This topic is about a person who, after having an ileostomy due to Crohn’s disease, has noticed small, hard white balls appearing in their ostomy pouch. These balls, which become gummy when squeezed, have puzzled both their gastroenterologist and colorectal surgeon. Here are some helpful insights and advice on this situation:

1. Undigested or partially digested medication is often the cause:
- Extended- or slow-release tablets, like Tramadol SR or Metformin, may pass through an ileostomy with only their outer coating removed.
- Potassium citrate tablets can appear intact a few hours after ingestion but turn to powder when pressed, fitting the gummy description.
- Consider switching to immediate-release formulations, breaking tablets in half, or asking for a product with minimal coating. Always check with a pharmacist before making changes, especially with capsules.

2. If medications that previously dissolved well suddenly stop doing so, the manufacturer might have changed the coating. Splitting the pill or trying a different brand can often help.

3. Collect one of the white balls and ask a doctor or pharmacist to analyze it. This can provide a clear identification and peace of mind.

4. Keep a log of when each medication is taken and when the balls appear in the pouch. This can help identify which medication might be causing the issue.

5. Some food items can also appear intact in the pouch, such as corn kernels, pea or bean skins, mushroom pieces, grape skins, and some nuts. Chew food thoroughly and monitor your diet to rule these out.

6. Because rapid transit through the digestive system can limit absorption, it’s important to have periodic blood work to check nutrient and medication levels. Adjust supplements only if deficiencies are confirmed.