This topic is about someone experiencing pain when their ileostomy bag fills up, along with a noticeable shrinkage of their stoma over the past two years. They are worried that the change in size might be causing the pain.

Here are some helpful insights and advice:

1. The person has a history of bowel pain, initially thought to be IBS, and two years ago, they had emergency surgery for perforated diverticulitis, resulting in an ileostomy.

2. They have a physically demanding job and a limited appetite. Large meals cause discomfort when the pouch fills, and the stoma, although healthy-looking, measures only 26 mm at rest. Nighttime output often disrupts their sleep.

3. They have been advised to avoid popcorn and find it challenging to identify foods they can tolerate.

4. It is important to consult a stoma nurse or colorectal team because constant or severe pain is not typical. A medical review can help rule out complications like strictures, partial blockages, or a parastomal hernia.

5. Normally, ileostomies shrink only in the first few weeks after surgery and then stabilize. Ongoing reduction over two years is unusual and should be investigated.

6. Check the wafer opening to ensure it accommodates the stoma at full expansion during output. A too-small cut-out can pinch and cause pain, so enlarging the opening or changing the wafer size might be necessary.

7. If discomfort is accompanied by sore, inflamed skin around the stoma, using a barrier cream or film can help protect the area.

8. Momentary sharp pain can result from muscular contractions just before output. Partial blockages can temporarily shrink or tense the stoma; lying flat and taking slow deep breaths may help relax it.

9. If not already using one, consider asking about an anti-hernia belt or wrap and have the stoma site examined for a hernia.

10. If pain persists, imaging like a CT scan or MRI can help clarify internal causes when an external exam is normal.

11. Dietary adjustments can be beneficial:
- Eat smaller, more frequent meals to avoid over-filling the small intestine and pouch.
- Avoid foods that commonly aggravate output or blockages, such as green vegetables, skins (baked beans, peas, sweet corn), seeds, popcorn, whole-meal breads, spring rolls/bean sprouts, and excess chocolate. Opt for low-residue items like white bread.
- Since individual tolerance varies, keeping a food/output diary can help identify personal triggers.

12. Gentle manual pressure around the stoma can help release trapped air and reduce discomfort.