Living with an ostomy presents unique challenges, and one common issue ostomates face is "pancaking." This article provides comprehensive guidance on understanding, preventing, and managing pancaking, focusing on dietary adjustments and practical solutions.
Understanding Pancaking
Pancaking occurs when a vacuum forms inside the ostomy bag, causing the bag to stick together. This prevents the stoma output from dropping to the bottom of the bag, leading to stool accumulating around the stoma. Consequently, the stool may make its way under the pouch adhesive, potentially lifting it and causing leakage and skin irritation.
Pancaking is more frequent in individuals with colostomies because the stool is generally thicker due to the colon's water absorption function. However, it can also affect those with ileostomies, especially when the stool consistency is thicker than usual.
Dietary Strategies to Prevent Pancaking
Diet plays a crucial role in managing stool consistency and preventing pancaking. A balanced approach to diet and hydration is essential for ostomates.
Fiber Intake
The role of fiber in the stoma diet is complex and depends on the individual and the type of ostomy.
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- Low Fiber Diet Considerations: While a low-fiber diet is sometimes suggested for managing diarrhea or constipation, it may not be suitable for everyone, especially individuals with diabetes. Fiber helps stabilize blood glucose levels, a cornerstone of diabetic diets.
- Balanced Fiber Intake: A balanced, fiber-rich diet is generally vital for managing ostomy pancaking. Fiber regulates bowel function and adds bulk to the stool, reducing the likelihood of pancaking. The recommended five servings of fruits and vegetables still applies to those with an ostomy.
If incorporating fiber, do so gradually and monitor the effects on your stoma output.
Hydration
Dehydration can lead to thicker output, increasing the risk of pancaking. Ostomates should aim to drink around 2.5 liters of fluid daily, approximately half a liter more than the average person.
Food Diary
Keeping a food diary can help identify foods that worsen symptoms or thicken output. By tracking your meals and their effects, you can make informed dietary choices to minimize pancaking.
Eating Habits
- Small, Regular Meals: Eating small meals regularly, every three to four hours, can help maintain stable weight and consistent stoma output. A small meal should be about the size that fits in a mug or on a side plate.
- Gradual Introduction of Foods: After ostomy surgery, introduce foods back into your diet gradually. This allows you to monitor how your body responds to different foods and identify any that may cause issues.
- Chewing Thoroughly: Some high-fiber foods can cause food blockages if not properly digested. Chewing food thoroughly can help prevent this.
Foods to Consider
- Fruits and Vegetables: While beneficial, the skins of some fruits and vegetables can be difficult to digest. Peeling them, especially potato and apple skins, may help avoid problems. Increasing your vegetable intake can also help if your output is often thick.
- Foods That May Thicken Output: Be mindful of foods that may thicken your output and adjust your intake accordingly.
Practical Tips and Solutions
Beyond dietary adjustments, several practical tips can help manage and prevent pancaking.
Pouch Management
- Air in the Bag: Before applying the bag, blow some air inside, pulling the walls apart if the bag has no filter. For bags with filters, covering the filter can sometimes create a vacuum, so consider using an ostomy cover or tape.
- Water Rinse: Rinsing the bag with warm water can provide relief from irritation caused by pancaking. After emptying your bag, adding about 3/4 cup of water, closing it, and swishing it around can help loosen any pancaked stool.
- Lubricating Deodorants: Using lubricating deodorant can help stool slide down the bag, preventing it from sticking around the stoma.
- Regular Emptying: Empty your ostomy pouch regularly to prevent excess stool from building up around the stoma.
Pouch System
- Pouch Type: Explore different ostomy pouching systems to find one that suits your body and lifestyle. Some pouches have features like integrated filters or convexity to prevent pancaking.
- Convex Wafers and Support Belts: For retracted stomas, convex wafers and support belts may be helpful.
- Stoma Size and Shape: Ensure your stoma opening is the right size and shape for your body. Consult with your ostomy nurse to ensure your stoma opening is the right size for your body.
Lubricants
In-pouch lubricants can facilitate the movement of stool away from the stoma and into the bottom of the pouch. These lubricants create a slick surface on the inner lining, helping thick stool slide down and preventing pancaking. Some lubricants, like Revel's "It's in the Bag," can last up to 24 hours.
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Addressing Retraction
If you have a retracted stoma, consider a revision to pull it out a bit. A well-protruding stoma (about 3/4 of an inch at its lowest point) can help prevent pancaking.
Additional Considerations
- Multivitamin and Mineral Supplementation: Depending on your diet and output, multivitamin and mineral supplementation may be necessary.
- Psyllium Husk or Metamucil: If your motions are watery, adding psyllium husk or Metamucil can help bind the watery flow.
- Tight Clothing: Avoid wearing tight clothing around your bag, as it can restrict output from moving down the bag.
Seeking Professional Guidance
Living with an ostomy can be overwhelming, especially when facing challenges like pancaking. Consulting with a healthcare professional or ostomy nurse is crucial for personalized advice tailored to your unique needs. They can help you adjust your diet, recommend appropriate pouching systems, and provide guidance on managing any complications.
Example Meal
Here’s an example of a meal that may be suitable for someone managing pancaking:
White bread wrap with sliced chicken, Dijon mustard, sliced peeled Lebanese cucumber, and a slice of cheese.
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