This topic is about managing severe pancaking and blow-outs for someone with a high colostomy. Pancaking occurs when thick, pasty stool sticks around the stoma instead of dropping into the pouch, which can lead to pressure build-up and cause the wafer to come loose, resulting in blow-outs. Here are some helpful tips and insights to manage this situation:

1. **Filter Management**
- Consider completely covering or taping over the filter air-hole, or switch to non-filtered pouches to prevent pancaking.
- Keep a small air pocket inside the pouch by inserting a rolled strip of toilet paper or a small foam piece after each emptying to prevent a vacuum.

2. **Product Changes**
- Try using a convex flange instead of a flat wafer, as it can help the stool drop and reduce the risk of undermining.
- If already using a convex flange, add a barrier or seal ring for extra height and protection.
- Request free samples from ostomy manufacturers to try different convex and ring styles.

3. **Application Technique**
- Ensure the skin around the stoma is completely dry before applying the wafer. Some people warm the wafer with a hair-dryer for about 30 seconds and press firmly with their palm for a stronger bond.
- Wear looser waistbands to reduce external pressure on the pouch.

4. **Lubrication Inside the Pouch**
- Continue using Hollister Adapt oil or switch to a more affordable option like baby oil.
- Some people add Na-Scent liquid deodorizer along with the lubricant.

5. **Manual “Massage”**
- Periodically feel the pouch through clothing and gently push the stool downward before it collects at the top.

6. **Diet and Scheduling**
- Maintain a regular meal and emptying routine to make output more predictable.

7. **Irrigation Option**
- Once healing allows, consider irrigation to flush the colon every 24–48 hours, which can eliminate the need for a pouch. This method can stop pancaking even with pasty stool, but suitability should be assessed by a stoma nurse.

8. **Psychological Reassurance**
- Remember that blow-outs happen to most ostomates. With experience and the right gear, the risk can be significantly reduced. Stay calm and carry on.