Quality of life with an external appliance has a significant impact on decision making when considering an incontinent or continent ostomy. A majority of clients with external pouches are content with their pouches and enjoy a good quality of life. For others, not having to deal with an external appliance is reason enough to consider surgery. Major physical and psychological lifestyle changes occur with the ileostomy, particularly with body image and self-concept (Reynaud & Meeker, 2002). Having an external appliance can lead to depression for the client because of skin irritation, leakage of stool, and difficulty securing the appliance. Other issues include moving wrong while sleeping, which can create an uncomfortable feeling of warmth across the abdomen, and putting on a seatbelt can be a challenge.