Jul 12, 2021

This is when thick, pasty stool accumulates around the stoma instead of falling down into the pouch. As more output is produced, it can start pushing under the baseplate because it has nowhere else to go. If not caught and corrected in time, this can cause leaks and skin irritation.  

Pancaking generally happens for one of two reasons, and often a combination of both:  

The stool is too pasty 

The pouch isn’t open enough for stool to drop down into it 

To “bulk up” stool, increase your intake of insoluble fiber. Bran cereal, dates & figs, lentils, nuts, and avocados are particularly rich in insoluble fiber. Bulking agents like METAMUCIL® or BENEFIBER® can be helpful here too, if you have trouble getting enough fiber through your diet. [Note: This doesn’t apply to ileostomates, who shouldn’t eat a high fiber diet. And remember, ostomates with underlying medical conditions should always consult with a doctor or registered dietician before making changes to their diet). 

If you’re increasing your fiber, whether through diet or a bulking agent, remember to increase your water intake too. This might sound odd, since the goal is to make the stool less pasty, but it’s important. Without extra water, the stool can become too hard. You don’t want to cross the line into constipation!  

You also want to make it easier for the stool to drop away from your stoma and down into the pouch. Sometimes your pouch can stick to itself, like plastic cling wrap, leaving no space for the output to drop into. There are a few tricks to deal with that.  

When applying a new pouch or bag liner, blow air into it to make sure it’s not stuck together. 

Squeeze a little oil into the pouch opening (or the bag liner after it’s inside the pouch), and rub it around to coat the inside, from top to bottom. You can buy a lubricating deodorant made especially for this purpose, or use baby oil. I’ve even heard of some people spraying cooking oil into the pouch. Whatever you use, make sure it doesn’t get on the flange, as this could interfere with the seal of the pouch.  

Pouches with filters allow gas to escape. That’s a good thing if you have excessive gas. But if it works too well, it can be almost like a vacuum, sucking air out of the pouch and making it stick to itself. If this is happening, try blocking the filters with the little stick-on tabs that usually come with the pouches.  

Another way to keep the pouch open is to drop a wad of wet toilet paper into the bottom. This creates a little space at the bottom of the pouch. It’s not a perfect solution, but anything’s worth a try.  

Some ostomy supply companies offer small foam blocks to place inside the pouches, keeping the sides apart. These are called “stoma bridges.” 

Excessive pressure from tight clothes or tummy wraps can flatten the pouch and keep output from falling into it. Try loosening them up a little to see if it helps.  

Stoma guards are another helpful product. They’re fairly rigid and function like athletic cups. Although principally designed to protect the stoma from injury (like in sports or other physical activities), stoma guards are also great for preventing the pouch – and therefore your output – from being squished and flattened by tight clothes or binders.  

Personally, I had a lot of pancaking with a colostomy until I started using bag liners. Once inserted into the pouch, I shove my fingers down into the liner to make sure it’s open and roomy. Then I squirt a little baby oil into the opening.  

Everyone’s different. What works like magic for one person may not work at all for another. Try a few different techniques to find the best pancaking solution for you. 

Courtesy Joan Scott, author of The Ostomy Raft