This topic is about a 57-year-old woman who has been experiencing a sudden change in her ileostomy output. After having a loop ileostomy for several months with normal, porridge-like output, she suddenly began experiencing extremely thick output that was difficult to manage. Despite trying various remedies, the issue persists, and she is seeking advice and insights on how to address this problem.

Here are some helpful suggestions and insights:

1. Ensure you are drinking at least 2 liters of fluids daily, including an oral rehydration or electrolyte solution, to keep your output fluid and replace any lost salts.

2. Consider seeking a second or even third medical opinion, as the current surgeon's response to your symptoms may not be adequate.

3. Consult with a different colorectal surgeon or stoma nurse to evaluate:
- Any possible mechanical or functional causes for the sudden change in output consistency, despite good hydration.
- Whether the stoma is unusually small or if there might be an issue with its construction, such as the active limb being positioned incorrectly.

4. During your appointment with the ostomy nurse, request a thorough hands-on assessment of your stoma. This should include measuring and observing both lumens to verify their orientation and functionality.

5. Keep a detailed record of your fluid and food intake, medications (like Miralax and Motegrity), timing, and the exact consistency of your output. This information will be valuable for any healthcare professional you consult next.

6. If your output stops or you experience abdominal pain, do not hesitate to visit the emergency room again. Your safety is more important than any provider's impatience.

Referenced products and medications include:
- Miralax (polyethylene glycol 3350), a laxative for emergencies.
- Motegrity (prucalopride), a pro-motility agent.
- Ensure, a liquid nutritional supplement noted in thick output.
- Hollister stoma measuring template, indicating a very small stoma size.