Turn on the Instant Pot sauté function and add the olive oil to the pot.
If using pre-cooked sausage, slice it and add it to the Instant Pot. If using raw sausage, remove it from the casings and add it to the pot.
Add the chopped onion and sauté with the sausage until the sausage is browned and the onion is softened. If using uncooked sausage, break it into smaller pieces as it cooks. Press cancel to turn off the sauté function.
Add the bell peppers, water, Italian seasoning, and 1 cup of marinara sauce. Stir, scraping up any bits stuck to the bottom of the pot.
Add the penne pasta on top without stirring. Press it down into an even layer. Pour the remaining marinara sauce evenly over the pasta without stirring.
Close the Instant Pot lid and set the steam release valve to the sealing position. Cook on high pressure for 2 minutes. (This time is for whole wheat penne with a stovetop cook time of 9 minutes for al dente. Adjust as needed for different pasta types.)
The Instant Pot will take about 20 minutes to reach pressure before the cook time begins. Once the cooking time ends, quick release the pressure by carefully moving the steam release valve to the venting position. When the steam has fully escaped and the pin drops, open the lid. There may be a little extra liquid, but it will absorb as the pasta rests.
Stir the pasta, then mix in the spinach, followed by the shredded mozzarella. Serve warm.