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Bethanechol is a synthetic small molecule and direct-acting muscarinic agonist used primarily to treat postoperative and postpartum nonobstructive urinary retention and neurogenic atony of the bladder with retention. It selectively stimulates muscarinic receptors, especially in the detrusor muscle of the bladder, leading to increased tone and contraction sufficient to initiate micturition and empty the bladder. Bethanechol does not significantly affect nicotinic receptors, nor does it cross the blood-brain barrier due to its quaternary amine structure. It may also be used off-label for gastroesophageal reflux disease (GERD) by increasing gastric motility and lower esophageal sphincter tone[2][4][5][6].
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