Pancaking is a common problem which many ostomates experience. It can be a frustrating issue which can cause discomfort, ballooning, leaking and sore skin.
So let’s learn more about pancaking, understanding what is and why it happens so we can prevent it and manage it, if it does happen.
What is pancaking?
Pancaking is a term which is used to describe the stoma output sticking to the plastic inner lining of your stoma bag, which stops the contents dropping to the bottom of the bag as they should. When you experience pancaking, you’ll find that the output is usually a lot firmer than usual. This can then pool around the aperture (opening of your bag around your stoma) and if caught unawares the ostomate might not have the time or privacy to push the stool down into the bag, which can lead to an embarrassing situation of the bag pushing away from your body and leaking. This can result in sore and irritated peristomal skin.
The cause is a vacuum within the pouch itself which means the inner surfaces stick together. A little bit like the thin supermarket carrier bags when you can’t get into them!
What causes it?
It usually happens due to a combination of:
- Sticky or thick stool. Often the output from your stoma is thicker than usual when the pancaking occurs. This is more common with a colostomy rather than an ileostomy.
- Lack of air in the bag, creating a vacuum that pulls the pouch walls together.
- Poor pouch airflow from a clogged filter or tight seal
- Tight clothing pressing against the pouch, can prevent the output from sliding down into the pouch
- If the filter on your stoma bag works too well, it may remove the air from your pouch, resulting in the vacuum effect.
- Poor lubrication. Without lubrication, stool sticks rather than sliding down.
Signs and symptoms:
- Thicker stool – pancaking is more common when stool is thicker and less fluid.
- Collection of stool around the stoma
- Stool may not fall to the bottom of the bag as expected, instead, it builds up around the stoma and potentially under the adhesive.
- Leakage can happen because of pancaking
- The accumulated stool can push against the adhesive, causing it to lift or tear, leading to leaks.
- Sore skin – the trapped stool and potential leaks can irritate the skin around the stoma.
- Pancaking can make it difficult for the stool to move down into the bag, leading to a feeling of fullness or difficulty passing stool.
Prevention strategies and tips
- Diet can help to improve pancaking issues.
- Ensure you are drinking plenty of fluids as this can help soften the stool and help any risks of pancaking.
- Water is also hydrating.
- Fruit juices such as orange apple and prune juices can help loosen the output. But be careful of these if you have an ileostomy as they can make your output too loose.
- Eat plenty of fibre. High fibre foods such as whole grains, fruits and vegetable will help to ensure the stool will pass safely through your stoma. If you have an ileostomy, again be mindful to avoid any fibrous foods that usually cause you problems.
Managing pancaking:
- Try and put some air into the stoma bag by blowing into the pouch prior to application, then apply a filter cover, this will make sure some of the air remains inside the pouch to prevent any vacuum. Once you have had a bowel movement, remove the filter cover. This will hopefully allow the stool to drop to the bottom of the bag.
- Some people find it helpful to use a drop of oil into the stoma bag through the hole/aperture of the adhesive before applying, make sure you lubricate the opposite side of the internal film so when the stoma touches the material it will not stick, and the stool can slide to the bottom of the bag. If you have tried this with no effect, try some stoma deodorising lubricating gel.
- Rolling a small piece of toilet paper or cotton wool ball and dropping into the bottom of the stoma bag before you apply your pouch, can help provide some weight to the bag and the vacuum will hopefully then not occur.
- If you are using a two-piece system some people find it helpful to “burp” the bag, by lifting the edge of the bag off the flange to allow some air to escape and then re-seal. The same can be done with a drainable bag, simply undo the drain and allow any gas to escape.
- At the top of your stoma bag there should be a filter which allows air and gas to escape from your pouch. On occasions this filter can work too well, and it is worth placing a filter cover over the filter completely or cover half the filter. These covers are little stickers which can be found at the bottom of in your box of stoma bags. This can allow the air to keep the bag from sticking.
Impact on daily life:
Pancaking with a stoma can become a real challenge. You may find that pancaking doesn’t happen all the time, but it can often be unpredictable which can impact your daily activities. You might find yourself going out less as you feel you cannot trust your pouch, which starts to feel socially isolating. When your stoma bag starts to let you down, it can understandably create feelings of fear and anxiety. Don’t suffer in silence, reach out to your stoma care nurse for advice and support.
FAQs and concerns:
Q: Can pancaking cause leaks?
A: As the stool pools around the aperture part of the stoma bag, it can push the stoma bag off the skin causing leaks and sore skin. Make sure when you change your stoma bag, you clean the skin around your stoma and remove any caked stool from your skin to avoid developing sore skin
Q: Is it true that drinking more water can help?
A: Yes, this is true, as more fluids can help soften the stool and make it less sticky
Q: If I change my stoma bag more often, can it help with pancaking?
A: Yes – changing your ostomy pouch when they are full can help with pancaking
Q: Should I try to increase the amount of fibre I eat?
A: The aim is to try and keep the stool consistency soft, increasing fibre in your diet and drinking more fluids can help
Q: Why has my filter stopped working – is it related to the pancaking?
A: As most filters are placed at the top area of the stoma pouch, they can easily become blocked by the stool which pools around the top of the stoma bag when it pancakes.
Q: I read somewhere that I can get something called a stoma bridge?
A: Stoma bridges are a small foam or plastic devise which can be inserted into the stoma pouch to prevent sticking of the pouches front and back layers. Contact your delivery company and they will be able to direct you.
Q: Should I try another stoma bag if nothing helps with the pancaking?
A: Speak with your stoma nurse and they will guide you to what stoma products might help you. If you have tried all the regular tips for pancaking, you may well benefit from trialling a different stoma bag. Again, reach out to your stoma care nurse to find out which ones would be the best ones to try.
