This topic is about a person who has been living with a stoma for 18 months after a twisted bowel. They usually use a Salts “Confidence BE” drainable pouch, but recently, they've experienced sudden high-volume output that caused the pouch to overflow twice in two weeks. This has understandably made them anxious about leaving home. Here are some helpful insights and advice for managing this situation:

1. Possible Causes of Sudden Flooding:
- It might be due to a brief stomach or intestinal bug, bacterial overgrowth, or a side effect of medication. These episodes often resolve within a day or two.
- A partial blockage could cause a buildup behind the stoma, which then releases suddenly, leading to rapid filling.
- Certain triggers like strong coffee, Pepsi, or specific foods might also cause high output.

2. Check Pouch Capacity and Size:
- The Salts Confidence BE pouch comes in small, medium, and large sizes. Make sure you are using the right size and consider moving to a medium or large if needed.
- Other high-capacity options include:
- Coloplast drainable pouch, approximately 6 inches by 7 inches, which expands well without bursting.
- Hollister drainable pouch, 6 inches by 9 inches, with larger sizes available.
- All major manufacturers offer large-capacity or “high-output” bags. You can request samples or consult your stoma nurse.

3. Bag Features and Alternatives:
- During high-output periods, use drainable or “open-end” pouches to empty them without removing or opening the wafer seal each time.
- Ensure the pouch and wafer remain adhered even with liquid output. Change them sooner if you notice pancaking or seepage.

4. Management Tips for High Output:
- Empty the pouch as soon as it starts filling. You might set a timer or check for weight.
- If allowed by your doctor, take loperamide (Imodium) before going out to slow down transit.
- Eat foods that thicken output, like peanut butter, bread, bananas, and potatoes. Try to reduce or avoid stimulants like strong coffee and fizzy drinks.
- Keep re-hydration solutions handy and drink steadily to prevent dehydration.

5. When to Seek Help:
- Contact your stoma clinic or colorectal nurse if flooding happens again, if the output remains watery for more than a day, or if you suspect a blockage or infection.
- Antibiotics might be necessary for bacterial overgrowth, so a medical review is recommended if symptoms persist.

6. Reassurance:
- Many people with ostomies experience an occasional “bag blow-out.” Confidence usually returns once the underlying cause is addressed and an appropriately sized pouch is used.