It is estimated that around one in 500 people in the UK are living with a stoma, with approximately 21 000 operations that result in stoma formation being performed each year ( Colostomy Association, 2016 ). These people face a unique set of challenges in maintaining the integrity of their peristomal skin. This article explores the normal structure and function of skin and how the care and management of a stoma presents challenges for maintaining peristomal skin health. Particular focus is paid to the incidence of skin problems for those living with a stoma, whether it is temporary or permanent, and the factors that contribute to skin breakdown in this population. Wider factors such as the central role of the clinical nurse specialist and the impact of product usage on positive outcomes and health economics are also considered.

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For some patients, the formation of a stoma marks the beginning of a long path of treatment, while for others it may come at the end of years of intervention, medication and treatment, and mark a return to a more normal lifestyle. Either way, stoma formation will impact on patients and the way they live their lives. As nurses caring for this group, it is important to consider the problems they face and how they adapt to their new way of living. In this article, Anna Boyles examines the psychosocial impact of stoma formation and its influence on patient outcomes in terms of their self-perception and quality of life.

A range of products and accessories are available to assist patients to overcome a number of stoma problems and enhance their self-care. Used in conjunction with good appliance selection, they help to maintain peristomal skin integrity and promote pouch reliability. For many patients they make the difference between gaining independence in their stoma care, and living with continuing problems. Anna Boyles examines the incidence of problematic stomas, why accessories are used and who should recommend them. A range of problems are examined and the choices available on the market and their appropriate use are discussed.

Studies have suggested that 21–70% of people living with a stoma and undergoing stoma-forming surgery will experience complications (Leenen and Kuypers, 1989; Bass et al, 1997; Shellito, 1998), with the likelihood of problems increasing over time following surgery. Anna Boyles outlines what is considered normal in terms of stomal and peristomal appearance and function, and examines the predisposing factors that may make complications more likely. Methods of preventing and treating complications are also considered.