This topic is about managing a common issue called "pancaking" for someone with an ileostomy. Pancaking happens when thick output collects around the stoma, which can erode the seal of the ostomy appliance. The person in question is using a Coloplast SenSura Mio two-piece system and is looking for practical solutions to manage this issue. Here are some helpful tips and advice:

1. Keep a Small Cushion of Air
- After emptying the pouch, gently puff a little air into it.
- If the filter removes air too quickly, cover it with tape, use a non-filtered pouch, or modify the filter by removing the plastic pre-filter but keeping the charcoal disc.
- Place a rolled-up piece of toilet paper at the pouch outlet to maintain space until the next emptying.

2. Add a Lubricant Inside the Bag
- Use commercial lubricating deodorants, baby oil, mineral oil, coconut-oil spray, or a few drops of olive oil.
- Try different brands to see which works best, as some oils might cause the pouch walls to stick together.

3. Loosen Output With Diet & Fluids
- Increase intake of water, fruit juices, coffee, a prune a day, yogurt, or a probiotic.
- Limit foods that thicken stool, such as bananas, excess bread, large servings of red meat, shrimp, cheese, poutine, cheesecake, and high-sugar drinks.
- Identify personal "trigger" foods through trial and error.

4. Manual Techniques
- Gently massage the pouch through clothing to move stool away from the stoma.
- Empty the pouch frequently and consider rinsing it with warm water; use a hair-dryer to dry the interior without damaging the pouch.

5. Appliance & Accessory Adjustments
- Consider using a light or soft convexity if currently using a flat appliance, as it can help angle the stoma toward the pouch interior.
- Use a support or diagonal ostomy belt to keep the wafer snug and prevent output from seeping under the barrier.
- Barrier rings can create a small air pocket and protect the skin.

6. Alternate Pouching Systems
- Some people have switched from SenSura Mio to Hollister when pancaking persisted.
- Coloplast offers non-filtered Mio pouches in limited sizes, and customer service can assist in locating them.

7. Miscellaneous Tips
- Warm water flushes followed by thorough drying can reduce thick residual output.
- Avoid letting the pouch "vacuum-seal" under tight clothing; untuck shirts or add air before activities.
- Night-time checks and controlled intake of gas-producing foods can help prevent ballooning or blowouts.