When I think about innovation in ostomy products, one brand that comes to mind quite often is Salts. In this review, I’ll be looking at their Confidence Natural Advance system.I originally inquired about this line of products and was told that they weren’t yet available here in Canada.

But Argyle Medical Distributors Inc. out of Montreal, Quebec was nice enough to let me know that they had samples available and provided them to me for this review.

Video Review

https://youtu.be/077Q1M_TQVw

About the Confidence Natural Advance

The appliance I used for this review:

Product name: Confidence Natural Advance
Manufacturer: Salts Healthcare
Product #: NDA13
Dimensions: 28cm (top to end of tail) x 14.5cm; 19.5cm x 14.5cm (closed). 11″ x 5-3/4″ (top to end of tail);  7-2/3″ x 5-3/4″ (closed)
Quantity per package: 30

Salts Healthcare is a company based out of the UK. They’ve been around for over 300 years (I shit you not!) and they’ve come up with some pretty nice products along the way.

The Confidence Natural Advance is a newer version of their Confidence Natural line and it features several improvements such as:

  • An improved adhesive.
  • An opaque outlet tail.
  • A non-return valve.
  • Outlet drainage tab.
  • Improved filter.

This is the first Salts appliance that I’ve tried and I was quite interested to see how it would perform considering it seems to hit all the marks I’d be looking for in a great appliance.

I appreciate that Salts includes a stoma measuring guide (made of paper) and filter stickers out of the box. They also include instructions, which contain no words at all, but the images are easy enough to follow and work well for the majority of users.

The Wafer

Salts Confidence Natural Advance wafer

Those slits along the edge really do help to give you a better fit and reduce edge wrinkling.

Currently, the Confidence Natural Advance is available in a flat wafer design. Salts does offer convex appliances, but in their Confidence Natural line only.

This appliance is offered in both pre-cut and cut-to-fit options, and I’m happy to say that the back of the wafer does have cutting lines to make it easier to cut without a template.

These wafers are hydrocolloid, which also means they are thicker than the tape borders you’ll find on the Hollister New Image or Premier line, but not stiff like the Coloplast Xpro wafers.

Unfortunately, the adhesive used in the wafer does contain gelatin (which is usually derived from pigs), so the vegans out there may want to take note.

The Confidence Natural Advance wafer is unique in a few ways:

Aloe Vera

Salts infuses Aloe Vera in many of their adhesives. This should allow the wafer to be more skin-friendly, and anecdotally it seems to work for me.

“Flexifit”

Salts has added five slits to the outer portion of the wafer to allow it to better conform across the skin.

This may not matter so much if you’re stomach is flat, but if you have a hernia or your abdomen bulges out a bit, then these should fit well!

In the past, I’ve experienced wrinkling around the edges of the wafer (see my B. Braun Flexima 3S review), but not with the Confidence Natural Advance.

While I haven’t had trouble with the edges wrinkling, I do notice that they peel quite easily when I’m not wearing a support belt or wrap. This doesn’t seem to affect the wear time of the appliance, but it is annoying.

The Pouch

Wearing Salts Confidence Natural Advance

The bag looks nice and feels good.

The Confidence Natural Advance pouches have features worth mentioning.

Cloth Material

Out of the box, I noticed just how soft the cloth material is. While that’s a nice touch, it’s not nearly as durable it should be.

The cloth quickly absorbs water, which makes it a chore to dry off after showers. I also find that it starts to pull apart quite easily as you can see in the photo below.

Salts Confidence Natural Advance wet bag

Stays wet after showers.

The bag starts to fall apart in no time.

The bag starts to fall apart in no time.

The cloth is opaque enough to hide the contents of the bag, but it’s not the best I’ve seen and as the materials degrade it exposes more.

There is an option to get a fully transparent version of this appliance, but I haven’t tried it myself.

Inspection Window

One feature to note is the inspection window on the front of the bag. This is something I’d like to see on all one-piece opaque systems as it makes appliance changes and monitoring of the stoma so much easier.

Salts Confidence Natural Advance inspection window no stoma

Inspection windows should be standard on all opaque bags!

Salts Confidence Natural Advance inspection window

The inspection window allows you to easily check the condition of your wafer and stoma.

Outlet

Perhaps the most important part of an ostomy bag for many people is the outlet. Since it’s the part you’ll be using multiple times a day, it’s important that it’s designed to be easy to use and reliable.

The Confidence Natural Advance seems to offer both, however, there are some specifics that I’d like to bring up.

Firstly, the outlet uses a “Velcro-like” closure. There are two tabs that open up on each side of the closure that “stick” to a strip of cloth a few centimeters from the bottom after the outlet is rolled up.

Salts Confidence Natural Advance closure

The smooth fabric of the closure.

Salts Confidence Natural Advance closure tabs

The closure tabs don’t have much bite to them, but they do the job.

This closure is easy to open and close, but some may find that it needs to be stronger (like traditional Velcro). I haven’t had trouble with it opening unexpectedly or leaking.

Rolling and unrolling the outlet is pretty standard for this style, and it’s been reliable for me.

Salts added a small patch of fastening hooks just under the bottom of the cloth cover. This allows you to tuck your outlet under the cloth cover (without needing to use a hack like this one), but as the cloth cover wears out I notice the outlet no longer stays tucked in.

Salts Confidence Natural Advance closure tabs folding patch

That white patch allows you to fold up the outlet tail so the bag is smaller.

The outlet itself is easy to open, even with one hand, which I really appreciate. I do find that it’s not as easy to clean 100%, but this is more about my own personal preference as it doesn’t seem to create any problems with odors or leaks.

Salts Confidence Natural Advance outlet open

Really easy to open – even with one hand!

One unique feature, which I’m glad to see, is this small tab built into the outlet to make emptying the bag easier. This can be especially handy if you find it difficult to hold the end of the bag while emptying it.

Salts Confidence Natural Advance outlet tab in toilet

The outlet tab is a nice addition!

For those who are curious, yes, the bottom half of the bag uses opaque plastic, so you can’t see the contents easily.

Salts Confidence Natural Advance opaque outlet

Not 100% opaque, but it’s better than nothing.

Non-Return Valve

A common annoyance for those who have loose our liquid output is when it comes time to lay down.

In a traditional bag, out output will flow back towards the top when you lay down. With this non-return valve, that’s not as easy, so this should (in theory) help to prevent various issues ranging from leaks to clogged filters.

The Filter

Arguably the most important part of an ostomy bag (at least to colostomates and some ileostomates) is the filter.

Salts have gone above and beyond trying to make the filter on the Confidence Natural Advance the best around. It uses several layers to create an obstacle course for stool to pass through before it reaches the filter, yet it allows gas to pass through without much trouble. The placement of the filter is also in an unconventional way (near the middle), which helps to make this system of layers work more efficiently.

I was pretty amazed to see that no output ever reached the filter, however, the filter didn’t seem to work as intended and I ended up with ballooning pretty much every day. This was a huge disappointment that left me quite confused considering it should have worked very well.

Ballooning with Salts Confidence Natural Advance

Ballooning was a daily occurrence.

Nothing could really explain why the filter wasn’t working for me, but I’m sure not everyone would have the same experience.

The filter does need to be covered with a filter sticker to prevent it from clogging during showers.

My Experience

Salts Confidence Natural Advance wearing with jeans

The “standard” size bag is not too big and not too small.

The Confidence Natural Advance is really comfortable to wear. It molded nicely to the shape of my abdomen and it allows me to bend and move without a problem during physical activity.

Edge peeling happened often, although it was mitigated when I wore a support belt or ostomy wrap (because of the gentle pressure it applies to the wafer). This didn’t shorten my wear time, but if you like to swim then I would suggest using a wafer extender.

Salts Confidence Natural Advance edge peeling

Edge peeling happened often but did not reduce wear time for me.

Without using a support band, I could only suggest that during a fresh appliance change you hold your appliance and apply gentle pressure for several minutes to get the adhesive to bond better.

My wear time for this appliance was approx. 3-4 days (I would change it on a schedule). The wafer held out quite nicely during that time, giving no indication that it was eroding too much.

Surprisingly, despite the constant ballooning I experienced, I had zero leaks during the several weeks I wore this appliance.

For those who like to wear their appliance sideways (like I do), I feel that the many layers in this appliance make it difficult to move stool towards the outlet to drain. I suspect that the transparent version would be slightly better, but it’s the internal layers that are causing this problem.

Salts Confidence Natural Advance sideways

It works but is not the best for wearing sideways due to all the internal layers.

That’s not to say you can’t wear this appliance sideways, it’s just not the best for the job.

Conclusion

At the time of this writing, The Confidence Natural Advance is available in the UK, but not yet in North America. It’s unknown if Salts will be launching this product in North America anytime soon (or at all), but it may be one to look out for.

If you live in the UK, you can ask for samples directly from Salts.

Pros
  • Comfortable
  • The adhesive around the stoma is one of the best I’ve used.
  • The inspection window comes in really handy.
  • Cloth material is soft and nice on the skin.
  • Opaque tail.
  • The closure is easy to open.
  • The outlet drainage tab works as intended.
Cons
  • Made with animal ingredients.
  • Limited availability.
  • Edge peeling was a problem most of the time, but it did not affect the appliance wear time.
  • The filter doesn’t live up to expectations. (In my experience! This may work fine for others)
  • Cloth material isn’t very durable and soaks up water during showers.
  • Not as easy to clean the outlet compared to similar pouches.
Recommended (especially if the filter works!).

Overall, the Confidence Natural Advance is a pretty great appliance. The only real “fatal flaw” for me is that the filter doesn’t seem to work, but that’s just my experience. The fact that it does contain animal ingredients prevents this from being a product that I’d personally use, but if other appliances haven’t worked for you then this one won’t compromise on quality or features.

I think that anyone who’s looking for a one-piece appliance should at least consider this one. While it may not be available everywhere, it’s worth keeping an eye out for!

If you’re already using the Salts Confidence Natural products, then the Confidence Natural Advance should be a nice upgrade.

For more information, please visit http://salts.co.uk or
Question: Have you used this appliance?