Question: Seeking Solutions for Pancaking and Leaking Post-Colostomy

I underwent rectal cancer surgery on November 20, 2018, which resulted in a colostomy, rectum removal, vaginal reconstruction, and skin grafts. Recovery has been challenging, particularly due to dense, heavy stools causing pancaking and leakage. Lubricants and baby oil haven’t been effective, and I struggle to empty the bag due to the compactness of the stool. I would greatly appreciate any advice to help manage these issues.

Response: Effective Strategies for Managing Dense Stools and Pancaking in Colostomy Care

Pancaking, where output collects around the stoma instead of moving into the bag, can be a frustrating issue. It often occurs due to insufficient air in the bag, causing output to not flow downwards as needed. Here are some strategies to address this:

  1. Lubrication: You’ve tried baby oil, but consider other products available from ostomy supply companies. Some individuals find success by applying a small amount of oil or gel inside the bag and spreading it around before attaching it.
  2. Clothing Choices: Tight clothing around the stoma can contribute to pancaking. Opt for looser clothing to avoid creating a vacuum inside the bag. Pay attention to where belts or waistbands sit in relation to your stoma.
  3. Body Positioning: Your sitting posture can affect how the bag functions. Long periods of sitting, especially in certain positions, can cause the bag to fold and restrict stool movement.
  4. Bag Ventilation: If your pouch has a filter, consider blocking it with waterproof tape or the tabs provided with the pouch. This helps maintain air inside the bag, reducing the vacuum effect and allowing the stool to drop down.
  5. Dietary Adjustment: Dense output might be related to your diet. Consult a nutritionist or dietitian for personalized dietary advice. They can help identify foods that might be contributing to thicker output and suggest alternatives.
  6. Fluid Intake: Increasing fluid intake can sometimes help in softening the stool, making it easier to manage.
  7. Routine Monitoring: Regularly monitor your pouch, changing it before it becomes too full. This can prevent leaks and ease the emptying process.
  8. Professional Guidance: Always seek advice from a healthcare professional, such as an NSWOC (Nurses Specialized in Wound, Ostomy, and Continence), who can provide tailored suggestions based on your specific situation.

Managing a colostomy can be challenging, especially post-surgery. By experimenting with these strategies and seeking professional guidance, you can find a routine that works best for your comfort and lifestyle.

Jo-Ann L. Tremblay
FACEBOOK – Author Jo-Ann L. Tremblay
TWITTER @joanntremblay Author of “The Self-Coaching Toolbox”, “Better With A Bag Than In A Bag”, “Another BAG Another DAY”, “BAGs Around the World”, “Why Buttercup Wears a BAG!”, “The Sibs Gang Cave of the Golden Heart”,,
Member Ostomy Canada/Medical Lifestyle Advisory Committee Member – Ostomy Lifestyle Expert
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