Everything in the photos is included: the raised toilet seat itself, the attached water splash guard (EW59055R), and the instruction manual. I thoroughly cleaned and washed it before listing, but there are still some minor stains that I couldn't remove, likely due to long-term storage. This type doesn't interfere with the washlet function and seems suitable for those with knee pain. Please note that compatibility with your toilet bowl is necessary for installation. Please check beforehand and consider purchasing accordingly.