This topic is about managing the challenges of living with a high-output ileostomy, particularly focusing on issues like weight loss and the need to empty the pouch frequently at night. Here are some insights and advice that might be helpful:

- The ileostomy has been in place for over 15 months, and there is a predictable surge in output around midday, which starts thick and becomes watery. This requires setting alarms to empty the pouch 3 to 4 times every night.

- Despite being on a lot of medication to slow the output, there hasn't been a satisfactory solution from doctors. The person has undergone 13 abdominal surgeries in 4 years, including an esophagectomy and gastric surgery, and is dealing with a total colectomy due to a non-cancerous "mega-colon."

- There has been a significant weight loss of 20 pounds, bringing the weight down to 80 pounds at a height of 5 feet, with difficulty in gaining weight. There is a concern about possibly having short bowel syndrome and whether others experience similar issues with excessive thinness.

- Dresses are no longer practical due to the need to frequently check and empty the pouch. Mornings are manageable, but the major output spike at midday causes exhaustion. At 74 years old, the person was very fit before these problems began. While medications help thicken and slow the watery output somewhat, gaining weight remains a challenge.

Here are some suggestions and insights:

1. Consider the possibility of short bowel syndrome (SBS) and discuss it with a surgeon or gastroenterologist, as SBS can cause high, hard-to-control output.

2. Some improvement might be expected over time, as 15 months is still relatively early for an ileostomy, and the output may calm down eventually.

3. To help thicken the output, try oatmeal-raisin cookies, plain oatmeal, or Metamucil Gummies (psyllium). High-protein Greek yogurt might also help slow the flow for some people. Imodium (loperamide) can be taken as needed to reduce volume, but coordinate the dose and timing with a physician. Keeping a food and drink log can help identify personal triggers, such as high-water foods like cucumbers and pickles, certain types of fish, and very sugary or caffeinated drinks.

4. Consider using a larger-capacity pouch if not already doing so, as it can provide more time between empties. For very high night output, a night-drainage system might be useful, such as the Coloplast Assura/Alterna 2-Piece Ileo Night Drainage Bag.

5. Interrupted sleep is common, with many needing to empty the pouch 3 to 5 times per night. Taking naps during the day can help manage fatigue.

6. If antidiarrheal medicines are not improving nutrition or weight, discuss with a doctor about possibly tapering doses, as slower transit can sometimes impair the absorption of oral nutrition and medications.

7. Re-repair of hernias is often delayed unless symptomatic, due to high recurrence rates after many abdominal surgeries.

8. Feeling isolated or discouraged is common, but connecting with other long-term ileostomates can provide practical tips and reassurance that you are not alone.