I love pancakes, but I don’t like pancaking! In the world of ostomies, pancaking can be a frustrating, challenging and sometimes a messy ordeal. Pancaking applies mostly to colostomates, although some ileostomates with thick stool might experience this too.
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First, a quick definition:
“Pancaking” is a word that an ostomate might use to describe when their stoma output stays on the top part of the pouch and/or collects around the stoma.
Without anyplace for the stool to go (stubborn stool!), it often forces its way under the wafer or muscles through to push the pouch off. Obviously, nobody wants to deal with leaks in this way, so it’s important to identify the cause and correct the problem.
I’m my experience with thick ileostomy output, pancaking has only caused leaks when it happens overnight; when it happens during the day, I can usually intervene before things go south.
Here are a few possible causes and some things to try:
Thick Stool
There are a few ways of dealing with thick stool; I wrote an entire article about it HERE, but these tips are specific to help prevent pancaking.
Lubricate the inside of your pouch. This can be done using a lubricating gel or liquid designed specifically for ostomy pouches, or using DIY methods like olive oil or cooking spray. The idea is to coat the inside of your pouch so that stool can slide down to a happy place at the bottom of your pouch. Lubricants need to be reapplied whenever the pouch is emptied, but it’s important that you Lubricate up to the top of the pouch (if possible).
Drink more liquids. Adding more water or other fluids to your diet will help to soften stool. Some people might try beverages known to loosen output like prune, apple or grape juice; other options like coffee or even soda could create the same effect too.
Increase fiber intake, but focus on insoluble fiber. This shouldn’t be a problem if you’re eating a lot of plant foods, but increasing insoluble fiber will move things along and can prevent stool from becoming dry, hard and difficult to pass. You’d typically want to focus on whole grains, vegetables and produce with skins. Use caution with high-fiber intake if you’re fresh out of surgery.
Some ostomates are told to take laxatives by their doctor. I would personally avoid this option as laxatives can create other problems down the road. Check with your stoma nurse or doctor if you feel that laxatives are needed.
Check Your Filter
Believe it or not, some pouch filers work too well, and they remove air from the bag while creating a vacuum at the same time. If this is the case for you, cover the outer filter on your pouch using a sticker (they often come included with your pouches). Some brands, like Hollister, don’t include these stickers, so you’ll have to improvise and use tape or something similar.
If it turns out that your filter is being too aggressive, keep using the sticker, and periodically remove it when your pouch begins to fill with gas. If this is too much trouble, you might want to try other pouch systems to see if another style of filter weekends l works better.
You can also try blowing a bit of air into the pouch when you empty or change it; this bit of air will counter the vacuum effect and will help regardless if your pouch has a filter on it or not.
Stuff It!
I’ve heard of some ostomates putting a bit of wet tissue/toilet paper inside their pouch to prevent the pouch from being too flat. This method is similar to blowing air in your pouch, although it may not prevent the vacuum effect caused by a filter. The downside is that it’s more inconvenient to use this method.
Let’s Get Physical!
Sometimes you have to manually move pancaked stool down in order to avoid problems from developing. Don’t be afraid to push, shove and squeeze that stool down to the bottom of your pouch. This may be necessary if you’re wearing an ostomy wrap or tight-fitting clothes.
Additional Tips
- If you’re covering your filter, uncover it at night so you don’t have problems with ballooning (when your pouch is too full of gas).
- Rinse the inside of your pouch before changing it, as it’ll help remove any stool that might be stuck around your stoma.
- Rinsing can also help to empty your pouch during regular toilet visits.
- Some oil lubricants may reduce your wear time, so use a commercial ostomy lubricant to minimize that risk.
- Experiment with different ostomy systems to see if another brand or style reduces pancaking for you. This may be necessary if the filter on your current pouch is too troublesome.
Question: What do you do to prevent or deal with pancaking?
Hi Mike,
I shower with wafer on and bag off all the time.
I use Coloplast SenSura Mio barrier and the Brava protective seal together. I have not had an issues with the shower compromising the wafer. I take long hot showers and intentionally spray the hot water on the wafer to get it as clean as possible. The protective ring does break down a little bit ( melts a little ) over time but not enough to have leaks.
I usually change my wafer every 5 days or so.
cygo
One of the ostomy nurses I had this time around was big on viva paper towels. I’ve never showered with the wafer on and bag off. Is there a chance of compromising the wafer if you do that?
Thank you for creating this space and sharing great info.
I have pancaking with every device I’ve tried. The consistency of my stool is like pudding. There are medical reasons I won’t go into that this is the best consistency I can have for my current circumstances.
The way I am managing the pancaking is to use a 2 piece system and remove the bag from the wafer once a day and clean around the stoma without removing the wafer. I use wet guaze, toilet paper or wet viva paper towels. Sometimes I use q tips as well if I am being more detail oriented. Sometimes I may add a little paste if I see a gap. I like the safe n simple paste with pectin because it is a paste, but dries quickly and not as viscous as the adapt paste.
I like the coloplast 2 piece the best so far because it is best on my skin and stays in place with less odor and noise compared to other products I’ve tried so far. I had leaks with the coloplast one piece, but so far none with the 2 piece.
That’s interesting what you say about the coloplast filter making the pancaking problem worse. Maybe that’s true, but I have stool sticking to my stoma with every device I’ve tried so far. For me, it has more to do with the consistency of my stool. I use the lubricant, but there is always still some stool on my stoma unless I manually clean it. I suspect the water rinsing of the bag could work as an alternative or just help clean out the bag better.
I use the convex flip wafer with the petals. (I also have a hernia and uneven skin where my stoma is placed. My stoma is a loop diversion colostomy and the placement is not ideal, but because I had emergency surgery due to an obstruction it was where they could put it at the time.)
I usually have a lot of output before noon or so and then little to none until the next day, so I am using a drainable bag in the morning and then sometimes switching to closed bags until the next morning.
I’m changing my wafer every 3-4 days. I remove it in the shower. I think showering without the wafer is helping my skin. It’s a gentle way to remove some of the adhesive and just relax. There is an ostomy support group in my area that recommended the shower for bag changes. They also recommended using viva paper towels with water saying they are low lint paper towels.
Thank you so much for sharing your tips, Jen!
Oh this pancaking! Yes I have it all the time!! I found if I leave a little air in the pouch and try not to wear too tight if clothing helps a little bit.