Ask the Ostomy Nurse
Linda Coulter has been a Certified Wound Ostomy & Continence Nurse for 10 years. In addition to working with hundreds of people with stomas, she has trained several WOC nursing students at the R.B. Turnbull Jr. School of WOC Nursing. Linda has presented nationally and internationally on ostomy related topics. From her home base at University Hospitals’ Ahuja Medical Center, Linda is active in raising Ostomy Awareness, and works to distribute ostomy supplies to people in need throughout the world.
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Pancaking
I have an ileostomy and have been having problems with pancaking while sleeping. I drink 8-10 glasses of fluids per day, avoid foods that tend to thicken my stools. I have tried drinking a glass of fruit juice in the evening and eat lots of fruits and vegetables. I have had to change my pouch every morning due to pancaking.
L.C.
Thanks for this question. Pancaking is an issue for many people who have ileostomies and colostomies. For readers who do not know, pancaking is when thick stoma output collects around the stoma and doesn’t flow to the bottom of the pouch. This becomes a problem because the output can seep under the wafer, leading to a leaking pouch and possibly irritated skin.
There are three steps to help minimize pancaking. L.C., you are already taking the first step, which is consuming foods and beverages to help keep the stoma output loose. Let’s discuss the additional two steps, pouch lubrication and filter management, in more detail.
Making sure the inner pouch surface is coated with a pouch lubricant will help thick output slide into the pouch. Most lubricants also include a deodorizing component in them. Not all insurance providers will cover lubricant, so some people will use vegetable oil or cooking spray as economical and usually effective alternatives.
The final consideration has to do with pouch filters, which allow gas to slowly escape from the pouch. Filters also include charcoal to deodorize the escaping gas. Sometimes filters don’t work well or for long. Other times the filters work too efficiently, letting out so much air that the pouch and stoma output become suctioned down onto the stoma. There needs to be a small amount of air in the pouch in order for output to slide to the bottom of the pouch. Covering the filter at least partially with a filter cover or household tape will help keep some air in the pouch. Most boxes of filtered pouches include a sheet of sticky round or rectangular filter covers.
If you are unsure if your pouch has a filter, inspect the front of your pouch. The filter is located near the top of the pouch either on the front or back of the pouch. It may be under a fabric flap, making it difficult to locate. The filter will be round or slightly arc-shaped and is usually gray or half black and half white. Look closely and you will find a small opening in the filter. This is where you will place the filter cover or tape.
It may take some a few tries to determine if you need to completely or just partially cover the filter in order to keep enough air in the pouch so the output will slide well into the pouch. Start by covering the filter completely. If the pouch gets too full of air, peel off the sticker and cover the filter only halfway. Be sure to keep enough gas in the pouch to allow the output to flow away from the stoma, without the pouch ballooning noticeably under your clothing.
L.C., I hope the additional steps above, coupled with your food and fluid intake, will provide you with a more successful pouching experience.
