This topic is about a 75-year-old man who is considering an ileostomy reversal after having his entire colon removed due to a C. difficile infection. He is currently living with an end-ileostomy and is contemplating an ileorectal anastomosis, where the ileum is attached directly to the rectum. Here are some of his concerns and the advice he has received:

- He is worried about urgency and the risk of incontinence, especially at night, after the reversal.
- He is curious about how often he will need to have bowel movements once things stabilize.
- He is concerned about how the reversal might affect his already fragile sleep.
- He wants to know if he will be able to manage long car trips, like his annual 800-mile, 12-hour drive.
- He is familiar with pelvic-floor exercises and wonders if they will help control urgency.

Additional questions and information include:

- He does not know the length of his rectum and plans to ask his surgeon at the next visit.
- He has been living with an ileostomy for five months and has learned to keep the output thicker to minimize leakage, hoping to use the same strategy post-reversal.
- He has not found others whose colectomy was triggered by C. difficile and is seeking similar experiences.

Advice and insights offered to him include:

1. Pelvic-floor therapy:
- Start before the reversal and continue afterward, as strong pelvic muscles can help reduce urgency and accidents.
- A therapist suggested aiming to walk one mile daily before surgery to build core and pelvic strength.

2. Expected bowel frequency and consistency:
- Surgical teams often estimate 4-6 bowel movements per day once things settle.
- Individual experiences can vary widely, with diet and meal frequency playing significant roles.
- Thicker stool usually improves continence.

3. Travel and lifestyle planning:
- After the reversal, it may still be necessary to plan bathroom stops and time meals, especially on long drives.
- Consider nighttime stops and safety issues, particularly for solo travelers.

4. Age considerations:
- A motility specialist noted that outcomes decrease with age, so it might be advisable to proceed with the reversal sooner rather than later if he chooses to do so.

5. Rectum length matters:
- Having an adequate rectal remnant is crucial, as too short a segment can lead to problematic frequency and urgency. It is important to discuss this with the surgeon.

6. Search strategy:
- Use forum searches for "reversal" but ensure that posts describe an ileorectal anastomosis, not a J-pouch or colostomy takedown, for accurate comparisons.

7. Weighing risks:
- Long-term ileostomy users caution that repeated abdominal surgeries increase the risk of adhesions and obstructions. Some prefer to stay with a well-functioning stoma rather than risk incontinence.