Which class of medication is most commonly associated with urinary retention in older men with Benign Prostatic Hyperplasia (BPH)?

Anticholinergics are known to cause urinary retention, particularly in older men with Benign Prostatic Hyperplasia (BPH). This is due to their mechanism of action, which blocks the action of acetylcholine, a neurotransmitter that promotes bladder contraction and facilitates urination. In men with BPH, the prostate enlarges, leading to obstruction of the urinary flow, so any medication that further decreases bladder tone or inhibits bladder contraction can exacerbate urinary retention.

In older men who already have compromised urinary flow due to prostate enlargement, the use of anticholinergics can significantly increase the risk of urinary retention, making this class of medication particularly concerning in this population. Other medication classes, such as beta-blockers and diuretics, have different primary effects and are less directly associated with this specific side effect. Alpha-blockers are often used as treatment for BPH because they relax smooth muscle in the prostate and bladder neck, improving urinary flow rather than causing retention.