This topic is about a parent seeking advice for their child who recently had surgery and now has an end ileostomy. They are facing two main challenges: the stoma opening is pointing upwards, causing thicker output to collect at the top, and there is severe pancaking inside the pouch. They are looking for practical solutions to redirect the stoma opening and prevent pancaking, and they are curious if the pouch filters might be part of the problem.

Here are some helpful suggestions:

1. Filters and Gas Management
- Filters can sometimes vent gas too efficiently, creating a vacuum that flattens the pouch and leads to pancaking. Try covering the filter with tape or using pouches without filters to allow a small amount of gas to remain. Remember to "burp" or change the pouch before it becomes too inflated.
- Some people avoid filters because they can also cause leakage and clothing stains.

2. Pouch Lubrication
- To help the output slide down more easily, you can squirt a lubricating deodorant into the pouch. Alternatively, you can use a little cooking oil or medical lubricant.

3. Clothing Fit
- Avoid wearing tight clothing over the pouch, as this can increase the pressure and contribute to pancaking.

4. Appliance Choice
- Consider using a light convex appliance. This type of appliance gently pushes a flush or upward-facing stoma outward, helping the opening to angle more forward or downward, which can improve the flow.