This topic is about managing constipation for someone with a colostomy and Type-2 diabetes. The person in question is 83 years old and had a colostomy after rectal cancer surgery. They are experiencing severe constipation, which is challenging to manage due to their dietary needs and the absence of a rectum. Here are some insights and advice to help navigate this situation:

1. The emergency room recommended using polyethylene glycol 3350 (Miralax) in high doses to clear the constipation. However, there is concern about the potential for continuous high-volume output that their regular pouch might not handle, especially overnight.

2. Consider using a high-capacity drainage or irrigation pouch before starting the high-dose Miralax. These are available from major ostomy manufacturers and can handle larger volumes safely.

3. Follow the prescribed Miralax regimen, staying near a bathroom and emptying the pouch frequently. Regular pouches can manage if emptied often, but larger bags provide extra security.

4. Maintain energy and hydration by continuing to eat and drink. Walking and mild abdominal movements can help move the stool along.

5. After clearing the constipation, establish a daily maintenance plan to prevent it from happening again. Options include:
- Taking psyllium fiber powder like Metamucil once daily to bulk and soften stool.
- Using a smaller, individualized daily dose of Miralax, which is gentle and non-addictive.

6. Some additional aids that might help include warm Senna tea (used occasionally), warm lemon water, hot showers, gentle abdominal massage, and regular walking.

7. If taking opioids, chemotherapy, or other medications that cause constipation, consider using Miralax 1–2 times daily while on these medications.

8. Reach out directly to the hospital’s stoma or enterostomal therapy nurse or nutrition department for guidance. Ensure that ostomy-knowledgeable staff are available or on call.

9. Advocate for yourself with healthcare providers. Surgeons may not have long-term ostomy care expertise, so seek advice from an ET nurse or gastroenterologist familiar with ostomies.

10. Avoid chronic use of stimulant laxatives like senna to prevent dependence. Instead, rely on PEG-3350 or fiber.

11. Remember that large volumes of stool can accumulate without immediate risk of rupture. Prompt laxative therapy, along with movement and hydration, is the safest approach.