Pancaking: Why It Happens and How to Prevent It

Pancaking is an ostomy problem in which stool collects as a firm, flat mass over the stoma opening instead of dropping into the base of the pouch. The output cannot fall downwards, so it presses against the join between stoma and baseplate and can work under the seal, causing leakage and sore peristomal skin. It is common, well described, and usually manageable once you understand the mechanism. If it keeps happening, ask your stoma care nurse to review your appliance and technique.

What Is Pancaking and Who Does It Affect?

The term describes the flat, ‘pancake-like’ shape stool takes when it gathers immediately around the stoma rather than falling freely into the lower pouch. Because output cannot travel downwards, it builds up against the junction between the stoma and the baseplate, exerting steady pressure on the adhesive seal.

Pancaking most commonly affects people with a colostomy, particularly those whose output is formed or semi-formed — typical of a sigmoid or descending colostomy. Ileostomy output is generally more liquid and flows freely, making it less susceptible, although ileostomates with a tendency towards thicker output are not entirely immune. People who have had a portion of bowel removed, who take constipating medicines, or who are in the early weeks after surgery may also notice it more often, because output patterns and appliance habits are still settling.

It is worth separating pancaking from ordinary leakage at the outset. Leakage is what happens when stool gets under the adhesive ring and onto the skin. Pancaking is the upstream event — the output never reaches the base of the pouch to begin with — and it is one of the common routes to leakage. Fixing pancaking often prevents the leaks that follow it.

Why Does Pancaking Happen?

Three factors usually combine: pressure inside the pouch, the consistency of the stool, and the geometry of how the pouch sits against your body. Understanding each one makes the practical measures later in this article easier to apply selectively.

The Vacuum Effect

The most common culprit is a negative pressure — a partial vacuum — inside the pouch. Most modern pouches are fitted with a charcoal filter designed to allow flatus to escape while neutralising odour. That is a welcome feature, but it has a side effect: as gas vents out through the filter, the inner walls of the pouch are drawn together. With the walls touching, there is no open space for stool to fall into, so output piles up at the stoma.

The effect is easiest to see on waking. A pouch that was inflated at bedtime can be flat and clinging to the stoma by morning, with a disc of stool trapped on top of it. Some people notice it more when they have been lying down for hours, when the pouch is small or full, or when the filter is new and venting briskly.

Stool Consistency

Firm or sticky stool does not flow easily even when there is adequate space inside the pouch. Dehydration, a low-fibre diet, or simply the individual’s normal colonic transit pattern can produce output that clings to the stoma and the inner surface of the pouch. In these cases, even a well-vented pouch may not be sufficient to prevent pancaking on its own. Output that is unusually pasty — something people with an ileostomy sometimes describe when they have not been drinking enough or are taking thickening medicines — can behave in the same way.

Pouch Position and Body Posture

Gravity assists stool in travelling downwards — but only if the pouch is positioned correctly and the person is reasonably upright during the time of output. If the pouch lies flat against the abdomen with no internal air space, stool has nowhere to go but sideways or back towards the stoma opening. A pouch that is too small, worn under tight clothing, or seated at the wrong angle on the body can make this worse, and so can long periods sitting at a desk or in a car, where a pouch folds against the abdomen.

Other Contributing Factors

Some people notice worse pancaking after a stretch of reduced drinking, during hot weather, or when their meal pattern changes, for example with a large evening meal. Mornings are a common time for problems because output has been collecting overnight while lying down. None of these is a fault in your technique; they are simply the conditions that make the underlying mechanism easier to see.

Practical Strategies to Prevent Pancaking

There is no single fix that works for everyone, and it is usually a combination — a small air pocket, sensible filter handling and attention to fluid and diet — that settles the problem. Try one change at a time so you can tell what is working.

1. Introduce a Small Air Pocket

Before fitting the pouch, trap a small puff of air inside it so the walls stand apart. Some people gently blow into the pouch through the opening before sealing it; others simply hold the pouch open as they attach it. This creates a small internal space that gravity can use.

Some people place a tiny piece of crumpled tissue or a folded paper towel inside the pouch to prop the walls apart. Remove it after the first output has fallen to the base, or leave it in if it does not affect the seal. Never put anything inside the pouch that could be swallowed or that might press directly on the stoma, and be cautious if your skin is already sore. Ask your stoma care nurse before using any helper object as a matter of routine.

2. Manage the Filter

Covering the filter with its adhesive disc, usually supplied with the pouch, stops the vacuum from forming. Use this strategy during periods when pancaking is problematic, but be aware that blocking the filter entirely may lead to ballooning — gas building up and inflating the pouch uncomfortably, with the risk that the pouch lifts or the seal is disturbed. Many people find a middle ground: covering the filter at night and leaving it open during the day, or covering it only on days when output is firmer than usual. Some pouches are made with filters that can be reopened; others have no filter at all.

3. Adjust Fluid Intake

Drinking adequate fluid — typically around 1.5 to 2 litres a day for most adults, and more in warm weather or during physical activity — helps maintain a softer, more mobile stool consistency. Even modest dehydration can noticeably firm up colostomy output. Spreading fluid intake throughout the day is more effective than drinking large amounts in one sitting.

If you have been told to restrict fluids because of another condition, such as heart or kidney disease, follow that advice and discuss hydration with the clinician who set the limit rather than changing it yourself. People with an ileostomy need particular care, because they lose more fluid and salt than others and can become dehydrated without noticing.

4. Apply a Lubricating Deodorant Gel

Pouch lubricant or lubricating deodorant drops, applied to the inside of the pouch before fitting, reduce friction on the inner walls and help stool slide freely towards the base. A few drops squeezed in before sealing the pouch is usually sufficient; more than that can affect the seal if it reaches the adhesive ring. Lubricants help most when the problem is sticky output rather than a strong vacuum.

5. Consider Dietary Modifications

While radical dietary changes are rarely warranted, reducing foods known to thicken stool — such as bananas, white rice, and marshmallows — during periods of troublesome pancaking may help. Conversely, foods and fluids with a mild loosening effect can soften output enough to resolve the problem. Individual responses vary considerably, and what thickens one person’s output may have little effect on another’s.

A registered dietitian with expertise in stoma care is the best person to advise, particularly if you also have to follow a therapeutic diet for diabetes, kidney disease or inflammatory bowel disease. Do not cut out food groups without advice; the goal is a comfortable consistency, not a restrictive diet.

6. Review Your Appliance Choice

Some pouch designs manage airflow and internal space better than others. A pouch with a different filter position or construction, a different size, or a different base shape may make a significant difference. Your stoma care nurse can help you trial alternatives, and in many health services these samples are supplied through the stoma service rather than bought blind.

It is also worth checking whether the pouch opening is cut correctly. An opening that is too large exposes skin, but an opening that is too tight can keep output pressed close to the stoma; your nurse can check the template size while they review the rest of the setup.

Things That Do Not Help, and May Make It Worse

Some instinctive responses backfire. Over-tightening the baseplate or adding extra tape around the edge does nothing about pressure inside the pouch and can trap stool against the stoma instead. Repeatedly opening and emptying a well-filled pouch may briefly relieve pressure but will not stop the vacuum re-forming. Cutting a makeshift vent in the pouch risks odour and contamination and should not be attempted.

Doubling up on constipating medicines, or taking extra thickening agents to control output, can make firmness worse; any change to medication should go through your GP, pharmacist or stoma care nurse. It is also unwise to try to keep the pouch rigidly inflated by tying or taping it; that interferes with how the pouch is designed to work.

When to Seek Professional Advice

If pancaking is happening regularly, causing repeated leakage, or resulting in skin soreness around the stoma, it warrants a review with a qualified stoma care nurse or specialist. Persistent skin breakdown can become a clinical problem in its own right, interfering with appliance adhesion and comfort. A stoma care nurse can assess your current appliance, output pattern, diet, and technique together, and recommend an individualised plan.

Seek advice the same day for vomiting, a swollen or tender abdomen, severe cramping, or output that stops entirely or becomes unexpectedly watery — particularly with an ileostomy, where these can signal a blockage or dehydration. Do not attempt to manage significant or worsening skin damage without professional input, and do not make large changes to your diet or medicines to fix pancaking alone.

Pancaking with a Colostomy Compared with an Ileostomy

For a colostomy, pancaking is largely a matter of formed output and pouch vacuum, and the measures above usually bring it under control. For an ileostomy, the output is more liquid, so pancaking is less common — but when it appears it often reflects output that has become unusually thick, sometimes after reduced drinking, a change in diet, or a new medicine. In that situation the priority is to keep output flowing normally and to make sure you are drinking enough, rather than to sharply increase thickening foods. Anyone with an ileostomy who notices a change in output should speak to their stoma care nurse before adjusting things at home.

The Bottom Line

Pancaking is a common, well-understood ostomy appliance problem with several effective solutions. The vacuum created by pouch filters is frequently the primary cause, but stool consistency, hydration, and appliance design all play a role. In most cases, a combination of introducing an air pocket into the pouch, adjusting filter coverage, and optimising fluid intake will resolve the issue. If the problem persists or is causing skin breakdown or frequent leakage, consult your stoma care nurse promptly — they are the most important resource for personalised, evidence-based guidance on stoma appliance management.