This topic is about someone who has been experiencing persistent abdominal swelling after returning to an ileostomy. Despite leading a healthy lifestyle, the swelling has been a constant issue since the ileostomy was re-established. Here are some insights and advice that might be helpful:

1. The swelling occurs across the entire abdomen and is not limited to one side. It tends to be flat in the morning but increases throughout the day after eating or drinking.

2. There is a slight stoma prolapse, but no hernia has been detected so far. The person has a history of surgeries, including a reversal and two bowel obstructions, with the most recent ileostomy surgery revealing bowel twists.

3. It might be beneficial to check for a hernia, as abdominal bulging can be an early sign. Imaging or a surgical review could provide clarity.

4. Traditional abdominal exercises might not be advisable, as many clinicians recommend against them for ostomy patients.

5. Healing after surgery can take a long time, sometimes up to two years. The swelling and fatigue might be part of the ongoing recovery process.

6. Wearing an abdominal or hernia support belt can help by flattening the abdomen cosmetically and providing support to prevent herniation.

7. It is a good idea to ask the surgeon to rule out fluid collections like seromas or ascites, which can cause visible distension without pain and can be drained if necessary.

8. Consider the possibility of small-intestinal bacterial overgrowth (SIBO) or a parasite infection. Breath tests can be used for diagnosis, though they are not foolproof. Antibiotics might help reduce bloating, but their effectiveness can vary.

9. Adhesions from multiple surgeries could be causing intermittent bloating and should be considered in the diagnosis.

10. A suggested diagnostic pathway includes endoscopic evaluation, MRI or CT imaging, and serial follow-ups to identify any mechanical or infectious causes.

11. It's important to acknowledge that frequent hospital visits can lead to anxiety or PTSD-like reactions. Being aware of this can be helpful when planning further investigations.