Belcher J. Does honey have a place in stoma care?. Br J Nurs.. 2013; 22:(12)

Black P. Accessories in stoma care. Nursing and Residential Care. 2015; 17:(2)68-70

Boyles A. Keeping up to date with stoma care accessories: enabling informed choice. Gastrointestinal Nursing.. 2010; 8:(6)24-38

Buckle N. The dilemma of choice: introduction to a stoma assessment tool. Gastrointestinal Nursing.. 2013; 11:(4)26-32

Burch J. Stoma care-related skin problems and solutions. Br J Nurs.. 2011; 20:(21)

Burch J. What you need to know about caring for the skin around a stoma. Journal of Community Nursing. 2014a; 28:(4)90-93

Burch J. Stoma appliances and accessories: getting it right for the patient. Br J Nurs. 2014b; 23:(17)S4-S6

Burch J. Post-discharge care for patients following stoma formation: what the nurse needs to know. Nurs Stand.. 2017; 31:(51)41-45

Burch J. Using convex stoma appliances. Gastrointestinal Nursing.. 2019; 17:(7)20-22

Burch J, Sica J. One- and two-piece colostomy appliances: merits and indications. Br J Nurs.. 2007; 16:(17)1042-1047

Operational productivity and performance in English NHS acute hospitals: unwanted variations. An independent report for the Department of Health by Lord Carter of Coles. 2016. (accessed 13 August 2020)

Cottam J, Richards K. Closing the audit loop—stoma complications within 3 weeks of surgery. Gastrointestinal Nursing.. 2011; 9:(9)18-22

Cremen J, Lee A. An overview of stoma care in the residential setting. Nursing and Residential Care. 2016; 18:(11)596-602

Cronin E. A guide to the appropriate use of convex stoma care products. Gastrointestinal Nursing.. 2013; 6:(2)12-16

Department of Health and Social Care. Safeguarding adults protocol. Pressure ulcers and the interface with a safeguarding enquiry. 2018. (accessed 13 August 2020)

Erwin-Toth P, Thompson SJ, Davis JS. Factors impacting the quality of life of people with an ostomy in North America: results from the Dialogue Study. J Wound Ostomy Continence Nurs.. 2012; 39:(4)417-422

Evans M. The use of Manuka honey within stoma care to maintain peristomal skin integrity: the ostomates perspective. World Council of Enterostomal Therapists Journal. 2018; 38:(2)

Gardiner A. Addressing common stoma complications. Nursing and Residential Care. 2013; 15:(3)128-133

Hanley J. Effective management of peristomal pyoderma gangrenosum. Br J Nurs.. 2011; 20:(7)S12-S14-S17

Hanley J. Convex stoma appliances: are we getting it right?. Br J Nurs. 2013; 22

Haughey S, McGroggan G. Living well with a stoma: a descriptive evaluation. Gastrointestinal Nursing.. 2017; 15:(7)41-48

Herlufsen P, Olsen AG, Carlsen B Study of peristomal skin disorders in patients with permanent stomas. Br J Nurs. 2006; 15:(16)854-862

Hoeflok J, Kittscha J, Purnell P. Use of convexity in pouching: a comprehensive review. J Wound Ostomy Continence Nurs. 2013a; 40:(5)506-512

Hoeflok J, Kittscha J, Purnell P. Use of convexity in pouching: a comprehensive review. J Wound Ostomy Continence Nurs. 2013b; 40:(5)506-512

Hoeflok J, Salvadalena G, Pridham S, Droste W, McNichol L, Gray M. Use of Convexity in Ostomy Care. J Wound Ostomy Continence Nurs.. 2017; 44:(1)55-62

Hopkins G. Stoma care: changing and removing ostomy pouches. Gastrointestinal Nursing.. 2015; 13:(7)20-22

Haughey S, McGroggan G. Living well with a stoma: a descriptive evaluation. Gastrointestinal Nursing.. 2017; 15:(7)41-48

Jemec GBE, Nybaek H. Peristomal skin problems account for more than one in three visits to ostomy nurses. Br J Dermatol.. 2008; 159:(5)1211-1212

Kelly O'Flynn S. Care of the stoma: complications and treatments. Br J Community Nurs. 2018; 23:(8)382-387

Kelly O'Flynn S. Peristomal skin damage: assessment, prevention and treatment. Br J Nurs.. 2019; 28:(5)S6-S12

McCahon S. Faecal stomas. In: Porrett T, Daniel N (eds). London: Whurr; 1999

Lee J, Morris O. Stoma complications: a case of cooperation. Br J Community Nurs. 2003; 8:(7)302-306

Metcalf C. Managing moisture-associated skin damage in stoma care. Br J Nurs.. 2018; 27:(22)S6-S14

NHS Business Services Authority. Prescription Cost Analysis (PCA) data, MAT/04/2020. 2020. (accessed 13 August 2020)

NHS Improvement. Getting It Right First Time (GIRFT) recruits new clinical leads. 2017. (accessed 13 August 2020)

Nursing and Midwifery Council. The code: professional standards of practice and behaviour for nurses, midwives and nursing associates. 2018. (accessed 11 August 2020)

Pearson B. The clinical governance of multidisciplinary care. International Journal of Health Governance. 2017; 22:(4)246-250

Perrin A. Convex stoma appliances: an audit of stoma care nurses. Br J Nurs.. 2016; 25:(22)S10-S15

Rat P, Robert N, Fernandes I, Edmond D, Mauvais F. Evaluation of a one-piece soft convex ostomy appliance: a prospective, multicentre, open-label pilot study. Br J Nurs. 2018; 27:(16)S20-S28

Richbourg L, Thorpe JM, Rapp CG. Difficulties experienced by the ostomate after hospital discharge. J Wound Ostomy Continence Nurs.. 2007; 34:(1)70-79

Rolstad BS, Boarini J. Principles and techniques in the use of convexity. Ostomy Wound Manage.. 1996; 42:(1)24–26-28–32

Rolstad BS, Erwin-Toth PL. Peristomal skin complications: prevention and management. Ostomy Wound Manage.. 2004; 50:(9)68-77

Royal College of Nursing. Principles of nursing practice. 2020. (accessed 11 August 2020)

Swan E. Follow-up for ostomates: are we getting it right?. Gastrointestinal Nursing.. 2018; 16:(3)18-21

Turnbull GB. The convexity controversy. Ostomy Wound Manage.. 2003; 49:(1)16-17

White P, Evans M. Clinical governance for ostomates at risk of peristomal skin complications. Br J Nurs.. 2019; 28:(16)S24-S32

Woodward S. Moisture-associated skin damage: use of a skin protectant containing manuka honey. Br J Nurs.. 2019; 28:(6)329-335

Selecting convexity to improve and maintain peristomal skin integrity

10 September 2020
Volume 29 · Issue 16


Each person with a stoma is an individual who may react differently when faced with similar situations and, as such, each patient needs to be considered on a person-by-person basis to address their needs, support their acceptance of living with a stoma, as well as to encourage their rehabilitation. This article discusses the benefits that a convex flange can offer ostomates to reduce and minimise leakage episodes and in doing so support peristomal skin integrity and, in particular, the benefits of a convex pouch with a hydrocolloid flange containing medical grade Manuka honey. It reports on the findings of an independent nurse study, which included discussions about the varying types of convexity offered to ostomates, following an assessment of patients' needs.

The following question was posed to the authors after they had presented the findings of their previous retrospective peristomal skin studies, which looked at pouches containing Manuka honey, at the 2019 conference of the European Council of Enterostomal Therapists (ECET): ‘Was any improvement in peristomal skin attributable to the benefits of convexity as opposed to the Manuka honey convexity flange?’ As clinicians, we felt obliged to investigate further. The primary focus of the study described in this article is therefore whether the use of a Manuka honey convexity flange improves peristomal skin integrity for patients experiencing sore skin, despite using other convex flanges. Patient assessment and evaluation was undertaken independently by patients’ stoma care nurses (SCNs).

An extensive literature search was undertaken to try to establish a consensus on the definition of the term ‘convexity’ and to further investigate the uses of convex flanges and pouching appliances; several seminal texts were identified and are discussed in the article. Convexity appliances are generally used to help in the management and/or prevention of complications, such as output from the stoma seeping under the appliance adhesive. These appliances are designed to place pressure on the skin surrounding the stoma, increasing its protrusion and improving the seal between the appliance and the patient's skin, thus reducing the risk of leakage.

Register now to continue reading

Thank you for visiting British Journal of Nursing and reading some of our peer-reviewed resources for nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • Unlimited access to the latest news, blogs and video content