Many people notice that right after changing or emptying an ostomy (stoma) pouch it puffs up a little, then settles into a flat shape before long. Wondering whether there is a way to keep it looking a bit fuller is completely natural. Understanding why the pouch inflates and then deflates also helps you judge whether the current state is something to worry about.
Most ostomy pouches have a filter that traps odor while letting gas escape slowly. Gas produced during digestion collects in the pouch and makes it swell briefly; as the air passes out through the filter, the pouch flattens again. In other words, a flattening pouch can simply be a sign that the filter is doing its job, and usually is not a problem.
The situation that actually deserves attention is different. If the front and back walls of the pouch stick together right over the stoma opening, waste cannot fall to the bottom and instead piles up around the stoma. This is commonly called 'pancaking.' When output works its way under the baseplate (the wafer that adheres to the skin), it can leak or irritate the surrounding skin — so it is this sticking together, rather than the flat shape itself, that leads to real discomfort.
The opposite can also happen: if the filter becomes blocked by moisture or output, gas cannot escape and the pouch swells like a balloon (ballooning). Because both extremes — sticking flat and over-inflating — are signals that need managing, the goal is a moderate middle ground.
If you want to keep the walls from sticking, there are a few things to try. You can add a few drops of a pouch lubricating deodorant (a product placed inside the pouch), or a small amount of cooking oil or baby oil to keep the inner walls slippery. Some people tuck a small piece of tissue into the bottom of the pouch to hold the two sides apart, or gently add a little air to the new pouch before applying it. There is no need to inflate it forcefully, and for hygiene it is best to avoid blowing air in by mouth.
Filter care helps too. Covering the filter with the sticker provided when you shower keeps it from getting wet and reduces clogging. Also, gas-forming foods such as beans, carbonated drinks, and onions can make the pouch swell more often, so it can help to notice which foods lead to more gas for you.
If it keeps leaking despite changing your approach, if the skin around the stoma becomes red or broken, or if the amount, color, or form of the output clearly differs from usual, please do not tough it out alone — talk with a wound-ostomy-continence (WOC/ET) nurse or your care team. The right technique can vary slightly with the products you use (baseplate shape and pouch type).
This article is for general information only and does not replace individual diagnosis or medical care. Please make decisions about symptoms or management in consultation with your treating clinician or a nurse who specializes in ostomy care.