Question:

My colostomy leaks every day. If I’m not leaking, I have a pancaking issue. My stoma is right below the skin surface and is next to my surgical incision. I have tried switching appliances, rings, and paste. Is there something I can do to reduce the leaks and pancaking?

Answer:

Thank you for your question — daily leakage and pancaking can be extremely frustrating, especially when the stoma sits flush or recessed and is close to a surgical incision. This anatomy makes it harder for stool to drop into the pouch and easier for output to sneak under the barrier. Here are strategies that often help:

1. Support the stoma with convexity

A convex wafer (light, medium, or deep) helps push the stoma outward so stool goes into the pouch instead of building up around the base.

• If you’ve only tried one type of convexity, a different depth or brand may make a big difference.
• Belt use with convexity can improve the seal.

2. Fill the dips and protect the incision line

Being next to an incision can mean there are dips or uneven skin.

• Use moldable rings (thicker types) to fill in the dip beside the incision.
• You can also “stack” a thin ring under a thicker one for a firmer seal.
• Rings generally work better than paste when there’s significant unevenness.

3. Managing pancaking

Pancaking happens when stool sticks to the top of the bag instead of dropping down.

• Apply ostomy deodorant inside the top of the pouch with each change.
• Place a small amount of crumpled tissue inside the pouch to help maintain air flow (this reduces suction).
• Avoid pouches with filters, or cover the filter with a sticker if you’re already using one. Too much vacuum can contribute to pancaking.

4. Skin prep caution

If you’re using a barrier wipe every change, know that overuse can reduce wear-time due to residue buildup. Many people with flush stomas get better wear-time by skipping skin prep unless the skin is broken.

5. When to get reassessed

If the stoma has changed shape, become more recessed, or the incision site has pulled inward, an assessment by a NSWOC (Nurse Specialized in Wound, Ostomy and Continence) can help. They can determine whether:

• A different depth of convexity
• A moldable system
• Use of an appliance belt
• Or a custom solution is appropriate for your situation.

Sometimes persistent leaks are not a product problem but a result of changes in the anatomy around the stoma.

I hope you find this information helpful and that you get some relief soon.

Answered by

Andrea Manson (BSN, NSWOC, NCA, Retired Nurse and Ostomy Specialist)
Medical and Lifestyle Advisory Team Lead,
Ostomy Canada Society