Pancaking is a common issue for individuals with a colostomy, occurring when stool adheres to the top of the pouch instead of dropping to the bottom. This happens because the output forms a flat, sticky mass around the stoma. When the output blocks the opening, it can lead to severe skin irritation, pouch ballooning, and a higher risk of the appliance leaking or lifting off the skin.
Understanding the Cause
Pancaking is driven by two factors: the physical consistency of the output and a vacuum effect within the pouch. Colostomy output is typically thicker and more pasty than ileostomy output because the large intestine has absorbed most of the water. This lack of moisture creates a dense, adhesive output that readily clings to the inner plastic walls of the appliance.
The second factor is the creation of negative pressure inside the pouch. Modern colostomy pouches feature charcoal filters designed to vent gas and control odor. If these filters work too efficiently, they pull air out faster than it enters, causing the pouch walls to collapse. This vacuum effect flattens the pouch, forcing the output directly against the stoma face and the adhesive barrier, preventing it from sliding down.
Immediate Pouch Management Techniques
Addressing the immediate problem involves breaking the vacuum and creating a slick barrier to encourage downward movement. Before applying a new pouch, introduce a small amount of air using the “puffing” method by gently blowing into the clean pouch. Quickly cover the filter with its included sticker to trap the air. This trapped air creates space between the pouch walls, preventing collapse and allowing the output to drop away from the stoma.
Another highly effective technique is to use a specialized lubricating deodorant or commercial anti-pancaking drops. These products are squirted or sprayed into the top of the pouch, near the stoma opening, to coat the interior plastic with a slick, non-stick film. Alternatively, some individuals find success using a few drops of olive oil or baby oil, ensuring the oil evenly coats the area above the stoma to facilitate the slide of the dense output.
If the filter seems to be the primary cause, covering it with the small, circular stickers provided in the appliance box can slow the rate of air removal. This helps maintain a small air cushion within the pouch, which is necessary to keep the walls separated. For a two-piece system, a quick and temporary fix for an already-pancaking pouch is to gently lift the edge of the pouch away from the flange, allowing a small rush of air to enter and relieve the vacuum seal.
When pancaking has already begun, gently manipulating the output can prevent it from blocking the stoma. By lightly pressing and massaging the pouch over your clothing, you can manually push the thick mass downward and away from the adhesive barrier. If the issue persists, switching to a pouch system with a convex wafer may help, as the slight outward curve of the barrier can encourage the stoma to protrude more, physically guiding the output into the pouch center and away from the adhesive.
Adjusting Output Consistency Through Diet
Since output thickness contributes significantly to pancaking, long-term dietary adjustments can reduce stickiness. Maintaining high levels of hydration is primary, as adequate fluid intake directly softens the stool, making it less likely to adhere to the pouch walls. Ostomates are often advised to aim for a daily fluid intake around 2.5 liters, alternating between plain water and electrolyte-rich beverages.
The role of dietary fiber also requires careful consideration, as it needs to be balanced with fluid consumption. While fiber adds bulk, too much insoluble fiber without sufficient water can result in a thick, sticky mass that exacerbates pancaking. Focusing on soluble fiber, which forms a gel-like substance in the bowel, or consuming cooked fruits and vegetables can help to achieve a smoother, less adhesive stool consistency.
Specific foods known to help loosen the output include fruit juices like prune or apple juice, and cooked vegetables such as spinach and broccoli. Conversely, very dry or dense foods, like dry granola or nuts, contribute to a thicker, drier output. Regulating the digestive process by eating smaller, more frequent meals throughout the day can help maintain a consistent flow, preventing large, dense masses from accumulating.