Pancaking is when a colostomy pouch goes flat and stool collects on top of the stoma instead of falling to the bottom of the bag. It usually comes from a lack of air inside the pouch combined with stool that is too thick to slide down. The fixes are mostly simple: get some air back into the bag and make the stool softer. It is common, and the most helpful changes cost little or nothing.
Why Your Stoma Bag Goes Flat
A vacuum inside the pouch makes the inner surfaces stick together.1Unora Health. Why does my stoma bag pancake when wearing tight clothes? With the walls sealed against each other, stool has no open space to fall into, so it stays around the stoma and pushes upward and outward against the wafer.
Most closed colostomy pouches have a small charcoal filter that lets gas out while trapping smell. The filter can sometimes pull the bag flat while it releases gas, creating a vacuum in the pouch.2Unora. How to prevent a pancaking stoma bag The vacuum forms when gas leaves through the filter faster than new gas arrives.
Clothing plays a part too. Tight clothes are a common trigger for a pouch going flat.3Unora Health. Why does my stoma bag pancake when wearing tight clothes? Some people find that support belts and wraps stop stool flowing down into the bag and cause pancaking and leaks.4PubMed Central. Experiences of support garments following bowel stoma formation: analysis of free-text responses in a cross-sectional survey
Thick stool makes everything worse. Stool that is thick and pasty is more likely to sit over the stoma than slide down.5United Ostomy Associations of America. Managing the Challenges of Pancaking
Quick Fixes When You Change Your Bag
Start with the filter. Put the sticker that comes with the pouch over the filter, or over half of it, to stop the vacuum forming.6Unora. How to prevent a pancaking stoma bag A partly covered filter still lets some gas out but can no longer suck the bag flat. Getting the amount of cover right takes a little trial. Start with half covered and see how the bag behaves. If it still flattens, try covering it fully. If the bag starts to balloon or smell, go back to partly covered.
Next, blow a little air into the pouch before you put it on, so the two sides of plastic aren’t touching.7Unora. How to prevent a pancaking stoma bag The walls start apart and are more likely to stay apart, letting stool drop to the bottom.8Unora. How to prevent a pancaking stoma bag Folding a pleat into the pouch before fitting also helps keep the inner surfaces from sticking together.9Unora. How to prevent a pancaking stoma bag Stoma nurses suggest making sure there is air in the appliance when you apply it.10Dansac. Quality Of Life Case Study
A common mistake is using too much air, which can make the bag puff out under clothes. A little is enough to separate the walls. Adding air again after emptying a drainable pouch can help too.
Once the bag is on, look at it after an hour or two of sitting and standing. The bottom should still have a small open space rather than lying flat against itself.
Softening Stool Through Fluids, Food and Medicines
Not drinking enough fluids makes stool too thick and encourages pancaking.11SIIL Ostomy. Ostomy Pancaking: Causes & Practical Tips Binding foods such as bananas, rice, applesauce and cheese can thicken stool,12SIIL Ostomy. Ostomy Pancaking: Causes & Practical Tips and so can medicines including opioid painkillers, iron tablets and anti-diarrhoea drugs.13SIIL Ostomy. Ostomy Pancaking: Causes & Practical Tips
Stoma nurses advise increasing fluids as part of managing pancaking.14Dansac. Quality Of Life Case Study Sip rather than drinking a lot at once. Water, diluted juice, soups and milky drinks all count. Drink more in hot weather or when exercising, and pale urine is a rough sign you’re drinking enough.
Extra fluid takes time to change consistency, so you may need a day or two of steady drinking before you notice anything. If you have been told to limit fluids for a heart or kidney condition, check with your doctor before drinking more.
You don’t need to ban bananas or cheese. Notice patterns instead. Try reducing one food at a time and watch for change, and pair binding foods with fruit, vegetables and fluids. A food diary over a week can show what is linked to bad days. If your stool is regularly very hard or you go for days without output, mention it to your stoma nurse.
Don’t stop a prescribed medicine on your own. Ask your doctor or stoma nurse whether there is an alternative. Useful questions: whether a pain medicine could be swapped or reduced, whether an iron tablet comes in a gentler form, and whether a stool softener would suit you.
Products and Bag Changes That Help
Stoma bridges are small sponge squares that stick inside the pouch to keep it slightly open.15Colostomy UK. All your pancaking advice Some people who use them say pancaking stopped completely.16Colostomy UK. All your pancaking advice They are available from stoma suppliers with a usual prescription.17Colostomy UK. All your pancaking advice
A bridge props the front and back walls slightly apart and gives stool a channel to move down. Because it works by physical separation, it doesn’t rely on air staying in the bag. Fit it inside the pouch before applying, and combine it with filter covering and air.
Changing the appliance can help too. In one reported case, a woman with pancaking two months after surgery was moved from a flat one-piece bag to a soft convex base and pouch.18Dansac. Quality Of Life Case Study The change was meant to help stool drop into the bag and make cleaning easier.19Dansac. Quality Of Life Case Study
A flat base sits level on the skin. A convex wafer curves slightly outward, pressing gently around the stoma, and it can help the stoma point into the pouch rather than sideways. It needs fitting advice, so ask your stoma nurse before switching.
Why Pancaking Leads to Leaks and Sore Skin
Thick stool sitting over the stoma can work its way under the pouch adhesive and lift it.20United Ostomy Associations of America. Managing the Challenges of Pancaking Stool then reaches the skin around the stoma and leaks.21United Ostomy Associations of America. Managing the Challenges of Pancaking The leak can damage that skin, lift the pouch further, and cause odour and stool on clothing.22United Ostomy Associations of America. Managing the Challenges of Pancaking When strategies fail and pouches keep leaking or need early changes, people often feel helpless and demoralised, and quality of life can suffer.23PubMed. Patients’ experiences of pancaking while living with a colostomy: a survey
Watch for redness, soreness or stinging under the wafer, itching, broken or weepy skin, and a wafer lifting at the edges sooner than usual. Change the pouch promptly if you feel stool under it.
Once skin has been exposed, remove the pouch gently, supporting the skin rather than pulling quickly. Clean with water and a soft cloth or wipe, then dry thoroughly before applying anything new. Avoid heavy creams and oily products where the wafer will stick, since they stop the adhesive from holding. If the skin stays red, weeps or doesn’t improve after a couple of changes, ask a stoma nurse to look at it.
When to Contact Your Stoma Nurse
Stoma care nurses can offer strategies to ease pancaking.24PubMed. Patients’ experiences of pancaking while living with a colostomy: a survey Reasons to call include pancaking several times a week despite the quick fixes, leaks that force early bag changes, sore or broken skin around the stoma, and worry about a support garment or belt you’ve been told to wear. On garments: don’t stop wearing a prescribed hernia support without advice. Do ask whether a different garment or fit puts less pressure on the pouch, and try loosening tight waistbands over the stoma.
The nurse will usually look at your stoma, the skin around it and the pouch you use, so be ready to change your bag in front of them. Ask for a follow-up plan so you know when to check back if the first change doesn’t help. Have a few things ready: how often it happens and at what times of day, which fixes you’ve tried and what changed, your current pouch type and filter use, and your usual drinks, foods and medicines.