This topic is about managing thick output and a common issue known as "pancaking" when using a new drainable ostomy pouch. Pancaking occurs when the output doesn't drop to the bottom of the pouch, making it difficult to empty. Here are some helpful tips and insights to manage this situation:

1. Identify your stoma type:
- If you have an ileostomy, expect watery output. A colostomy usually results in thicker output. Knowing your stoma type helps in managing the output consistency.

2. Consider using a 2-piece system:
- A 2-piece system, which includes a wafer and a pouch, allows you to detach the pouch for cleaning without removing the wafer. This can help reduce skin irritation and extend the wear time of the appliance. Some recommended brands are Hollister and SenSura Mio by Coloplast.

3. Add water to the pouch:
- To help thin the output, gently add warm tap water into the pouch using a non-needle syringe, squeeze bottle, or a cup while in the shower. Swish the water around and then drain it to help break up thick stool.

4. Lubricate the inside of the pouch:
- To prevent pancaking, you can use products like Perfect Choice Super Strength Lubricating Deodorant or commercial pouch lubricants. Adding a few drops of olive oil or baby oil around the stoma and inside the pouch before reattaching can also help.

5. Manage the filter and deodorant needs:
- If pancaking blocks the filter, cover it with the provided circular sticker to stop air suction. Hollister pouches are noted for their long-lasting filters and easy-to-use plastic rings.

6. Consider stool-softening or regulating agents:
- With your clinician's approval, using a daily stool softener like generic MiraLAX (polyethylene glycol) can help keep the stool looser, reducing pancaking for those with a colostomy.

7. Explore colostomy irrigation (if applicable):
- For those with a colostomy, regular irrigation can lead to more predictable and liquid output, allowing for longer periods without a pouch. There are instructional videos available online for guidance.

8. Practical tips:
- After emptying, fold a longer drainable pouch in half for a more discreet profile. Some users have reported being able to wear the wafer/flange for 1–2 weeks using these methods.