This topic is about a 41-year-old man who is 10 weeks post-colostomy surgery for rectal cancer. He is about to start a 4½-month course of preventative chemotherapy. He is experiencing irregular bowel movements and is seeking advice on how to manage this and establish a more regular pattern.

Here are some helpful insights and advice:

1. **Normal Adjustment Period**: It can take several months, and sometimes up to a year, for the colon to adjust and find a new rhythm after surgery. Chemotherapy and steroids can extend this adjustment period.

2. **Irrigation**:
- This is a method of regular colonic flushing that many colostomates find helpful once they are fully healed, usually 4-6 months post-surgery.
- It can provide predictable, near-24-hour continence and may eliminate the need for a pouch for some people.
- It's important to consult with a surgeon or ostomy nurse before starting, as not everyone is a suitable candidate. Proper training in the technique is essential.
- Resources for learning about irrigation include YouTube videos, premium content on ostomy irrigation, and local UOAA support groups, which now meet via Zoom.

3. **Diet and Chewing**:
- Avoid tough, fibrous foods like steak until the stoma is more accustomed to handling them.
- Chew food thoroughly to a mushy consistency to reduce the risk of blockages.

4. **Medication Balance**:
- Consider whether daily laxatives like Miralax and stool softeners are necessary, especially if the output is already very soft. Some people find they need Imodium instead to thicken the output.
- Work with your medical team to experiment with different medications and dosages to achieve a manageable stool consistency.

5. **Support and Learning**:
- Joining local or virtual ostomy support groups can provide real-time tips and support.
- Patience is crucial, as each person's body responds differently, even after similar surgeries.