Pancaking is a challenge that many ostomates face. It usually occurs when the inside lining of the pouch sticks to the stoma itself. This leads to stool sitting on and around the stoma which fails to drop down into the bottom of the pouch, as it should. As more stool comes through, there is nowhere for it to go, so often it finds its way out beneath the flange. This can then lead to leaks and sore skin, which is pretty miserable! It can often feel like you’ve tried everything, but don’t give up…. here are a few tips to try to limit the pancaking in your pouch.
Causes of pancaking:
- Often the output from your stoma is thicker than usual when the pancaking occurs. Therefore, it is more common with colostomies rather than ileostomies.
- Tight clothing around your pouch can prevent the output from sliding down the bag causing pancaking.
- If the filter on your stoma pouch works too well it may remove the air from your pouch.
Changing a stoma bag that has pancaked:
It is always a good idea to keep some spare stoma supplies with you so that if you are out and about you can change a stoma bag that has pancaked. If you have experienced pancaking before you will know it can be a messy business as the stool will have pooled around the aperture area and there will be plenty of it!
You will need to prepare plenty of moistened dry wipes before removing your pouch. You will also need your small disposal bag at the ready. Place the majority of the pouch into the bag before you remove it. As you spray around the pouch with the adhesive remover (if you use one) to gently remove the bag, peel it off slowly and let it drop straight into your disposal bag. Clean your skin thoroughly with the moistened wipes to ensure all stool has been removed from your skin around the stoma. Thoroughly dry the area by dabbing with a dry wipe.
If the stool has been sat on the skin a short while before you could get the change it and becomes sore, try some stoma powder to help soothe the skin. Remember to only apply a very thin layer and dust off any excess to prevent it from compromising your pouch adhesion.
Dietary tips to improve pancaking:
Ensure you are drinking plenty of fluids. 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 vegetables will help ensure the stool will pass safely through your stoma. If you have an ileostomy, be mindful to avoid any fibrous foods that usually cause you problems.
Tips for pancaking:
Try and put some air into the pouch by blowing into the pouch before 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 pouch 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 pouch.
Rolling a small piece of toilet paper or cotton wool ball and dropping it into the bottom of the pouch 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 pouch 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 the escape.
At the top of your stoma pouch, there should be a filter that 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 that can be found at the bottom of your box of pouches. This can allow the air to keep the bag from sticking.
If you try all these tips and are still experiencing pancaking issues, it may be a good idea to discuss this with your Stoma Care Nurse for support and advice.