An ostomy appliance comprises a pouch having first and second walls, with an inlet aperture in the first wall. A stoma seal is carried by the second wall, and is disposed generally in register with the inlet aperture for sealing against a stoma in use. An outer coupling element is coupled to the first wall and surrounds the inlet aperture. An inner coupling element for supporting the stoma seal, is coupled to the second wall and/or to the stoma seal. The outer coupling element surrounds a periphery of the inner coupling element. The stoma seal may be of an inflatable type or an insertable type. Manipulation tabs may be provided associated with the inner and outer coupling elements.