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.
Table of Contents
Video Review
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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
Currently, the Confidence Natural Advance is available in a flat wafer design. Salts does offer convex appliances, but in their Confidence Natural line only and although they are labled as Confidence Natural products, they have the same features as the Advance ones in this review.
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
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.
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.
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.
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.
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.
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.
For those who are curious, yes, the bottom half of the bag uses opaque plastic, so you can’t see the contents easily.
Non-Return Valve
A common annoyance for those who have loose or 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.
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
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 often happened, 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.
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.
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 https://salts.co.uk
Question: Have you used this appliance?
I’ve been using the salts NDA 13 bags and have had no problem with leaks or ballooning. I also have a hernia and I find they fit very well around it. I do have a problem once in a while with pancaking. So what I do is blow into it and seal the filter, which helps, then if I do get some ballooning I let the air out from the bottom. I have a lot of output so when I drain the bag I rinse it out with warm water and it’s like I have a new bag on. Also for showering I cover the bag with something like a shower cap ( I use the ones you use for covering leftovers in a bowl as they are softer) then tape it down with waterproof tape. This bag is very comfortable and you don’t even know it’s on (unless it’s full)
Thank you for sharing your feedback, Del!
Well….I tried this one from Salts which you reviewed here. I got leaks from the side of the wafer after just one or two days wear.
My bomb-proof bag at the moment is the SALTS XND 1352. It’s got a SUPERB, Large, sticky flange and I am soooo confident wearing this. It IS a Convex bag but it’s fine for me even though I do not need a Convex as my Stoma protrudes sufficiently. I use a Secuplast washer underneath the flange (haven’t found a bag yet that I can wear without a washer!!).
I LOVE the Coloplast Sensura Mio. It’s state of the arts – BUT I get side leaks each time I wear one. My HOLY GRAIL bag would be the Sensura Mio, made with the SALTS XND 1352 fabulous flange!!
SALTS have JUST RELEASED a BRAND NEW BAG – available in THREE Colours. It’s called the Confidence Be. I’m ordering samples tomorrow, so I’ll get back to you all after my trial of it.
That’s too bad this one didn’t work for you, but it could be because it’s not convex since you’ve had success with their other products.
I saw the new bags – they look beautiful! I have to get my hands on them this year for a review ;)
I live in the UK and have been using these bags for a couple of months now, but I have been bothered with constant leaks, so I’m in the process of trying to find a new bag. The problem I have been having is that I have clumping of the more solid material round my stoma, then the liquid part is constantly leaing out of the cut in areas of the wafer. I haven’t had problems with balooning though and the bag is very comfortable to wear. My search for the perfect bag goes on!
Sounds like you may be having a problem with “pancaking". I do find that bags with multiple layers (like the Salts Confidence bags) can increase incidences of pancaking, but it varies with each person.
Good luck!
Hi
I think I’ve definitely been experiencing pancaking, big time. Trying to up my fluids and that seems to be helping. I left a message on your Facebook page about the Salts Confidence Be, saying I’d tried out the black one and loved it. Well I saw my stoma nurse today to get it added to my prescription. She has approved it and as long as my doctor approves it too, I should have supplies of it in around three weeks.
I see that you’re unable to get samples of it at the moment, so if you would like to try it out, I could send you a few if you give me your address. We are so fortunate in Scotland to have the NHS and get all our supplies for free. I am so grateful to you for all the information you have on your website and all your youtube videos. I came out of hospital eighteen months ago with an illeostomy and a mucous fistula after emergency surgery feeling very depressed, lost and alone wondering how on earth I was going to cope with all this. However I found your videos on youtube and they have taught me so much. Your positive attitude also helped me to accept my stomas and realise that I could still have a normal life, just a different normal from before. I’ve also since become a vegitarian, not quite at the vegan stage yet, but thinking about it!
Hope you’re keeping well
Thanks, Wendy.
I have some contacts at Salts who may be able to provide me samples of their new products when I’m ready to try them. I’ll give them a shout in the new year.
Thats great, glad you will be able to get them
I’m in the UK and I use the Confidence Natural soft convex. From the pictures it looks very similar. The convex bit is less stiff that others I tried. Like you, I liked the opaque outlet and the viewing window, especially that the fabric has an overlap so it’s only “open" when you want it to be. It feels like the bag has actually been designed by someone with a stoma! I also find the outlet more difficult to clean, but I like all the other features enough to put up with that.
I change my bag every day or every other day. I find that the fabric starts to wear out on the second day, but not too badly. It is annoying that it takes a while to dry, but if I am not changing my bag I slip a flannel into my waistband for a bit after my shower. That absorbs the water from the cover and stops it leaving a damp patch on my clothes!
The edges peel away slightly sometimes, but when I remove the bag it is well stuck on. I have been swimming with this bag without any problems. I always use a barrier ring underneath as my stoma is a slightly odd shape. But other than that I didn’t use any extra adhesive.
My only major negative is that the other day I had a small amount of leakage from the filter. I had extremely liquid output that day, basically just water, and some ballooning. So I think some liquid had been forced into the filter layer and then it seeped through. I haven’t been able to replicate this so I don’t know if that bag just had a faulty filter or whether this is a common problem with watery output.
Thanks for sharing that, Chris.
I’m not sure if the filter problem you’ve experienced would be solved in the “Advance" version of the Confidence Natural, but I would say that it’s very difficult for the filter to get clogged on these bags due to the non-return valve and the way the layers inside the bag are positioned.
Unfortunately, I don’t believe they have a Convex version of this appliance available.
i have used the salts bags before and like you experienced a lot of ballooning. the filters did not work for me and even adding an osto e z vent this didn’t help because of the double inside bag manufacture of these bags.
That’s a good point – As an experiment, I added a third-party filter (not the EZ-Vent) to these bags and had no luck with them because of the many layers inside the bag.
Salts sent me a large box of samples. They say they are bringing to America. I had no success. There are so many flaws. I felt I should reach out and tell them because they were so generous to send samples. I’m also a Brit, I owed them that much. I warned them to get focus group to test and give honest opinions over a few weeks. Mine leaked at a restaurant and in bed. In America they would be sued and would cost them alot of money. They will need to retain lawyers in every state. This seems like a mom and pop type company. I’d hate to see them go bust through lawsuits.
Hi Peter,
It’s unfortunate that these bags leaked on you. The reality for us is that no appliance will be perfect for all users, and there may be incompatilibites with our skin and the adheisve that causes problems no matter how good a product may be (I’ve experienced this myself with many different supplies).
I’m curious to hear about the other flaws you mentioned. What else didn’t work for you?
Hey Chris,
Just a quick FYI, I’ve been told by Salts that the Natural Convex you use has the same featues as the “Advance" product I reviewed here – they haven’t changed the name to reflect that.