Topic Explanation
The forum discussion centers around a male participant named Ron who has had a loop ileostomy for nearly six years due to cancer. He developed complications post-surgery, including an anastomotic leak and sepsis, which led to the permanent nature of his ileostomy. Ron's primary concern is the excessive activity of his stoma during the night, which disrupts his sleep and contributes to his depression. He seeks advice on how to manage this issue, as his current regimen of taking loperamide before bed has not been effective, and his local doctor and stoma nurse have not provided helpful suggestions.

Advice and Insights

1. Dietary Adjustments:
- Evaluate and possibly modify your daytime diet to include foods that increase bulk, such as potatoes and rice.
- Avoid tea and coffee, especially if you have a high-output stoma, as they can increase output.
- Consider adding a spoonful of creamy peanut butter or short-grain white rice to your diet to help manage stoma activity.

2. Medication Timing and Dosage:
- Take loperamide with your morning and evening meals instead of just before bed to allow it to work more effectively.
- Consult with a doctor about increasing the dosage of loperamide, as two capsules might be a low dose.

3. Consultation with Specialists:
- Seek a referral to a consultant and dietician to get professional advice tailored to your specific needs.

4. Alternative Supplements:
- Experiment with psyllium husk powder, which can be added to food or water to absorb liquid and slow down the digestive process. Start with a small amount and adjust as needed.

5. Meal Timing:
- Avoid eating past 6:00 pm to ensure that food passes through your system before bedtime, reducing nighttime stoma activity.
- Monitor how active your pouch gets after other meals to identify patterns and make necessary adjustments.

6. Additional Tips:
- Eating bananas or applesauce can help harden loose stool and slow down the digestive process.
- Consider eating light meals by 6:00 pm and limiting fluid intake in the evening.
- Some participants find that eating marshmallows as a snack can help manage stoma activity.

7. Lifestyle Adjustments:
- Experiment with sleeping positions, such as using a recliner chair, to see if being prone for several hours influences