I have the same issues with pancaking. Stool builds up to the point of pushing the whole appliance off my skin. After 3 years of trying every suggestion I've heard, to no avail, I have finally come up with a method that works for me. It might sound a little gross, but then, would there be a solution that didn't? I use a stick (as opposed to click) 2 piece appliance. When I feel the pressure of stool buildup in my pouch, I open the pouch at the top, and clean out the stool there, using toilet paper. In order to for this to work well, my stool has to be fairly solid. I have difficulty achieving that if I eat fruit or vegetables regularly (which I like to do), so I have experimented with Immodium (with the blessing of my surgeon). I find that 1 or 2 of the Immodium every day generally produces a firm stool. I have a minor problem with Immodium - it makes me drowsy. So, I take it at bedtime every day. If I find that I need extra Immodium during the day, I try to limit it to 1 so I'm not too drowsy. I find this system works well for me, and as I said, I have tried everything else. If you try this, be careful not to touch the sticky part of your flange with the toilet paper, as it will stick to the flange and then that part won't stick to your pouch. Your flange should continue to stick to your pouch for several days even if you open it several times a day. Maybe this would work well with a click 2 piece system, but I haven't tried it. By the way, I also find that eating foods with non-soluble fibre (oatmeal, bananas, mango etc) help to keep stool firm. Hope this is helpful. If you find another solution that works for you, please let me know.