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What to do if your stoma pancakes

Pancaking with a stoma is an annoying issue which many ostomates struggle to deal with. Not all ostomates experience it, but it can be a common problem for those with a colostomy or an ileostomy.  Understanding why and how pancaking happens can really help manage the issue and resolve any unnecessary messing about with your pouch to get it to behave.

What is pancaking and why does it happen?

Pancaking is a term which is used to describe the stoma output sticking to the plastic inner lining of your stoma pouch, causing the contents to not drop into the bottom of the pouch. It then pools around the stoma area and pushes the pouch away from the body. This can result in leaks and sore 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!

People with stomas are vigilant at frequently checking their pouch, but when you experience pancaking you’ll find that the output is usually a lot firmer than usual.  This can pool around the aperture (opening of your pouch around your stoma) and if caught unawares the ostomate might not have the time or privacy to push the stool down into the pouch, which can lead to an embarrassing situation.

If your output is becoming thick, speak to your Stoma Care Nurse about starting a short course of laxatives as this may help soften the output and prevent pancaking.

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 into the pouch, causing pancaking.
  • If the filter on your stoma pouch works too well, it may remove the air from your pouch, resulting in the vacuum effect.

Diet can help improve pancaking issues:

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 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.

Tips for pancaking:

  • Try and put some air into the pouch 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 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 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, simple undo the drain and allow any gas the escape.
  • At the top of your stoma pouch 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 pouches. This can allow the air to keep the bag from sticking.
  • Don’t forget, your Stoma Care Nurse is always there to talk with for support and advise about pancaking issues.

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