There are many psychosocial issues to living with an ostomy. Many of the concerns that people with an ostomy have are often discussed in terms of body image issues. Concerns over appearance and the impact of changes in bowel or bladder functioning will to varying degrees affect all patients with an ostomy. The pre-operative and emotional status of a patient will influence the adjustment period post-operatively. However, those who require emergency surgery due to trauma, obstruction or injury to the bowel usually have no choice or control over the impending surgery and equally no time to prepare mentally for it. A sense of grief over the actual loss of a body part may be experienced if the ostomy surgery requires the removal of the bladder or rectum which will indicate the need for a permanent stoma. The elimination process will be in a place where the person can see it. In order to learn about the stoma the patient will need to not only talk about it but equally listen to it being talked about. This may bring fear to the patient in a society where talking about it is taboo. The adaption to altered body image and function depends on the nature of the threat, its meaning to the individual, coping abilities, response of significant others, pre-surgical personality and relationships as well as the help available in adjusting to the change. In addition some surgical interventions can interfere with normal sexual functioning. As a consequence feelings are intertwined with guilt, shame, rejection and loss of control. The fear of social and sexual inadequacy may become exaggerated.

Negative feelings are more than likely to develop when patients learn that they will have ostomy surgery. There is a threat with loss of control over elimination and concerns regarding the ability to remain clean and odour free can arise.

Undertaking assessment and management of psychosocial aspects following the formation of a stoma can mean that the health care professional/ team will encounter difficult situations. The patient may refuse to discuss how they feel or may even relate that everything is fine but the behaviour does not support their statement. Sometimes patients can also make unreasonable demands on their relatives and equally the health care professional.