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Ask Angie: Pancaking

Posted: 18/03/2026

In our new series, Ask Angie, Clinical Education Lead Angie Perrin shares her expertise by answering frequently asked questions about key stoma care topics. First up is pancaking.

"Pancaking is a challenging problem. It always makes my heart sink when a patient mentions they’re experiencing leaks or sore skin due to the stool not going into the bag. The fact there’s very little research regarding this distressing problem makes things even more difficult. 

Research carried out over ten years ago highlighted that 82% of respondents were likely to experience some degree of pancaking and that an alarming 58% changed their bag more frequently as a management technique.¹ This has consequences for the health economy because everyone who suffers from pancaking uses more appliances — something which may well have been a catalyst for the Government’s current review into stoma care. 

As Stoma Care Nurse Specialists, we offer a variety of strategies to try and alleviate the symptoms of pancaking. But when these strategies fail and appliances continue to leak or require frequent changing due to risk of leaking, it can leave those living with a stoma feeling helpless and disheartened, negatively impacting their quality of life quite considerably. 

What’s thought to cause pancaking? 

Pancaking occurs when the stool accumulates at the top of the bag around the stoma and does not drop into the lower part of the bag. This is thought to be caused by almost all the air being filtered out of the bag by the integral filter, creating a vacuum in the bag that prevents the stool from dropping. It’s speculated that when filters weren’t integral to the bag itself, pancaking was relatively limited — although there’s no evidence to support this claim. 

Pancaking is a significant factor in skin irritation and can negatively affect quality of life for individuals living with a stoma.

 A study by Klok-Vonkeman (2013) suggested that pancaking is a significant problem amongst people.²

How can pancaking be prevented? 

The first port of call is to address diet and fluids. Daily oral fluid intake should be approximately 1,500–2,000 mL unless contraindicated. Increasing the amount of fibre in a person’s diet can also help stool consistency, allowing the stool to drop into the bag more easily. 

Gentle activity (e.g. walking) or even just sitting upright after meals can help stool drop down. It’s also helpful to remind patients that posture can affect how stool moves into the lower part of the pouch.  

Studies suggest that type 4 on the Bristol Stool Chart is most prone to pancaking and that incidences of pancaking are reduced if the stool is looser.^1,2 It may be necessary to assess medication, especially analgesia, and consider the introduction of a laxative or stool softener to make the stool less ‘sticky’. 

Here are some extra tips to alleviate pancaking: 

Tip	Rationale
Oil (vegetable or baby)	Encourages the stool to slide down into the pouch
Liquid soap/lubricating gel	Encourages the stool to slide down into  the pouch
Crunched up tissue or cotton wool ball	Keeps the two sides of film of the pouch  apart
Air in bag before applying	Creates space for the stool to drop  down
Stoma bridges	Keeps the two sides of film of the pouch  apart
Filter covers (if filter is accessible on the  bag)	Offers ability to control the  amount of air in bag

 

How can product choice make a difference? 

The filter system on each product works differently, so it’s important to work with the patient to find a solution that suits them. 

If you’ve exhausted all the strategies listed above and pancaking is still happening, then consider a click-together two-piece product (rather than adhesive coupling). This enables the patient to release the bag from the wafer intermittently throughout the day, allowing additional air in or out. Klok-Vonkeman et al. (2013) also identified that pancaking is more prevalent in individuals using a one-piece closed pouch.² 

You could also consider soft convexity, but only after a thorough clinical assessment of the patient. 

Lastly, colostomy irrigation could be offered an alternative to try and alleviate any distressing symptoms."

Thanks, Angie, for all your helpful advice! We look forward to catching up for our next Ask Angie. 

References

1. Perrin A, Redmond C, Cowin C, Wiltshire N, Smith A, Lovelady N, Carlson G. (2013), ‘Patients’ experiences of pancaking while living with a colostomy: a survey’, British Journal of Nursing, 2013 (Stoma Supplement), Vol. 22, No. 16.

2. Klok-Vonkeman S, (2013), ‘Pancaking: an underestimated problem among ostomates. A cross-sectional study of the prevalence and consequences of pancaking’, WCET Journal, Vol. 33, No. 4.