This topic is about someone who has a 4-month-old ileostomy and is currently undergoing chemotherapy for stage-4 cancer. They are experiencing severe issues with their stoma, including watery and acidic output, bleeding, and unbearable pain. They are seeking immediate relief and advice. Here are some helpful insights and suggestions:

1. Seek urgent medical evaluation:
- Severe stoma pain is not typical. It's important to visit the ER or a physician immediately to rule out any serious issues like obstruction, ulceration, or infection.

2. Investigate possible mechanical causes:
- Check if the barrier or pouch is fitting poorly, which might allow output to pool and irritate the stoma.
- Look for signs of a parastomal hernia or stoma prolapse, which could be causing tension or pressure.
- Examine the stoma surface for granulomas or ulcerations.

3. Appliance and care tips:
- Re-measure the stoma size to ensure the barrier fits snugly without causing pressure.
- Inspect the paste, ring, or seal for any channels where liquid might seep underneath, and change the pouch early if leakage is suspected.
- Clean the area with warm water only, avoiding aggressive wiping or chemicals that could cause bleeding.

4. Diet strategies to thicken ileostomy output:
- Increase intake of low-residue starchy foods like white pasta, potatoes, rice, marshmallows, jelly babies, and white bread.
- Reduce or eliminate acidic foods and drinks such as citrus, tomatoes, coffee, and carbonated soft drinks, as they can worsen acidity and erode the seal.

5. Acid-related considerations:
- Continue taking the prescribed proton-pump inhibitor like omeprazole, and discuss the dosage with your oncologist or GP if acid output remains high.
- Persistent acidity might indicate gastric hyper-secretion or peptic ulcer disease, which requires medical evaluation.

6. General reminders:
- While minor bleeding when touching the stoma is common, constant or heavy bleeding needs prompt medical attention.
- The gastrointestinal tract can still generate pain, even without typical pain receptors. Chronic post-surgical abdominal pain should be managed with the help of palliative or pain specialists.
- Remember, you are not alone. Emotional support is important, and reaching out for help when things feel overwhelming is encouraged.