This topic is about a 58-year-old man who has been dealing with significant challenges following surgery for Stage-3 bowel cancer. After undergoing radiation, chemotherapy, and surgery that resulted in a permanent colostomy, he has been experiencing severe and disruptive bowel movements. These issues have greatly affected his quality of life, leaving him in pain and largely confined to his home. He is seeking practical solutions to help him regain a sense of normalcy.

Here are some pieces of advice and insights that might be helpful:

1. Seek further medical evaluation:
- Consider getting a second opinion from a colorectal or surgical specialist, as 18 months is a long time to wait for things to settle.
- Request imaging, like a CT scan, to check for any strictures, twists, or other issues at the stoma or internally.
- Inquire if there were any complications during surgery that haven't been discussed.
- Reach out to a colorectal or stoma nurse for a specialized assessment.

2. Investigate possible mechanical issues:
- There might be constriction at the abdominal wall or a kinked segment causing the symptoms.
- Regular colostomy irrigation could help regulate output, and a hospital stoma team can teach this procedure.

3. Optimize hydration and diet:
- Increase overall fluid intake, as dehydration can lead to hard stools followed by overflow.
- Try a soft, low-residue diet, avoiding raw vegetables at first, and chew food thoroughly. Eating smaller, more frequent meals might help.
- Drink a full glass of water before meals and sip fluids while eating.

4. Bowel consistency aids:
- Under medical guidance, consider using a daily spoonful of cod-liver oil as a lubricant laxative.
- Continue or adjust the use of bulk-forming fiber like Metamucil (psyllium) if it is tolerated.

5. Lifestyle measures:
- Gradually increase gentle physical activity, as movement can aid gut motility and improve overall well-being.
- Practice relaxation techniques to help reduce abdominal muscle tension and stress.

6. Psychological and social support:
- Recognize the emotional impact of these challenges. Unemployment and isolation are common after major surgery, so seeking counseling or peer support can be beneficial.

The products and medications mentioned include Lactulose, Metamucil (psyllium), and cod-liver oil.