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?
Hello all, an update from my last post above…I am back to my Hollister pouch & wafer (don’t fix what’s working is my motto).My Stoma has now shrunk from size 1-3/4 to 1-1/8, and even better then that, it is now just at skin level (it was below originally) but I worry that it would become another parastomal hernia, it would be the third time, I hope not. I am using now a cut to fit wafer (Hollister 11203 with filter, and so far it has done well for my skin around the Stoma, but pancaking is still an issue, and I still have to either drop it into the toilet, or push it down the bag. I ate a lot of Hummus (recommended by Stoma nurse as an oily substance) but as I wrote before, I did not believe it will work, and it did not.If I find a way to kill the pancaking, I will post it right away, in the hope to help others, I also found a support group right here in town, meeting in the hospital where I had my surgeries, maybe I can find someone with an answer.Have a great weekend everyone.Dan
Keep trying new things, danbh!
It would be amazing if some breakthrough in pancaking management comes along – but until then, all we can do is experiment to find something that works for us.
Hey Eric and All, yes allowing air into the bag is a good thing, and as far as the M9 goes, I will toot its praises. I use the Hollister 8331 with the filters and you are right they work poorly and only for about a day and a half. I like the plastic on this bag tho, it is quieter then on the bag without the filters unless my pharmacy had a lot of extras and they are old….Hmm? Maybe I should see if the comp. has changed the plastic on the bag without filters. However, I do find that the little it works, especially for the first day, it limits the amount my hands hurt after a bag change, by letting out the extra air for me. Most of it is being sure that the filter stays dry. Hardyhaha. But, this is where the Osto EZ Vent comes in too. Also, before bed when when having pancaking issues, I push the moisturizing liquid deodorant up and around the stoma and area, avoid the filter area by folding that part of the bag forward. I seem to always be aware of Rose working…so after I have had to help the contents along there way, I will try and take the sides of the bag where more deodorant may be and spread the liquid around there again. I have even taped it down that way. It too helps in conjunction with the other remedies. One more little thing, my Doctor lets me take Gas X and it has helped tremendously with the gas part of eating and guts. Not nearly the extent I used to get, and if it gets bad, there is little build up in my guts.
Thank you all for your ideas and solutions. I went yesterday to my Stoma nurse, and her idea was eating more oily stuff like Hummus, I love Hummus and will try it, but I don’t think this would help much. She also put on me a different make pouch and wafer, the Coloplast Sensura Mio, which I am having trouble with the lock, she showed me how to lock it, but when I unlock it, it still does not open easy, and you have to really pull on it to get the pouch off. Also my Hollister unit give you the space to click the pouch on the wafer, where on the Coloplast you have to press down on your abdomen to click it in, and with only 3 weeks since my surgery, with sutures still fresh, it HURTS. I am going back to what I know, and have no trouble with – The Hollister. As for my skin around the stoma I was told to use the “Stoma powder" and the Cavilon barrier. The Stoma powder I thought was only to make sure the area is dry, not to heal a damaged skin, so I am going to my Pharmacist and see if she has anything that would not effect the barrier ability to stick to my skin. I think that these nurses are great, and do a job of looking and cleaning poop, with out blinking an eye, but they forget that we can not see what they see standing in front of us, not even in mirror when your eye sight is not great (due to diabetes). Time will tell, and hopefully things get better. I am not giving up.Again, thanks to all who tried helping, and thank you Eric for a great website, and all your work. You are great.
Everyone is different so you need to experiment with foods and with appliances. I have had an iliostomy for 9 years. This is what I have done to CURE pancaking. First, I don’t know why anyone would use a 2 piece if they have pancaking issues. I have tried all the major manufacturers of 1 piece appliances over the past 9 years. For me it does not have much to do with what I eat. After trying multiple vendors I found Cymed had a product that would give me 3 days consistently. None of the others would last more than 1 day. Then in July of 2016 Cymed changed their wafer and adhesive(they had been getting their wafer material from Salts out of the UK). The new product would not last 12 hours. I contacted Salts(great people!) and they made only one product with this type of wafer (CDSS1325). They sent me samples. These lasted 3 to 6 days with NO pancaking. However, there are 2 things I am not happy about. One it is a convex wafer which tends to be a little bulky. Two, they do not have a distributor in the USA. I have to order them thru Canada(Argyle) and Medicare does not cover them. Cymed just went back to using Salts wafer material and I got 3 samples from them. They are not the same as the pre 2016 product. Leaked behind the wafer and somewhere on a seam….also they were almost impossible to empty and clean(see earlier threads on Cymed’s quality control).
Pancaking is debilitating. I hope this solution works for you. Good luck!
The powder can be used to help heal the skin around the stoma. Sprinkle near the stoma, dust off excess and them dab with a skin barrier wipe. I use cavillon. Let this dry for several seconds. Yiu will see it begin to crust. Then you apply your wafer.Do a youtube search… Type in crusting around a stoma….a video will show you just how it’s done.
Hi Shazzon, certain foods will keep the output thick, have you tried prune juice or other fruit juice to thin it out and keep things moving. Start with a little until you find what works. Some medication will cause thick output
I have pancaking all the time . I have tried everything.the tissue piece in the bag helps and leaving a little air in the bag helps. I also use liners whenever I can and I find this helps a lot as it is easier to clean when my output is thick which is most of the time . I have had my stoma for nine months now and have learned more from your site than anywhere else thanks again for all you do .