Poise Impressa
Poise Impressa is a single-use, tampon-like, disposable intravaginal bladder-support device sold over the counter for the nonsurgical management of female stress urinary incontinence (SUI). It supports the bladder neck and urethra to increase urethral resistance during increases in intra-abdominal pressure (cough, sneeze, exercise), is sized using a starter kit (sizes 1–3), and is inserted by the patient at home — no provider fitting required.[1][2][3]
For the umbrella article on intravaginal continence devices and the broader pessary class, see Continence Pessary. For the female SUI ladder, see the Female Stress Incontinence Database. For first-line conservative therapy, see Pelvic Floor PT.
How It Works
Impressa is inserted vaginally like a tampon. Once seated, it elevates and supports the bladder neck and proximal urethra, increasing urethral resistance to leak during stress maneuvers. It is not a pelvic-organ-prolapse pessary and does not provide vaginal-vault support.[1][3]
| Feature | Detail |
|---|---|
| Class | Disposable intravaginal continence device (DICD) |
| Sizes | 1, 2, 3 — starter / sizing kit available |
| Wear time | Up to 8 hours per device |
| Use | Single use — discard after wear |
| Distribution | Over the counter; no prescription required[1][2] |
| Fitting | Self-fit at home using the sizing kit; no in-office fitting needed[1] |
Indications
- Female stress urinary incontinence — leakage on cough, sneeze, exertion.[1][2]
- Situational SUI — especially exercise- or activity-related leakage where on-demand control is desired.[2]
- Patients who prefer a non-pharmacologic, noninvasive option, or who wish to avoid or delay surgery.[5]
- Patients unlikely to adhere to behavioral or pelvic-floor-muscle-training programs.[5]
It is not indicated for urgency or overflow incontinence.
Contraindications and Precautions
Drawn from the Nekkanti 2022 RCT exclusion criteria:[4]
- Pregnancy
- Active urinary tract infection
- Postmenopausal bleeding (un-evaluated)
- Neurogenic bladder
- Urinary retention
- Significant pelvic organ prolapse
Clinical Evidence
The Impressa-specific evidence base is limited; the contemporary expert reviews position it within the broader literature on intravaginal continence devices.
Nekkanti 2022 RCT — Impressa vs continence pessary
A randomized trial of 50 women with SUI compared Impressa to a traditional fitted continence pessary at 4 weeks:[4]
| Endpoint | Impressa | Continence pessary | p |
|---|---|---|---|
| Treatment success at 4 weeks | 75% | 80% | 1.0 |
| Improvement on questionnaire measures | Improved | Improved | — |
| Serious adverse events | 0 | 0 | — |
| Use of additional therapies over 6 mo | Higher | Lower | — |
The trial was underpowered — only 50 of a planned 138 participants enrolled — and the equivalence finding should be interpreted accordingly.[4]
Expert reviews
- JAMA review (Lukacz 2017): OTC vaginal-insert devices such as Impressa "may provide an alternative noninvasive treatment, although comparative data are lacking."[2]
- NEJM review (Wu 2021): Impressa is described as a commercially available option, but "additional comparative effectiveness studies are needed."[1]
- Cochrane overview (Todhunter-Brown 2022): mechanical devices including disposable intravaginal devices are within scope of conservative SUI therapy; certainty of benefit is modest.[3]
Place in the SUI Treatment Algorithm
| Tier | Option |
|---|---|
| First-line | Pelvic floor muscle training (12-mo cure ~58.8%) ± behavioral / lifestyle (weight loss, fluid / caffeine modulation)[2][5] |
| Second-line | Intravaginal continence device — fitted continence pessary, Poise Impressa, or Uresta; or office-based urethral bulking[1][5] |
| Third-line | Surgical intervention — midurethral sling, autologous fascial PVS, Burch colposuspension[1] |
Impressa fits within the conservative tier alongside fitted continence pessaries and PFMT. ACOG positions pessary-class therapy as appropriate for patients who wish to avoid surgery, are not likely to adhere to PFMT, or want immediate situational symptom control.[5]
Comparison with Other Intravaginal Continence Devices
| Device | Reusable | Provider fit needed | OTC | Wear time |
|---|---|---|---|---|
| Poise Impressa | No (single use) | No — patient self-fits | Yes | Up to 8 h |
| Uresta | Yes (up to 12 mo) | Telehealth fit, no in-person exam | Prescription pathway | Daily; reusable |
| Fitted continence pessary (ring/dish with knob) | Yes | Yes — provider fitting | No | Long-term with periodic checks |
The trade-off is access vs ongoing cost: Impressa is the lowest-friction entry option (OTC, no fitting), but the cumulative single-use cost can exceed reusable devices over time.[1]
Limitations
- Single-use cost accumulates with regular use — disadvantageous vs reusable Uresta or fitted continence pessaries for patients with daily SUI.[1]
- No large well-powered RCT specifically against sham or no treatment; the available comparative trial was underpowered.[4]
- Symptomatic, not curative — manages leakage while in place; does not address underlying pelvic-floor or urethral-support pathology.
Key Principles
- Impressa is a single-use, OTC, self-fitted intravaginal continence device for female SUI — sized using a starter kit (sizes 1–3) and worn up to 8 hours per device.[1]
- Best suited for patients with situational or activity-related SUI, those preferring noninvasive options, or those unlikely to adhere to PFMT.[2][5]
- The Nekkanti 2022 RCT showed comparable 4-week treatment success vs fitted continence pessary (75% vs 80%, p = 1.0) but was underpowered (n = 50 of planned 138).[4]
- Position in the SUI ladder is second-line alongside fitted pessaries and bulking — after PFMT, before surgery.[1][5]
- No prescription required lowers the barrier to treatment for patients reluctant to seek care for SUI.[1][2]
- Comparative effectiveness data remain limited — JAMA and NEJM reviews both call for larger trials.[1][2]
- Not for urgency or overflow incontinence; contraindicated in pregnancy, active UTI, neurogenic bladder, urinary retention, and significant pelvic organ prolapse.[4]
References
1. Wu JM. Stress incontinence in women. N Engl J Med. 2021;384(25):2428-2436. doi:10.1056/NEJMcp1914037.
2. Lukacz ES, Santiago-Lastra Y, Albo ME, Brubaker L. Urinary incontinence in women: a review. JAMA. 2017;318(16):1592-1604. doi:10.1001/jama.2017.12137.
3. Todhunter-Brown A, Hazelton C, Campbell P, et al. Conservative interventions for treating urinary incontinence in women: an overview of Cochrane systematic reviews. Cochrane Database Syst Rev. 2022;9:CD012337. doi:10.1002/14651858.CD012337.pub2.
4. Nekkanti S, Wu JM, Hundley AF, et al. A randomized trial comparing continence pessary to continence device (Poise Impressa®) for stress incontinence. Int Urogynecol J. 2022;33(4):861-868. doi:10.1007/s00192-021-04967-9.
5. ACOG Practice Bulletin No. 155: urinary incontinence in women. Obstet Gynecol. 2015;126(5):e66-e81. doi:10.1097/AOG.0000000000001148.