This topic is about someone who has been dealing with ongoing issues after having a colostomy in 2007. They are experiencing a range of problems, including a "pooch" around the stoma, chronic diarrhea due to Irritable Bowel Syndrome (IBS), pancaking, and skin irritation. They are looking for solutions and advice from others who might have faced similar challenges.

Here are some insights and advice that might be helpful:

1. Seek a thorough second opinion:
- It's important to find a more experienced colorectal or gastrointestinal surgeon, preferably at a university-affiliated center. Be cautious of any doctor who discourages seeking a second opinion.

2. Engage a specialized Stomal Therapy Nurse (STN):
- An STN can help assess the fit of your appliance, teach irrigation techniques to manage output, and provide advice on skin care.

3. Physical therapy for abdominal-wall weakness:
- Working with a physical therapist who has experience with post-ostomy or post-hernia patients can help strengthen the core and potentially reduce the "pooch."

4. Manage diarrhea with flexible dosing:
- Consider using loperamide in liquid form to adjust the dose more precisely. Some people find taking Imodium tablets before meals and snacks helpful. Discuss the possibility of using alosetron (Lotronex) with your doctor for IBS-D.

5. Dietary tweaks:
- Reducing caffeine and adding binding foods like cheese, marshmallows, and yogurt might help manage diarrhea.

6. Appliance and accessory tips to combat pancaking and odor:
- Using a lubricating deodorant inside the pouch can help keep output moving away from the stoma. Trying different wafer depths or brands might also help. Some people use dressings on raw peristomal areas before applying the pouching system.

7. Consider irrigation (for those with colostomies):
- Regular irrigation can lead to more predictable emptying, reduce pancaking, and allow for periods without a pouch, giving the skin time to breathe.

8. When chronic raw or bleeding stoma edges persist:
- It might be necessary to re-evaluate the stoma placement and consider surgical revision. If your primary surgeon is reluctant, seek another surgical opinion.

These suggestions are based on experiences shared by others who have faced similar challenges.