This topic is about managing some common challenges faced by someone with a new, indented colostomy, specifically dealing with issues like "pancaking" and pasty output. Here are some helpful tips and advice to make things a bit easier:

- The husband has had a permanent colostomy for about a month, and the stoma sits below skin level. They usually use convex appliances but currently only have flat pouches available. This has led to persistent "pancaking," where stool sticks around the stoma instead of dropping into the pouch. The output is also very pasty, and they are looking for ways to firm it up. They wonder if blowing air into the bag before applying it or other tricks might help.

- The ostomy nurse mentioned that the stoma is "irritating." Despite using a drainable pouch and oiling the inside, stool still collects around the indented stoma instead of entering the bag.

Here are some suggestions and insights:

1. Irrigation:
- Consider daily or every 1-3 days colostomy irrigation to empty the bowel on a schedule, which can greatly reduce pancaking. This process takes about an hour, and then only a cap or mini-pouch is needed. Even those with hernias have reported success with irrigation, and ET/ostomy nurses can provide training.

2. Bag preparation and fit:
- Lightly blow air into the pouch before attaching it to prevent a vacuum effect.
- If convex pouches are unavailable, try rolling a piece of toilet paper and placing it inside the pouch to keep the sides apart until output starts.
- Cover the filter’s air-vent with the small white tape disk that comes with many pouches to prevent a vacuum that encourages pancaking.
- Two-piece systems are preferred when frequent pouch changes are necessary, as the wafer can stay in place while only the bag is replaced.

3. Lubrication:
- Continue coating the inside of the pouch with vegetable or baby oil to help stool slide downward.

4. Medication and diet to modify consistency:
- Loperamide capsules (anti-diarrheal) at 1 per day, as recommended by a stoma nurse, can thicken output and lessen pancaking. Avoid higher doses to prevent constipation.
- Increasing dietary fiber may firm stool but can also risk blockage, so introduce it cautiously.

5. Expect natural change over time:
- Output often thickens on its own as the digestive tract adapts during the first months post-surgery.

6. Practical tips:
- Always carry spare pouches or caps because gas can occasionally dislodge equipment.
- Alternate between one-piece and two-piece appliances if the stoma shape or output changes.