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In the past 10 years, numerous medications have been developed that have significantly improved the treatment of urinary incontinence. These medications can eliminate or decrease the loss of urine in some patients who have one or more of the following types of incontinence: urge incontinence, stress incontinence, incontinence secondary to not emptying the bladder, and certain types of incontinence resulting from neurologic conditions. All medications used to treat urge incontinence due to an overactive bladder work by relaxing the bladder muscle and making it less sensitive. Examples of medications in this group are: Tolterodine Detrol ; , Oxybutynin Ditropan ; , Flavozate Urispas ; , Hyoscyamine Levsin, Lesinex, Cystospas ; , Dicylomine Bentyl ; , Propantheline ProBanthine ; and Impramine Tofranil, Elavil ; . There are potential side effects such as dry mouth, blurred vision, constipation and confusion. In the majority of patients, the side effects are minimal and do not result in discontinuation of the drug. For years, medications such as Entex, Sudafed and Ephedrine were used for stress incontinence. Their success was quite low; in addition, there were significant side effects. The most common medication prescribed now for this type of incontinence is Estrogen. This is most effective in postmenopausal women. Estrogen helps keep the urethra healthy by maintaining its blood supply. A healthy, supple urethra is much less likely to contribute to urinary incontinence. In the near future, a new medication Dulozetine ; will be available. This drug causes the sphincter muscle around the urethra to squeeze tighter. The research results on this new medication are very promising. For people who have incontinence because they do not empty their bladder, Flomax, Uroxitrol, Hy6rin and Cardura all cause the sphincter muscle to relax a little and make it easier for the patient's bladder to expel all the urine. Side effects such as dizziness, lethargy, "stuffy" nose and a nagging cough can occur. Certain neurologic conditions, such as multiple sclerosis and spinal cord injuries, can result in incontinence. Recently, the drug Botox has been shown to give significant improvement in some of these patients and aceon.

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The Center for Studying Health System Change, which describes itself as "a nonpartisan policy research organization committed to providing objective and timely research on the nation's changing health system, " reported in August on its most recent site visits to 12 nationally representative communities. What it found everywhere, the Center said, was a building boom and rapid expansion of both inpatient and outpatient capacity, in marked contrast to the mid-1990s, when many hospitals closed beds and shelved modernization projects in the face of declining service utilization, pricing pressures, and the high cost of borrowing. Today, overflowing emergency departments are a visible sign of tight hospital capacity. There is also a terrific amount of competition in health care-- between hospitals and between hospitals and physicians. Diagnosis and surgical services increasingly are being provided in physicians' offices and physician-owned ambulatory centers, and in many communities hospitals view the growth of physician-owned facilities as the most serious competitive threat they face. The Center sees some fallout from all of that competition, with the most obvious effect on costs. "Whether meeting or creating new demand, these capacity expansions are destined to lead to higher rates of care use." There's concern that physicians with an eye to profits in their own offices or facilities will recommend more services than patients really need. The movement of profitable services out of hospitals and into physicians' offices threatens the ability of some hospitals to provide less profitable services and to serve low-income patients. And the bricks-and-mortar expansions, along with increased acquisition of technology, "will increase demand for nurses and technicians already in short supply and whose compensation is being bid up." "The stage is set for growing health care cost and access problems, " the Center said in the August 2005 report. Effects on the Safety Net. Aliment pharmacol ther 2003; 17 suppl 2: 18-22 pubmed 59 feagan bg and fluticasone.

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