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?
Hey Dan…I can think of a thing or two here. Are you on a medication that may be causing your stool to be tight? Our bodies can sometimes react differently to things we are familiar with and change it up on us just for the heck of it. Also are you drinking enough or maybe less fluids then normal? I have failed to continue my usual amount of fluids after the summer heat is gone. Not hot and dry, less fluids…can be the culprit, even two glasses of water less can cause this issue for me. You apply the lubricating deodorant every time you rinse the bag right? If it is covered, because I find it expensive, have you tried two tubes of the stuff? So the next thing I would ask is are you pushing out all the air in the bag? It could be that you need to leave some in to give the bag room to expand and the output room to fall down the bag. I tend to put about 2 tablespoons of water in the bottom of the bag when I have days that mine is thick. This allows me to help thin the output by gently pressing the fluid up the bag to thin it there then again once in the bottom of the bag. I discovered this was one of my issues when my leaks were happening at night. It helped to have the fluid in the bag so I could move it around without getting up at night. One more thing, ask your doctor if it would be okay to take some magnesium with a meal to thin the putput where it starts. Only do this if your doctor is aware of it as a drug that builds up in the system can be dangerous, this something he should be in on from the start. You would not want to be harming yourself or an organ by not keeping him in the loop. Another thing I tried was taking Metamucil with a meal, that may cause constipation like affects, of worked like jello might, it made the product more slippery then usual. Check with your doctor first in case you have weight issues or to avoid a dangerous situation. That’ s all I have for you. For me, in the end, it was mostly the air in the bag thing and not wearing tight pants. Good luck with this issue, I know full well how frustrating this can be.
Help me get rid of pancaking please !!! I have my colostomy now for about a year and a half, and never had so much trouble with pancaking.First – I had a parastomal surgery a week ago, and still have sutures, pain, and the site is swollen. This may be a reason for my trouble, but I don’t see how.Second – I use the Adapt lubricating deodorant, and spread it inside the bag before the bag goes on.Third – before asking for help I watched all the videos Eric have regarding this, and tried all the great tricks Eric talks about, with no result.Forth – I eat the same things I was eating before this surgery, and used to have small hard marbles that would fall to the bottom of the bag right away. I could even feel them passing before they came out, and it was just shooting them down the bag.Fifth – My wafer is doing well because I clean it after emptying the bag (what a mess) so that lasts me for about 5 days, but some bags have to be thrown out, even water does not get the stuff out. Is there anything I am missing? I am using a 2-3/4″ bags and wafers, even the 2-1/4 bags do fit nicely, but both sizes give me the same – Pancakes.Please HELP, I thought after a year and a half I knew everything, guess I do not. Have an appointment with the stoma nurse, the fastest I could get to see her is in two weeks. Doctors and hospital nurses know nothing about it, and want nothing to do with it. (wonder why).I have no leaks – lucky me.Thank you for any suggestionsDan
Hey Eric!! I hope ur feeling better!! It’s nice to see u back in the fray again!!!
I’m two yrs w my ileostomy so Im not a newbie but I seem to have a serious problem w pancaking at night when hopefully I’m asleep and not able to remedy the situation before a major leak. As such I tend to leak most every night even if I have a new pouching system on!!
I just changed companies and therefore products so it’s a little better but still an issue! Much to my hubby’s and my dismay!!
But I have pretty much eliminated leaks during the day. I discovered that I must wear my bag vertically so it doesn’t pancaked & I have to leave it not compressed inside my clothing so I have purchased and made a few pouch covers so the pouch can hang independently so w my lubricant/deodorant the output will fall to the bottom but w my pouch cover it’s not very noticeable. On days where I’m feeling more confident, i wear a cover that has a design and is totally noticeable! So that depends on my mood!!
As u can imagine, I’m from Boston & w the Red Sox in the World Series, there will be MANY days I’m wearing a Red Sox themed cover!!
Again I’m so glad ur back at work!! Enjoy ur upcoming conference!! Can’t wait to see ur video from that!! HUGS!!!
Hi Sandy,
Nighttime pancaking and leaks are terrible. I use to have them all the time, but almost never have them anymore. The only I changed was that I don’t have very large meals at night (although, I still eat several times between 6pm and when I go to bed). I think the volume has a lot to do with my issues, although I can’t it will help with yours.
Have you been doing anything to loosen the output at night? Maybe drinking prune juice or more liquids when you eat supper?
I had my ileostomy in June, and I’m so grateful for your site. Thank you very much. My problem has been with thick stool at night that causes bag overflows, and this gives me some things to try and reduce the viscosity.
Hi.Im quite new at all this,3 months more or less and have had all the normal problems.Pancaking was one, i wear hollister products and as my stoma isnt long was finding that output wasnt going into the bag.I then bought the hollister belt and started using the plastic type rings to seal around stoma.This has worked great and no pancacking and am getting a good 6 days of wear from my wafer.I was looking into buying from china to save money, but since i discovered this method,if i can regularly can get 6 or 7 days wear im happy to pay the extra for reliabilty, and quality.I now buy from a hollister wholesaler who gives me a discount, so am saving money that way.
Hey Derek, glad you found something that works for you!
What are the plastic rings you use around your Stoma? I add a wax ring to my barrier but would purchase the plastic ring or call the company. Could you email me the info? (My surgery was last February abd I am still having issues. I am short waisted and gained a lot of weight abd I am short.)
I was told by Hollister and my Stoma Nurse never to put water in the pouch. The few times I did it was zero water or distilled water so that there was not micrbribes like you get from tap water.
I use tap water all the time while wearing the pouch and have never had problems.