The topic at hand is about dealing with "pancaking" in an ostomy pouch. Pancaking occurs when thick or sticky output clings to the top of the pouch instead of falling to the bottom. This can cause bulging under clothing, seepage at the wafer edge, and more frequent pouch changes. If you have a permanent stoma and are looking for ways to reduce or stop pancaking, here are some helpful tips:

1. Lubricate the pouch:
- Swish a tablespoon or a few drops of baby oil around the top of the bag before attaching it, or add it after emptying.
- Use a cooking spray like Pam to create a thin, even coating inside the pouch.
- Consider using Hollister Lubricating Deodorant, which many find effective. Some insurance plans cover one bottle per month.
- Use any lubricant sparingly to avoid loosening the seal by allowing excess oil to migrate under the wafer/flange.

2. Stay hydrated by drinking plenty of water, which helps thin the output and improves flow.

3. Manually manage the pouch by occasionally nudging or squeezing the stool downward, especially if you wake up at night.

4. Insert spacers, which are small blocks that can be placed inside the bag to keep the sides from sticking together when the output is extra thick.

5. Check the wafer opening and accessories:
- Ensure the hole in the wafer is large enough, typically about 1 inch for many ostomates.
- If using an Eakin Cohesive Seal or Hollister Adapt paste, make sure the pouch does not stick to these products, as they can obstruct flow.

6. Consider irrigation if you can do it successfully. Regular irrigation sessions may eliminate routine output and reduce pancaking.

7. Compare deodorants if needed. Some find Coloplast O.A.D. less effective than Hollister’s lubricating deodorant and seek others' opinions on deodorizing performance.