Peristomal skin complications remain one of the most common and preventable challenges in ostomy care. Understanding the epidemiology, risk factors, and impact of hygiene practices is essential for improving pouch adherence, patient comfort, and long-term outcomes. 

Why This Matters 

• Up to 80% of ostomy patients experience peristomal skin complications; many linked to hygiene and product misuse. 
• Impaired peristomal skin directly affects pouch adherence, increasing leakage, infection risk, and healthcare utilization. 
• Standardizing evidence-based hygiene practices is critical to improving patient quality of life and clinical outcomes. 

The Scope of the Problem: Peristomal Skin Complications Are Widespread 

Peristomal skin complications (PSCs) are among the most prevalent issues affecting individuals living with an ostomy. Despite advances in ostomy appliances and skin barriers, studies consistently report that between 36% and 80% of ostomy patients experience some form of peristomal skin complication.^1,2 

These complications range from irritant contact dermatitis and moisture-associated skin damage to fungal infections and mechanical injury. The high prevalence underscores a critical gap in care: even with modern technologies, maintaining healthy peristomal skin remains a persistent challenge. 

From a population health perspective, this burden is significant. In the United States, an estimated 725,000 to 1 million individuals are living with an ostomy, with approximately 100,000 new ostomy surgeries performed annually.³ This translates to hundreds of thousands of patients at risk for ongoing skin complications—many of which are influenced by hygiene practices. 

For wound care professionals, the sheer scale of this issue makes peristomal hygiene not just a technical consideration, but a central component of quality care. 

Why Peristomal Hygiene Matters for Skin Integrity 

The peristomal environment is uniquely vulnerable. Unlike intact skin, it is routinely exposed to effluent containing digestive enzymes, bacteria, and moisture—all of which can rapidly compromise skin integrity. 

Inadequate or inconsistent hygiene practices contribute directly to skin breakdown. Residual effluent, improper cleansing agents, and excessive friction during cleaning can disrupt the skin barrier, increasing susceptibility to irritation and infection.⁴ 

Peristomal moisture-associated skin damage (MASD) is particularly common, driven by leakage and prolonged exposure to effluent. Once skin integrity is compromised, a cycle of deterioration often follows: damaged skin leads to poor pouch adhesion, which increases leakage and further exacerbates skin breakdown. 

This cycle is not only difficult to interrupt but also highlights why foundational practices—such as appropriate cleansing—carry disproportionate importance in this patient population. 

The Link Between Skin Health and Pouch Adherence 

Pouch adherence is directly dependent on the condition of the peristomal skin. Even minor skin irritation can significantly reduce the effectiveness of adhesive barriers. 

Research shows that patients with peristomal skin complications are more likely to experience leakage, shorter wear times, and frequent appliance changes, all of which contribute to increased cost and decreased quality of life.² 

Leakage is not a minor inconvenience—it is a primary driver of both physical and psychosocial burden. It can lead to odor, discomfort, and embarrassment, ultimately affecting social participation and mental health. 

From a clinical standpoint, compromised pouch adherence also increases the risk of infection and hospitalization. Poor adhesion can allow for bacterial ingress, particularly in immunocompromised or medically complex patients. 

For clinicians, this reinforces a critical point: maintaining healthy peristomal skin is essential not only for comfort, but also for the functional success of ostomy management. 

Misconceptions and Variability in Hygiene Practices 

Despite its importance, peristomal hygiene is an area marked by significant variability in practice. Patients often receive inconsistent or incomplete education, leading to the use of non-recommended products or techniques. 

Common misconceptions include the routine use of soaps containing oils or fragrances, over-cleansing, or the application of products that interfere with adhesive barriers. These practices can leave residues that impair pouch adherence or irritate the skin.⁴ 

Evidence suggests that education gaps contribute significantly to PSC development, with many patients reporting uncertainty about proper cleansing techniques and product selection.⁵ 

This variability extends to clinical practice as well. Without standardized protocols, clinicians may rely on personal preference or anecdotal experience, further contributing to inconsistent patient outcomes. 

Clinical and Economic Impact of Peristomal Skin Complications 

The consequences of poor peristomal hygiene extend beyond skin irritation. PSCs are associated with increased healthcare utilization, including more frequent clinic visits, product use, and hospital readmissions. 

A cost analysis found that patients with PSCs incur significantly higher healthcare costs compared to those without complications, driven by increased appliance use and clinical interventions.⁶ 

Additionally, PSCs can delay recovery following ostomy surgery and contribute to long-term morbidity. Chronic skin issues may require ongoing management, placing a sustained burden on both patients and healthcare systems. 

Quality of life is also significantly affected. Studies consistently demonstrate that peristomal skin complications are associated with lower health-related quality of life scores, particularly in domains related to physical comfort, emotional well-being, and social functioning.² 

For wound care professionals, these findings highlight the broader implications of peristomal hygiene: it is not merely a routine task, but a determinant of both clinical and economic outcomes. 

A Vulnerable Population: Risk Factors and Comorbidities 

Certain patient populations are at even greater risk for peristomal skin complications. Individuals with obesity, diabetes, or limited mobility face additional challenges in maintaining effective hygiene and pouch adherence.⁵ 

Anatomical factors, such as stoma location and contour irregularities, can also complicate cleansing and increase the likelihood of leakage. 

Older adults represent a particularly vulnerable group. Age-related changes in skin integrity, combined with potential cognitive or physical limitations, can make consistent hygiene practices more difficult to maintain. 

These risk factors further emphasize the need for targeted education and support, as well as heightened awareness among clinicians managing these patients. 

Why This Topic Is Critical 

Despite the high prevalence and impact of peristomal skin complications, peristomal hygiene remains underemphasized in many clinical education pathways. 

For wound care professionals, this represents both a challenge and an opportunity. Improving hygiene practices has the potential to significantly reduce complication rates, enhance patient comfort, and lower healthcare costs—without requiring advanced or resource-intensive interventions. 

As the population of individuals living with ostomies continues to grow, the need for clinicians who understand the nuances of peristomal care will only increase. Engaging with this topic is essential for clinicians seeking to improve patient outcomes, optimize ostomy management, and deliver high-quality, patient-centered care. 

References 

1. Salvadalena G. Incidence of complications of the stoma and peristomal skin among individuals with ostomies: a systematic review. J Wound Ostomy Continence Nurs. 2020;47(5):457-464. 
2. Claessens I, Probert R, Tielemans C, et al. The Ostomy Life Study: the everyday challenges faced by people living with a stoma in a snapshot. Gastrointest Nurs. 2021;19(Suppl 2):S12-S19. 
3. United Ostomy Associations of America. Ostomy and Continent Diversion Patient Bill of Rights and Statistics. Updated 2023. Accessed April 15, 2026. https://www.ostomy.org 
4. Gray M, Colwell JC, Doughty D, et al. Peristomal moisture-associated skin damage in adults with fecal ostomies: a comprehensive review. J Wound Ostomy Continence Nurs. 2021;48(1):45-53. 
5. Colwell JC, Pittman J, Raizman R, Salvadalena G. A randomized controlled trial determining variances in ostomy skin conditions and the economic impact (ADVOCATE trial). J Wound Ostomy Continence Nurs. 2022;49(2):143-151. 
6. Meisner S, Lehur PA, Moran B, Martins L, Jemec GB. Peristomal skin complications are common, expensive, and difficult to manage: a population-based cost analysis. PLoS One. 2021;16(2):e0245630.