This topic is about managing issues like pancaking and leaks with a new ileostomy. The person is three weeks post-surgery and is experiencing some challenges with their stoma, which is named "Charlie." The stoma is about an inch long and is located near the navel on uneven skin. The output is thick, leading to pancaking, which causes discomfort and concerns about leaks, especially at night. They have tried different products and setups but are looking for practical tips to improve their situation. Here are some helpful suggestions:

1. Experiment with different products: Try samples from various manufacturers like Hollister, ConvaTec, Coloplast, and Salts. Use their stoma-nurse hotlines for advice. Test different wafers, rings, pastes, bags, and adhesive removers, and keep track of what works or doesn’t.

2. Consider wafer types: If the stoma protrudes enough, a flat wafer might be more effective. Convex wafers are designed to push the skin down so the stoma stands out more.

3. Use barrier rings and paste effectively:
- Mold a barrier ring snugly around the stoma and cut the wafer with enough clearance.
- For uneven skin, fill only the low areas with stoma paste for a better fit.
- Some people use a second ring on top of a two-piece wafer for extra sealing.

4. Reduce pancaking with lubrication:
- Use commercial lubricating-deodorizer packs or a few drops of baby oil inside the pouch.
- Swish a small amount of water through the pouch to help loosen stool.
- Stick to plain baby oil, as essential oils may have additives.

5. Adjust hydration and diet: Increase fluid intake and be mindful of foods like potatoes, rice, or pasta, which can thicken output. Aim for a balance of fiber and liquid.

6. Manage nighttime or heavy output: Keep a little air in the pouch to prevent stool from sticking to the wafer.

7. Support and prevent hernias:
- Use belts like Nu-Hope or Stealth Belt to hold the appliance securely and help prevent hernias.
- Avoid heavy lifting and brace your abdomen when coughing or sneezing.

8. Take care of your skin and ensure good adhesion:
- Use mild, additive-free soap before changing the appliance.
- Use barrier film or wipes only if the skin is irritated, as unnecessary film can weaken adhesion.
- For rashes, use stoma powder followed by a barrier wipe until healed.

9. Consider appliance weight: Lightweight one-piece bags, like Salts “Comfort B,” can reduce drag and improve adherence on uneven skin. Some bags have zinc in the wafer, which may help heal sore areas.

10. Understand seepage vs. leaks: Discoloration on the wafer tape that reaches clothing indicates a leak, while moisture absorbed within the wafer’s inner area is normal seepage.

11. General tips:
- Change the system every other day or as needed, and shower without the pouch on change days to keep the skin healthy.
- Keep spare supplies and accessories on hand to adjust your technique as your stoma and body change over the first few months.