Pancaking

Pancaking is a term used to describe the condition where a wet, sticky stool sits at the top of the pouch and does not drop down into the pouch. This can cause sore skin and result in the pouch lifting at the flange.

Action:

• Cover the filter with the cover/sticker provided with the appliance and add one or two pieces of scrunched tissue paper into the pouch prior to application, in addition to covering filters

and/or

• Add a small amount of baby oil carefully inserted directly into the pouch

And refer to stoma care nurse specialist service if problem persists.

Hernias

A significant swelling behind the stoma may indicate a hernia. This can also cause an enlargement of the stoma.

Action:

• Ensure that the pouch still fits the patient correctly; the pouch may need to be re-sized (cut to fit the stoma).

And refer to stoma care nurse specialist service if problem persists.

If the stoma stops working and the patient is in extreme pain, contact the patient's GP immediately.

Prolapse

Occasionally the stoma protrudes forward and may fill the bag.

Action:

• Ensure that the stoma remains pink and healthy and if not then refer to the patient's GP
• Re-size the pouch to fit the stoma and refer to stoma care nurse specialist service as soon as possible.

Retraction

Occasionally the stoma may retract back into the abdomen so that the output excoriates the skin.

Action:

• In these cases, re-size by enlarging the flange hole by 2mm and then apply a circle of paste immediately around the stoma on the skin.

And refer to stoma care nurse specialist service as soon as possible.

Leaks and dips

If a patient is complaining of leaks an assessment of the reason needs to be made.

Action:

• Remove the pouch
• Observe the abdominal area with the patient sitting, standing and lying down, making a note of any dips, crevices or skin folds, which may cause the leak.
• If the skin is excoriated, or wet, refer to section on skin care for guidance.

Refer to stoma care nurse specialist service

Other situations that may require referral to stoma care nurse specialist

• Routine over ordering of stoma supplies
• Long term use ≥ three months of skin protective products (wipes/films/paste/powders)
• Current use of shields – patient may benefit from the use of newer products with built in convexity
• Old style reusable bags
• Current use of adhesive rings, discs pads or plasters – newer products may be more appropriate
• Current use of products that are to be discontinued
• Patients experiencing dietary problems
• Patients having management difficulties, e.g. elderly
• At patient’s request
• Patients having psychological difficulties adapting to their stoma