This topic is about someone who had ileostomy surgery in July after dealing with bowel problems and weight loss for three years. Since the surgery, they have been experiencing several issues:

- Very high stoma output that isn't responding to Imodium
- Rapid digestive transit with poor food absorption
- Ongoing weight loss and severe dehydration
- Suspected small-bowel bacterial overgrowth (SIBO)

The current hospital management includes aggressive IV fluids, antibiotics, and considering total parenteral nutrition (TPN). Daily medications include Omeprazole and St Mark’s E Solution for oral rehydration. The stoma itself is manageable, but the high output and malnutrition are challenging. The person is seeking advice from others who might have experienced similar issues and wonders if things can improve.

Here are some pieces of advice and insights shared by others:

1. TPN / Bowel Rest
- Some people have used TPN for weeks or longer, which helped them regain weight, hydration, and nutrients. It often allows the gut to "reset" and is usually a temporary measure.

2. Possible Short Bowel Syndrome (SBS)
- High liquid output, rapid transit, and persistent thinness might indicate SBS. TPN along with acid-reducing drugs like Omeprazole are standard support options.

3. Output-Slowing Strategies
- Taking Omeprazole before meals may help reduce the volume of output.
- Liquid Imodium (loperamide) acts faster than capsules. Higher doses than the packet instructions can be used, but only under a consultant's guidance.
- In difficult cases, an injectable anti-motility drug is available, though it may have unpleasant side effects.

4. Treat Underlying Inflammation if Present
- If conditions like Crohn’s disease or another inflammatory bowel disease (IBD) are causing malabsorption, controlling inflammation is crucial. The typical medication ladder includes corticosteroids, aminosalicylates, immunosuppressants, and biologics. Imodium alone will not help with inflammation.

5. Antibiotics & Microbiome
- Broad-spectrum antibiotics can kill both good and bad bacteria. Many gastroenterologists now recommend adding specific probiotics, like Culturelle or Align, after finishing an antibiotic course. It's important to check the strain and dose with a doctor.

6. Hydration Formulas
- St Mark’s oral rehydration solution is a classic UK recipe. The newer WHO "reduced osmolarity" ORS is equally effective and tastes better.

7. Post-Operative Adaptation
- It's only been two months since the major surgery. Small bowel and stoma output often improve over several months. Patience and monitoring are essential.

8. General Recovery Tips
- Keep electrolyte levels up and have 10–12 small meals or snacks plus adequate fluids daily.
- Follow stoma-nurse instructions on diet, pouch care, and routine.
- Good pain control, such as using OxyContin under medical supervision, can prevent setbacks. The risk of addiction is minimal when used correctly.
- Use the hospital stay to gather information from each specialist, including the surgical team, stoma nurses, and dietitians.