Stoma pancaking is a common issue for individuals with an ostomy, a surgically created opening that allows waste to pass into an external pouch. Pancaking occurs when output remains stuck around the stoma opening instead of dropping into the pouch. This problem can lead to discomfort, frequent pouch changes, and leakage onto the skin. Understanding the causes and implementing solutions is necessary to maintain an effective pouching system.
Identifying the Root Causes of Pancaking
Pancaking results primarily from two distinct mechanisms: a lack of air inside the appliance and the consistency of the output itself. Most modern ostomy pouches are designed with filters to release gas, but if the filter is too efficient, it removes too much air, leading to a vacuum effect. This vacuum causes the inner walls of the pouch to stick together, collapsing the space needed for the output to fall freely.
The second factor relates to the stool’s texture, which is a common issue for people with a colostomy where the output is naturally thicker. When the stool is pasty, thick, or sticky, its adhesive properties make it easily cling to the plastic walls of the pouch near the stoma. This sticky buildup blocks the opening, preventing subsequent output from entering the bag correctly. The accumulation of output around the stoma can push the protective skin barrier away from the body, increasing the risk of leakage and skin irritation.
Immediate Pouch Management Techniques
When pancaking is occurring, several immediate adjustments can be made to the existing pouching system. One quick technique is to introduce air back into the appliance to counteract the vacuum effect, sometimes called “burping” the pouch. This can be done by gently lifting the edge of a two-piece flange or briefly opening the tail of a drainable pouch to allow a small puff of air inside.
Before applying a new pouch, it can be beneficial to manually inflate it by gently blowing a small amount of air into the bag to separate the internal layers. If the pouch has a filter, temporarily covering it with the provided sticker or tape will prevent all the air from escaping, helping to maintain a small air pocket. Once output begins to flow, the filter cover should be removed to allow gas to escape and prevent the pouch from ballooning.
Another effective strategy involves the use of lubricating products to create a slick, non-stick barrier inside the pouch. A few drops of a specialized lubricating deodorant, or even a small amount of baby oil or olive oil, can be swirled inside the bag before wear. This lubrication coats the plastic, allowing the thick, sticky output to slide down the pouch walls and away from the stoma. For active pancaking, gently massaging the pouch from the top downward can manually guide the stuck output away from the stoma site.
Adjusting Diet and Hydration for Prevention
Long-term prevention of pancaking often requires addressing the internal consistency of the output through dietary and hydration changes. Output that is overly thick or pasty is a primary cause of sticking, so modifying the diet to produce a softer, less adhesive stool can be highly effective. Inadequate fluid intake often leads to firmer output because the body attempts to absorb more water from the intestinal contents.
Increasing daily fluid consumption, aiming for a consistent intake of water or electrolyte-rich drinks, is a powerful preventative measure. For those with a colostomy, incorporating a balanced amount of fiber, including fruits, vegetables, and whole grains, helps regulate stool consistency. Conversely, for both colostomates and ileostomates experiencing thick output, temporarily limiting foods known to thicken stool, such as bananas, rice, applesauce, and white bread, may be helpful.
Some individuals find that incorporating specific liquids, such as prune or apple juice, can naturally help to loosen the stool and make it less sticky. Oral stool softeners or laxatives may also be considered in consultation with a healthcare professional to achieve a more manageable consistency. Chewing food thoroughly aids in digestion, which contributes to a smoother output that is less likely to adhere to the pouch walls.
Selecting the Right Ostomy System
The choice and fit of the ostomy appliance play a significant role in minimizing the risk of pancaking. Ensure the skin barrier, or wafer, is sized correctly to fit snugly around the stoma base without constricting it. An improperly sized opening can create a ledge where output can pool and begin to stick, initiating the pancaking process.
For a stoma that is flush with the skin or slightly retracted, a convex barrier may be beneficial, as its shape gently pushes down on the skin around the stoma. This action helps the stoma protrude slightly, directing the output straight into the pouch and away from the adhesive surface. Pouch accessories can further aid prevention, such as specialized anti-pancaking inserts or foam rings that are placed inside the pouch to keep the internal walls separated.
The design of the pouch itself is also a factor, particularly the functionality of the integrated filter. If a filter is hyper-efficient, it can create the vacuum effect that collapses the pouch. In such cases, switching to a pouch with a less aggressive filter, or one that uses a two-piece system which allows for easy “burping,” may be a better option. Routinely emptying the pouch before it becomes too full also prevents the weight of the output from collapsing the upper pouch material near the stoma.