Works well once you understand how to use it and how to conform it's features to the buttocks placed on it. I purchased these for my elderly parents. My dad who passed away last year was getting progressively smaller and smaller as he came nearer to death and so I had to constantly be adjusting the water flow and direction and temperature to clean him without discomfort. One thing to be careful of with the elderly is to make sure their buttocks are spread a bit as they sit down on the bidet so the water can get in there and clean. I guess my only suggestion for this thing is to put adjustable brackets on the bottom so it can be secured properly to all the different styles of toilet rims on the market. Many times my mom doesn't sit quite centered and I have to move her over and the seat moves with her, which it would not do.