This topic is about managing constant output with a sigmoid colostomy using a Hollister two-piece system. An 83-year-old man, who had a sigmoid colostomy nine months ago, is dealing with continuous output despite careful food choices. He finds himself emptying his pouch frequently throughout the day and night, which is exhausting. His surgeon suggested letting the waste accumulate to reduce bathroom visits, but he finds this idea unappealing and unhygienic. Here are some helpful insights and advice for managing this situation:

- Variation is normal: Output patterns can vary greatly from day to day, and this is common, especially in the early months after surgery. Over time, many people find that their output becomes more predictable.

- Consider colostomy irrigation: With a sigmoid colostomy, you might be a candidate for irrigation, which can provide up to 24 hours of stool-free time. Discuss this option with your ostomy nurse or surgeon.

- Gradually extend the interval before emptying: Try to wait a little longer each time before emptying your pouch. Start by waiting 5 minutes, then 10, and so on, until the pouch is about ¼ to ½ full. Most people find that a sealed Hollister pouch does not emit odors, with gas being the only potential smell risk.

- Night-time strategies: To reduce nighttime output, consider stopping eating by 7 p.m. or experimenting with an earlier cut-off time. Some people set alarms every 2 hours to empty their pouch preemptively, which can be helpful if you already wake up during the night.

- Medication: Over-the-counter loperamide (Imodium) can help slow down transit time. Some people take it proactively before bed, but always consult your physician before regular use.

- Cleaning tricks: After emptying your pouch, pour about ¾ cup of water into it, seal, swish, and then empty again. This helps rinse both the pouch and the stoma, reducing mess. Remember, the stoma is part of your colon and has been in contact with stool for years, so it won't be harmed.

- Mindset & acceptance: The pouch is simply replacing the rectum as a storage site, and carrying stool is normal. Keeping busy and wearing looser clothes can help you forget about the pouch. Focus on the benefits, like avoiding urgency accidents and being able to leave the house, rather than the presence of stool.

- Practical tips to avoid blow-outs: Start meals with an empty or nearly empty pouch to prevent over-pressurization from output surges. Burp gas promptly or use pouches with charcoal vents. Deodorant drops or tablets can help with odor if available.

- Accidents happen—be prepared: It's normal to occasionally get stool on your hands, clothes, or bathroom fixtures. Keep cleaning supplies within reach and view these incidents as routine, not failures.

- Product references: The two-piece Hollister colostomy system is the current device being used. Some users also mention Ensure Enlive nutritional shakes, Gatorade GFIT drinks for hydration, and loperamide/Imodium for output control.