This topic revolves around a difficult decision faced by someone who has undergone a total colectomy due to colonic inertia. They are trying to decide whether to continue living with a loop ileostomy or to reconnect their small intestine to the rectum. Here are some insights and advice shared by others who have faced similar situations:

1. **Progression of Motility Issues**
- Colonic inertia can sometimes affect the small intestine as well. One person shared that their condition spread to the small intestine, leading to complications with a J-pouch. They eventually found satisfaction with a permanent end ileostomy and advised caution with reconnections.

2. **Living with an Ileostomy**
- Many people have reported a good quality of life with an ileostomy. Long-term ileostomates have experienced fewer problems and lifestyle restrictions compared to when they had severe bowel dysfunction or frequent bowel movements.
- One individual, who faced severe diarrhea and other complications after a subtotal colectomy, expressed a preference for managing an ileostomy over dealing with constant bowel movements.

3. **Direct Connection of Small Bowel to Rectum**
- If the small intestine is connected directly to the rectum, it often results in 10–20 urgent stools per day because the small intestine cannot store waste. This could mean spending a lot of time in the bathroom.

4. **J-pouch Experiences**
- Some people with ulcerative colitis have had positive outcomes with a J-pouch, especially when performed by an experienced surgeon. However, patience and discipline are crucial.
- Others have faced complications like strictures, obstructions, or loss of pouch function, leading to a permanent ileostomy. Sometimes, a non-functioning pouch is left in place and may need removal later.

5. **Specifics of Colonic Inertia**
- The only definitive treatment is near-total colectomy, as untreated colonic inertia can lead to serious conditions like megacolon.
- High-fiber diets and laxatives often worsen symptoms or provide only temporary relief.
- It's important to find a surgeon experienced in J-pouches and complex motility cases.

6. **General Recommendations**
- Seek multiple opinions and get detailed information about blood supply, expected stool frequency, and long-term risks before deciding on further surgery.
- If opting for surgery, ensure the surgeon has a good track record with J-pouch or ileo-rectal anastomosis procedures.
- Non-surgical options are usually temporary solutions, as medications and bowel cleanses rarely address true colonic inertia.
- Some suggest exploring colon hydrotherapy for constipation, though others argue it is ineffective for inertia.