The topic is about preparing for a surgery known as a "Barbie-butt" or proctectomy, which involves removing the remaining lower part of the rectum. This person has already had significant surgery in the past, including the removal of the upper rectum, entire colon, and appendix, and now has an ileostomy. Along with the proctectomy, they will undergo an endoscopy and a vaginal exploratory procedure to address stenosis. Despite having been through major surgery before, they are understandably nervous about this next step, which is expected to be more painful.

Here are some insights and advice shared by others who have been through similar experiences:

1. On the day of surgery, only the rectal stump was removed, and a drain and sutures were put in place. The drain can cause sharp pain if it moves. Initially, post-op pain was managed with high-dose Tylenol, which felt like hemorrhoid pain and worsened with movement. General anesthesia led to severe nausea and vomiting, but this subsided, allowing for short walks.

2. By the third day at home, the pain was described as feeling like razors in the rectum when walking, moving, or coughing, with an overall ache similar to post-childbirth. Sleeping comfortably was difficult. Tylenol was used for pain relief as stronger medications offered little extra help.

3. A night of frequent pouch emptying led to taking a prescription pain pill (tramadol + gabapentin), which possibly caused an allergic reaction with itchy welts. Benadryl helped reduce these symptoms, and pain was then managed with Advil.

4. Recovery outlook: Many people find that recovery from a Barbie-butt surgery is often easier than expected. Some have even returned to physical jobs within five weeks.

5. It's crucial to strictly follow the surgeon’s post-op instructions and avoid overexertion, as too much activity can risk popping stitches.

6. For pain management:
- Staying on prescribed pain medication for a week or two can make movement more tolerable.
- Be aware of potential drug reactions; tramadol and gabapentin can cause hives and have challenging withdrawal symptoms, so if stopping, do so gradually.

7. For positioning and comfort:
- Use the softest pillow available when sitting to ease discomfort.
- Consider emptying the ileostomy pouch while standing to avoid putting prolonged pressure on the surgical area.