Pancaking and Blowouts: Need Advice!

Hello everyone.

I have had my colostomy "Colin" for a couple of months now after a blood clot stopped blood flowing to my colon and large intestines. I spent 16 nights in hospital, 3 in intensive care, and 10 x blood transfusions. I was bleeding out....

I'm recovering pretty well. But apparently my stoma site is high up and I am having problems with pancaking which blocks up around the stoma site and has led to blowouts. The worst was at a fine dining restaurant where only a tiny portion of my seal was intact. It was terrible.

I have tried adding more adapt oil into the bag before attaching, using the little dot to half cover the vent but they are not really helping greatly.

I have tried to drink more and have even resorted to Movicol to try to loosen the stool.

My surgeon suggested taking Benefiber each day but again I'm still having problems.

I am really active but my confidence is really taking a battering. I'm worrying all the time that I'm going to have a blowout. I had to change my bag two extra times a couple of days ago as I caught two very close calls.

Anatomically, there are no folds or issues why I'm having problems. The stoma opening is okay. The seal works each time but is forced up with the pancaking.

I don't know if I need to see a dietitian to find a better diet ....

As you can tell by my ramblings, I'm really concerned. I would really appreciate your advice, please.

Thank you, Gena

Hi Gena, sorry you are having to deal with this. I have had my colostomy for 2 years now. I had pancaking for awhile. I make sure now I completely cover the filter airhole with more than one dot or tape of some kind. I also try to wear loose clothing as much as possible so there is no pressure on my pouch. There are still times where I will check it constantly because of snugger fitting pants, etc. I have a regular eating/output schedule for the most part which makes dealing with it a lot better. Good luck with everything. I'm sure more of these great folks on here will be along with awesome advice.

Hi Gena, poor you! There are a number of things that can cause this, and it sucks! First of all, you don't say what kind of pouch you are wearing, but a pouch with a convex flange is much less likely to give you a pancaking problem. That is the first thing I would try. The convex flange applies a little more pressure right around your stoma, and makes it more difficult for the stool to get underneath. I don't know how many different products you have tried, but I can tell you that as a newbie, it is definitely worth it to try different brands and styles, as what works well for one person can be a disaster to another. There is also 'regular' and 'soft' convex in some brands, and again, one may work better or be more comfortable for you. Where your stoma sits can make a difference, but you should be able to find what works for you with some patience. To make sure you are getting a good seal is also important. Make sure the skin around your stoma is really dry, and warming the flange with your blow dryer for around 30 seconds and holding it fast with even pressure all around with the palm of your hand really helps it seal well. If you are already using convex, then it may be that you need to add a barrier ring, which sits on your skin right around your stoma, before you apply your pouch. All the ostomy companies are happy to send you free samples to try, so don't be shy about asking, or your ostomy nurse may even have some samples for you to try. Good luck, and let us know how you're doing.

Terry

P.S. Good for you for getting back out there (fine dining!) so quickly, and don't let this discourage you. You'll get there!

I have a problem with pancaking sometimes. I use a squirt of baby oil in my bag; it helps it slide down better. I also just keep feeling my bag and using my fingers and thumb on the outside of the bag to push it down into the end of the bag.

Hello Gena.

Thanks for your post and thanks to all those who have given you some great advice. Pancaking is a real 'pain in the bag' and the two things I found that really helped was 

1) Irrigation where I flush out the waste and don't wear a bag at all ( but use a plug for other reasons!)

2) When I am irrigating I use a 'sleeve' which used to also suffer with pancaking - Until I devised the baseplate so that it incorporates a 90% waste bend, which sends the waste away from the stoma and down the sleeve. It's a bit cumbersome, and would not do for everyday wear, but it works a treat!

I cannot emphasise enough the many benefits of irrigation and, as you have a colostomy, you might well be a good candidate to try it.

Best wishes. 
Bill   

Hi Gen, my pouch blew at a social dance while I was sat at a table with eight people who disappeared very quickly. Only happened to me once. Experience is a great teacher. Everything I would advise has been said, so keep calm and carry on. Patrick.

Are you using bags with a filter? If so, try patching/closing the filter or try bags without a filter. Good luck! Wonderful, you are getting out 2 months in... yeah! These experiences do teach you how to handle ostomy emergencies... but it is tough when it is happening.

Hello SallyNBC,

Thank you so much for your advice. I truly appreciate this.

I will try covering the vent more and yes, very loose clothing seems to be the best way to go.

Thanks again, Gena

PS: I love Canada - spent 3 glorious weeks there 3 years ago - even saw 17 bears out in the wilderness. Very lucky indeed xx

Hello Terry,

Thank you so much for taking the time to reply and your fabulous advice.

I have an appointment this Thursday with my Stoma Nurse and am thinking your suggestion of a flange is a good one. My bags seal directly onto my skin, no flange so it appears easier for them to be compromised.

That's a good idea about the hairdryer. I try to change my bags after a morning shower as I was having problems with excoriating around the stoma. I was using barrier wipes and powder but found the shower water with no soap appeared to help heal my skin. I thought the skin was completely dry but will double-check.

I love Canada - everyone there is so friendly, they reminded me of New Zealanders (where I was born) and Australians (where I now live).

Thanks so much, Gena

Hello lovely,

Thank you so much for your advice. I find that when there is just a little amount, I can ease it down, but I think I make it worse if it has already started pancaking. I'm learning that once this occurs, I need to change it straight away.

Will definitely get some baby oil as I'm going through the Adapt oil quickly.

Best wishes, Gena

Hello Bill,

Thank you so much for your advice. Irrigation does sound wonderful.

I did a little research which said it works better when the stool is firmer. Mine is always a paste as I have had both my sigmoid and descending colon removed.

I will definitely ask my stoma therapist about this technique.

Many thanks, Gena

Hello Patrick, it's awful - especially when you have no idea it is wreaking havoc until it's too late.

My manager was with me at the time, she was fantastic as I was hysterically laughing (in fear) with tears streaming down my face.

It's been the worst part of living with a stoma.

Thanks for sharing, I can imagine how terrible your experience was....

Best wishes, Gena

Hello Maried,

Yes, my bags have filters, so I have been testing partially covering this with the blue sticky dots.

Thankfully, I have an appointment with my Stoma Nurse this coming week to work out what is happening. They are all angels, and I am so grateful for their kindness.

Best wishes, Gena

Hello Marie,

Yes, my bags have filters, so I have been testing partially covering this with the blue sticky dots.

Thankfully, I have an appointment with my Stoma Nurse this coming week to work out what is happening. They are all angels, and I am so grateful for their kindness.

Best wishes, Gena

Hello Gena. 

My output is nearly always like paste. I partially agree that irrigation works slightly 'better' when the output is firmer, However, in my case the firmer it is the more likely I am to suffer from blockages so, I prefer the paste option. It's all about compromises and what works best for an overall feeling of 'success'.

Incidentally, it's usually the pasty option that is most likely to cause pancaking. Irrigation makes it much easier to manage all in one go.

Let's hope you are a suitable candidate.

Best wishes

Bill 

Gen, one thing I forgot to mention is inserting something beside lubricant into your bag... I always, when fitting a new pouch or after emptying and cleaning around the opening, squirt in some odor remover (na-scent). I then get one sheet of toilet paper, fold it in two, then roll it up like a cigarette and push it into the pouch so it will provide an air pocket to prevent pancaking. I have heard of people inserting pieces of foam-like material, though I have only ever used the rolled-up toilet paper sheet which is easier to insert than trying to insert a ball of toilet paper. Hope this adds to your knowledge. Patrick.