Sea sickness pills cause a medical emergency! :huh:

An OCC boat left Denmark this summer bound for Inverness and the Caledonian Canal. Strong westerlies had stirred the North Sea making for a lumpy passage so out came the sea sickness pills. One of the crew, a man in his early 60 's succumbed quite quickly and retreated to his berth. Only later did it emerge that this guest crew was taking a drug called alfuzosin to control his prostate symptoms. Within 24 hours he found that he could no longer pass urine and was becoming increasingly uncomfortable.

As his distress increased the skipper tried to contact any Coastguard for advice on the ship 's VHF but was unable to raise anyone. Eventually a passing helicopter picked up their call and relayed it to Aberdeen who recommended the yacht divert to there where they would be met by an ambulance. By now the crewman was in acute urinary retention and extreme discomfort. As this had been a relatively short passage the yacht was not equipped with urinary catheters and strong painkillers so there was no option but to forge ahead as fast as possible.

The story ended happily. The poor guy was transferred to hospital where the insertion of a catheter gave instant relief. He was treated for urine infection but has not been back on a boat since!

So a few questions for discussion.
Is everyone aware that most sea sickness remedies (including patches) have, what are called, parasympathetic side effects? This means they can cause a worsening of certain conditions such as urinary retention and glaucoma. Men with pre-existing prostate problems should be wary as they may tip the balance and result in acute urinary retention.
My guess is that most boats on passages of less than 500 miles would not routinely carry the equipment and skills required to catheterise a man. Should they do so if they have male crew on board above the age of 55?
My guess is this man got into trouble because he had a mixture of infection and parasympathetic drug side effects conspiring together to exacerbate his already precarious prostate. Do we all carry antibiotics and if so which ones?
If you are someone susceptible to urinary retention which sea sickness remedies should you use and which should you avoid?

Many, if not all - motion sickness medication have antimuscurinic (anticholinergic) side effects, which could include effects such as blurred vision, difficulty in micturition, dysuria, dryness of mouth, constipation etc. These effects occur because of a relaxing effect of the active drug on the bladder muscle (Similar drugs are used in case of 'overactive ' bladder - having to go frequently and not making it in time - for exactly that effect). Some drugs are more prone to causing these effects and some people are more prone to develop side effects.

People with uncorrected narrow angle glaucoma should be extremely careful since anticholinergic effects could potentially cause a spike in eyeball pressure.

Suddenly taking larger doses, such as when weather deteriorates quickly, might also increase the likelihood of problems, in contrast to when the medication is gradually started. Transdermal anti-seasickness patches have the same side effect profile. Many other drugs also have similar side effects.

In contrast, Alfuzosin is supposed to do the opposite - namely relax the bladder opening (in contrast to the bladder muscle) to make urination easier. It is used for prostate hypertrophy (increased prostate size) and is unlikely to be the cause here. More likely this gentleman was balanced on the edge, with the Alfuzosin allowing him to continue voiding, and then the antimuscurinic effects of his motion sickness medication pushed him over the edge.

In the 2010 Vic-Maui yacht race return trip (Maui to Victoria, BC ), the same thing happened and the victim - also a gentleman of the same general age - had to be taken off the yacht by a cargo ship, for the exact same reason.

Urinary catheters are very easy to insert and minimal training is required. It is definitely worth having on board. It could change a very painful and potentially serious (bladder rupture) ordeal into a five minute procedure with very little risk.

Magnus Murphy
Assistant Professor
University of Calgary
Division of Urogynecology