The Poise Impressa is a disposable, tampon-like bladder support sold over the counter for stress urinary incontinence. It is not technically a pessary in the traditional sense, though many people search for it that way. Traditional continence pessaries are reusable silicone devices fitted by a healthcare provider, while the Impressa is a single-use intravaginal insert you size and place yourself. Clinical trials suggest both approaches work for the majority of women who try them, though the experience of using each one day to day is quite different.
What the Poise Impressa Actually Is
Stress urinary incontinence happens when physical pressure on the bladder, from a cough, sneeze, laugh, or jump, overwhelms the closure ability of the urethra. The Impressa works by sitting in the vagina and gently pressing against the urethra from behind, providing mechanical support that helps keep it shut during those pressure spikes. You insert it like a tampon using an applicator, wear it for up to eight hours, and then remove and discard it. It comes in three sizes, and the manufacturer recommends a sizing kit so you can figure out which one gives you the best combination of comfort and leak protection.
Traditional continence pessaries work on the same basic principle: they support the urethra from behind the vaginal wall. But they are made of medical-grade silicone, designed to be cleaned and reinserted, and are typically fitted during an office visit. Some are ring-shaped, others are dish-shaped with a knob positioned to press against the urethra. The Impressa simplified this concept into something a person could buy off a drugstore shelf without a prescription or fitting appointment.
How Well It Works
A clinical trial of a disposable vaginal device for stress incontinence found that about 71% of participants experienced either a greater than 50% reduction in daily pad weight gain, a greater than 50% reduction in leakage episodes, or both. The average number of leakage episodes per day dropped from two at baseline to roughly one during treatment, a reduction of about 57%.1PubMed Central. Safety and Efficacy of a Disposable Vaginal Device for Stress Urinary Incontinence – Section: Results Those numbers reflect averages, though, and individual responses varied. About half the participants hit that 50% reduction threshold for leakage episodes, meaning the other half improved less or not at all.
A randomized trial directly comparing the Poise Impressa to a traditional continence pessary found high success rates in both groups: 75% in the Impressa group and 80% in the traditional pessary group, with no statistically significant difference between them. Impressa users showed improvement on quality-of-life questionnaires but were more likely to use additional therapies over the following six months.2PubMed. A randomized trial comparing continence pessary to continence device (Poise Impressa®) for stress incontinence That last detail is worth noting: women using the Impressa seemed more likely to seek out other treatments alongside it, which could mean they found it helpful but incomplete on its own, or simply that its over-the-counter accessibility made them more comfortable exploring options.
One limitation to keep in mind is that most of the published trials on disposable continence devices have been fairly small. The disposable device trial had 48 participants; the head-to-head comparison enrolled 50 women but only 22 made it to the four-week follow-up. These numbers are enough to suggest the product works for many people, but the evidence base is thinner than what exists for, say, pelvic floor muscle training, which has been studied in dozens of large trials.
Sizing and Self-Fitting
One of the main selling points of the Impressa is that you do not need a clinic visit to get started. The sizing kit contains one of each size so you can try them in order, starting with the smallest. You are looking for the size that stops leaks without causing discomfort. If the smallest works, there is no reason to go bigger.
Self-fitting has been studied in the context of newer intravaginal continence devices more broadly. In a randomized trial of a novel self-fitted bladder support, every participant was able to successfully fit the device on their own, meaning there were no “non-fitters” in the study.3PubMed Central. A Randomized Controlled Trial of a Novel Device for Stress Incontinence – Section: Results That is an encouraging finding for the general concept of self-fitted intravaginal supports, though comfort and effectiveness still vary from person to person depending on anatomy and the severity of leakage.
If you find that none of the three Impressa sizes feel right, whether because they slip out, cause pressure, or do not stop leaks, that does not mean intravaginal support cannot work for you. A traditional continence pessary, which comes in a wider range of shapes and sizes and is fitted by a specialist, may be worth trying. The over-the-counter sizing approach trades some precision for convenience.
Side Effects and Vaginal Health
Any device that sits in the vagina introduces the possibility of irritation, discharge, and shifts in the vaginal bacterial environment. With disposable devices like the Impressa, the exposure time is short (up to eight hours per use), which limits some of these risks compared to a traditional pessary that stays in place for weeks or months. But the concerns are not zero.
Research on traditional pessaries has found that bacterial vaginosis, a common vaginal infection characterized by discharge and odor, is more frequent in pessary users. One study found BV in about 32% of pessary users compared to 10% of women not using one, putting the odds of developing BV roughly four times higher with a pessary in place.4PubMed. Bacterial vaginosis increases in pessary users A separate study found BV rates that were higher in pessary users (about 31%) than controls (about 22%), though that difference did not reach statistical significance.5Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics. Can the Pessary Use Modify the Vaginal Microbiological Flora? A Cross-sectional Study The pattern across studies suggests pessary use nudges vaginal flora in an unfavorable direction, though the magnitude of the effect is debated.
A randomized trial tested whether vaginal probiotics could counteract these flora changes in pessary users. The result was disappointing: the vaginal microenvironment looked the same whether or not women used the probiotic at three months.6Urogynecology. The Impact of Vaginal Probiotics on Pessary Use: A Randomized Controlled Trial So the common advice to “just take a probiotic” does not appear to solve the problem, at least based on what has been tested so far.
Most of the BV data comes from studies of traditional pessaries worn continuously, not single-use disposables. Whether an eight-hour disposable device carries the same risk is unclear, but it is reasonable to assume the risk is lower simply because the exposure window is much shorter. If you notice unusual discharge or odor while using the Impressa, it is worth having it checked rather than assuming it is just a side effect you need to tolerate.
Tissue Irritation and Who Is Most Vulnerable
Beyond bacterial shifts, pessaries can cause physical irritation of the vaginal walls: redness, abrasion, and in more serious cases, erosion or ulceration. These problems are grouped under what researchers call vaginal epithelium-related adverse events. After menopause, the vaginal lining thins due to declining estrogen levels, making it more fragile and more susceptible to mechanical pressure from a device. The result is that postmenopausal women are at higher risk for these tissue-related complications.7International Urogynecology Journal. Factors for Vaginal Epithelium-Related Adverse Events in Pessary Users: A Secondary Analysis of a Randomized Controlled Trial
A Cochrane review of pessaries for pelvic organ prolapse (a related but distinct condition) found that pessaries may substantially increase the risk of adverse events compared to pelvic floor muscle training alone. The adverse events included increased vaginal discharge, worsened urinary incontinence, and erosion or irritation of the vaginal walls.8Cochrane Database of Systematic Reviews. Pessaries (mechanical devices) for managing pelvic organ prolapse in women That finding comes from prolapse pessaries, which are generally larger and worn continuously, so the risk profile does not map directly onto a disposable incontinence device. Still, the principle holds: anything sitting against the vaginal wall can cause irritation, and the risk climbs when the tissue is already thin.
The Estrogen Question for Menopausal Users
Given that thin, low-estrogen vaginal tissue is more prone to irritation, a logical question is whether vaginal estrogen cream helps. The answer is surprisingly mixed.
An observational study found that women who used vaginal estrogen alongside their pessary were much less likely to stop using it: about 31% discontinued compared to nearly 59% of those not using estrogen. Estrogen users also had less vaginal discharge. However, estrogen did not appear to protect against erosions or vaginal bleeding.9PubMed Central. Effect of vaginal estrogen on pessary use – Section: Results Those results suggested estrogen was helping, mainly by reducing the discharge that drives many women to give up on their pessary.
Then a large randomized, double-blind, placebo-controlled trial added more nuance. In that study, pessary continuation rates with satisfaction were virtually identical between the estrogen group and the placebo group: about 87% in both. Estrogen cream did not make women more likely to keep using their pessary overall. However, it was associated with less excessive discharge, fewer vaginal erosions or ulcers, and less vaginal bleeding.10BMJ. Effects of intravaginal conjugated oestrogen on pessary continuation for pelvic organ prolapse: multicentre, randomised, double blind, placebo controlled trial In other words, estrogen cream reduced side effects but did not change how many women stuck with the pessary, perhaps because the side effects it reduced were not the ones driving most discontinuations.
For Impressa users specifically, estrogen is less of an issue because the device is not sitting in the vagina for weeks. But if you are postmenopausal and experiencing vaginal dryness or discomfort with any intravaginal device, a conversation with your doctor about topical estrogen may be worthwhile for general vaginal health, even if the evidence for pessary-specific benefit is less clear-cut than it appeared in earlier studies.
How Long People Stick With Pessary Treatment
Dropout rates are high across all types of pessary treatment, and this is one of the least discussed aspects of the option. A study of women using pessaries for stress or mixed urinary incontinence found that of 106 women who took a pessary home, 55 used it for at least six months, but 45 discontinued before that mark, with a median duration of just one month among those who quit early.11PubMed. Vaginal pessaries for the management of stress and mixed urinary incontinence Among those who kept going, the median use was 13 months.
For prolapse pessaries (a related device category), about a third of women discontinued within the first three months. Younger age, prior pelvic surgery, and pessary expulsion or discomfort were the main drivers of early dropout.12PubMed. First-line treatment of pelvic organ prolapse and discontinuation of pessary treatment Among those who did achieve a successful fit and continued, the median time before eventually stopping was about four years, with vaginal erosion being the most common reason for finally giving up.13PubMed Central. Factors associated with unsuccessful pessary fitting and reasons for discontinuation in Korean women with pelvic organ prolapse – Section: Results
These numbers are mostly from traditional, provider-fitted pessaries. The Impressa may have different retention patterns because it demands less medical commitment (no office visits) but more ongoing cost (buying a new one each day you use it). Some women use the Impressa only on specific occasions, during a workout, a social event, or a long meeting, rather than all day every day. That intermittent-use pattern is harder for studies to capture but may reflect how many real-world users actually approach the product.
Cost Compared to Other Options
A cost-utility analysis comparing nonsurgical treatments for stress urinary incontinence found that pelvic floor muscle training was the most cost-effective option. The Impressa came in a close second, followed by a reusable continence device (Uresta), and then a traditional continence pessary.14Urogynecology. A Cost-Utility Analysis of Nonsurgical Treatments for Stress Urinary Incontinence in Women Pelvic floor muscle training is essentially free once you learn the exercises (possibly with a few physical therapy sessions), which gives it a structural cost advantage that no device can easily overcome.
The Impressa’s cost adds up because it is disposable. At retail, a box of roughly 10 devices typically runs somewhere in the range of $10 to $15, meaning daily use could cost $30 to $45 a month. A traditional reusable pessary, by contrast, has a higher upfront cost (the office visit and the device itself, which can run $50 to $150 depending on insurance) but then lasts for months or years. If you use the Impressa daily, a reusable pessary pays for itself within a few months. If you only use it a few times a week for exercise or outings, the math shifts in the Impressa’s favor because the per-use cost stays low and you avoid the overhead of a fitting appointment.
Beyond dollars, there is an environmental angle. The broader category of single-use absorbent hygiene products, which includes pads, liners, and disposable incontinence devices, contributes to landfill waste and is manufactured from fossil-fuel-derived materials.15PubMed Central. Holistically sustainable continence care: A working definition, the case of single-used absorbent hygiene products (AHPs) and the need for ecosystems thinking A reusable pessary or a regular pelvic floor exercise routine does not generate that waste stream. For people who care about the environmental footprint of their health choices, this is one more variable in the decision.
Using Intravaginal Devices During Exercise
One of the most common scenarios people reach for the Impressa is exercise. Running, jumping, high-impact aerobics, and weightlifting can all provoke leakage in women with stress incontinence, and wearing a pad during a workout is uncomfortable and often insufficient. Intravaginal devices offer a mechanical alternative: support the urethra during the activity, then remove it afterward.
Early evidence suggests that intravaginal devices, including both pessaries and even ordinary menstrual tampons, may reduce urine leakage and pad weight gain during individual exercise sessions. A study protocol for a randomized trial is underway comparing a pessary, a tampon, and no intervention over ten weeks of running training in women with exercise-induced incontinence.16PubMed Central. Intravaginal devices for running‐induced urinary incontinence symptoms in females: a study protocol The researchers note that existing studies are too small and inconsistent to draw firm conclusions about effectiveness, which is precisely why the trial is needed. But the plausibility of the approach is strong: if a device physically supports the urethra during a sudden pressure spike like a foot strike, it should reduce leakage during that moment.
For women who leak only during exercise and are otherwise dry, the Impressa can function as an activity-specific tool. You insert it before a run or a gym session, remove it afterward, and do not deal with it the rest of the day. That use case sidesteps many of the concerns about long-term wear, tissue irritation, and daily cost that apply to all-day users. It also means you do not need to commit to pelvic floor rehabilitation as a prerequisite, though strengthening the pelvic floor alongside device use is a reasonable longer-term strategy.
Combining Pessary Use With Pelvic Floor Training
Pessaries and pelvic floor exercises are sometimes framed as competing options, but evidence from the literature supports treating them as complementary. A review of nonsurgical treatment for pelvic floor disorders found that both pessary use and pelvic floor muscle training are effective conservative options, and there is no reason the two cannot be used together.17PubMed Central. Nonsurgical Treatment Options for Women With Pelvic Organ Prolapse In practice, the Impressa or a traditional pessary can provide immediate leak protection while pelvic floor training builds the underlying muscular support over weeks to months.
Think of it like wearing a knee brace while doing physical therapy for a knee injury. The brace handles the immediate functional problem; the exercises address the root cause. Some women find that after several months of consistent pelvic floor training, they no longer need the device, or need it only for the most demanding situations. Others use a combination indefinitely. Neither approach is wrong, and the low-risk profile of both options means combining them introduces no additional safety concerns.
When the Impressa Is Not the Right Fit
The Impressa is designed specifically for stress urinary incontinence, the type triggered by physical exertion, coughing, or sneezing. If your leakage is driven by a sudden, overwhelming urge to urinate (urge incontinence), or if you have a mix of both types, a device that mechanically supports the urethra may address only part of the problem. Urge incontinence involves involuntary bladder contractions, and no intravaginal device can suppress those.
Women with pelvic organ prolapse, where the bladder, uterus, or rectum drops into the vaginal canal, are in a different category entirely. Traditional prolapse pessaries are designed to physically hold organs in place and come in dozens of shapes and sizes to match different anatomies and prolapse stages. The Impressa is not built for that job, and trying to use it for prolapse support would be like using a bandage where you need a splint.
There are also women for whom any intravaginal device is uncomfortable or impractical, including those with certain vaginal conditions, active infections, or simply a strong preference against internal devices. For those individuals, pelvic floor training, absorbent products, or surgical options are the remaining paths. The validation study of one self-fit device found that the residual risks of over-the-counter intravaginal use were acceptable and outweighed by the quality-of-life benefit for the user population studied, but that assessment assumes the user is someone for whom the device is appropriate in the first place.18PubMed. A Self-Selection Validation Study of the Uresta Bladder Support
If you have tried the Impressa sizing kit and none of the sizes work, if you cannot keep the device in place during activity, or if you are leaking through it consistently, talking to a pelvic floor specialist opens up a wider toolkit. Traditional fitted pessaries, biofeedback-assisted muscle training, and newer device designs all exist in the space between “disposable drugstore insert” and “surgery,” and many of them are underutilized simply because people do not know they are options.