shooting pain on my side.  It seems to come later in the day, as if the pull of the weight of the baby is straining it somehow.  Also, some days it feels numb and tingly, but not in a good way.

A third young woman wrote:  My scar just feels like it’s going to bust open…. The pulling, burning and stabbing pains are becoming unbearable

Will my baby have what I had?

It all depends.  On the web there are statistics on the various possibilities: only one in three or four pyloric stenosis cases is female, but a mother with a PS history is more likely (about 20%)  than a father (about 5%) to have a child with the problem.  PS can also skip a generation or two  and occur on different branches of the family tree; in some families there are many sufferers, but in my family I’m the only one so far (and as far as I know).  I plan to post more about this at a later date.

Can my baby be tested for an abnormality pre-birth?

Scans very sometimes show up “minor” defects like pyloric stenosis, but not with great certainty.  Scans may or may not show up a particular abnormality, and the baby’s later development often “overtakes” early scans.  Some abdominal defects are truly congenital (present at birth); others like pyloric stenosis almost always develop after birth (but 20% show up very early, well before the usual range of between 3 weeks and 3 months).

What can I do about the grief my scar is giving me during my pregnancy?

The short answer seems to be: Rather little.

The value of massaging and skin creams is emphasised by some and doubted by others: try it and make up your own mind!  Using mild and doctor-approved pain medication in later pregnancy is probably the best course.  It is sensible to keep weight gain to a safe minimum to reduce pressure on the abdominal wall and scar region.  Some women report that pregnancy stretched and smoothed out their scar; other mothers report their scar looked (even more) unsightly and affected the surrounding area; if this remains so after the birth it can be reduced later by plastic surgery.

My scar affected my last pregnancy: should I expect this again?

Every pregnancy is different: there are countless variables.  Despite this, women with adhesion-like pain generally report having increasing discomfort during later pregnancies.

Finally, if you are uncertain about something related to the subject of this post, or are convinced something needs to be checked out, please urge and be prepared to pressure your doctor to work with you.  Read my recent post on getting supportive help in this!

Please remember that this blog is an overview of what information websites and web correspondents have put on the record and that it is not personal or professional advice.