This topic is about managing some challenges that come with having a permanent ileostomy, especially when engaging in twice-daily aerobic workouts. The person is experiencing issues like watery output, dehydration, frequent leakage, and skin irritation, which have led to the need for frequent pouch changes. They are looking for ways to manage these problems without giving up exercise or facing high costs for supplies. Here are some helpful suggestions and insights:

1. Consult with an ostomy nurse, either in person or over the phone, to assess the fit of your appliance, check your skin, and discuss possible prescriptions.

2. Consider modifying your workout routine:
- Reduce the intensity or impact of your exercises. Avoid excessive jumping or twisting.
- Try longer, lower-impact cardio activities like walking, or mix aerobic exercises with strength training to give your stoma a break.
- Use an ostomy or hernia support belt, which can help keep the pouch stable during exercise. These are often covered by insurance.

3. Focus on hydration and controlling output:
- Hydrate before exercising; don't wait until you're thirsty.
- Use oral rehydration or electrolyte mixes that are designed for better absorption in the small intestine. Follow the package instructions.
- Eat small "bulking" snacks like oatmeal, bananas, peanut butter, white rice, or plain crackers 30-60 minutes before working out. Limit caffeine intake.

4. Explore different appliance and skin-care options:
- Try various systems and manufacturers, and request free samples to find what works best for you.
- Consider using flat or convex wafers, moldable barrier rings, pastes, and seal extenders.
- When changing your appliance, remove any residue with an adhesive remover wipe, rinse with plain water, dry completely, and apply a skin-prep wipe. Mold the barrier ring snugly to your stoma, add paste to the flange edge, and press the wafer firmly in place.
- Leave the precut opening slightly larger than your stoma to prevent friction and bleeding.
- Shower during changes, thoroughly clean the area, and ensure your skin is completely dry before applying a new wafer.

5. Look into different pouch options:
- Consider using a high-volume pouch that can handle vigorous activity and high output, allowing for longer wear time and fewer leaks.
- Two-piece systems allow you to secure the flange well and swap only the bag if needed.

6. Establish a change schedule and prevention routine:
- Change your flange every three days, even if there are no leaks, to keep your skin healthier and maintain a predictable routine.
- Use a belt-attached pouch during workouts to minimize movement and stress on the appliance.

Remember to stay persistent and find a balance between your fitness goals and stoma comfort. With some compromise and gradual experimentation, you can usually find a routine that works for you.