Nausea and vomiting
At a Glance
Nausea is a sensation of uneasiness in the stomach that often accompanies the urge to vomit, while vomiting is the forceful expulsion of stomach contents through the mouth, both serving as protective reflexes or symptoms of underlying issues.
These symptoms are extremely common and affect individuals of all ages, from infants and young children to adults and the elderly.
Nausea and vomiting are typically acute and temporary symptoms, though they can become chronic depending on the underlying cause and are generally manageable.
The outlook is usually excellent as most cases resolve quickly with home care or treatment of the root cause, although chronic cases can significantly impact daily quality of life.
How It Affects You
Nausea and vomiting affect the body by disrupting the normal function of the digestive system and triggering forceful muscle contractions. Nausea creates a sensation of uneasiness in the stomach or throat, while vomiting involves the coordinated contraction of the abdominal muscles and diaphragm to expel stomach contents through the mouth. Prolonged or severe episodes can impact overall health in several ways:
- Rapid depletion of body fluids and essential salts, leading to dehydration.
- Physical strain on the abdominal muscles and potential damage to the lining of the esophagus.
- Inability to retain food or medication, hindering nutrition and treatment of other conditions.
Causes and Risk Factors
Causes of Nausea and Vomiting
Nausea and vomiting are symptoms rather than specific diseases, and they can be triggered by a wide range of conditions affecting the digestive tract, brain, or other body systems. Common infectious causes include viral gastroenteritis, often called the stomach flu, and food poisoning caused by bacteria or parasites. Physical triggers include motion sickness, inner ear disorders like labyrinthitis, and obstructions in the intestine. For many women, pregnancy is a primary cause, particularly in the form of morning sickness during the first trimester. Other frequent causes include migraines, severe pain, emotional stress, and the ingestion of toxins or excessive alcohol. Medical treatments are also common culprits; general anesthesia, chemotherapy, and radiation therapy frequently trigger these symptoms, as do certain prescription medications like opioids and antibiotics.
Risk Factors and Triggers
Several factors increase the likelihood of experiencing these symptoms. Age and biological sex influence susceptibility; children are more prone to viral infections and motion sickness, while women are more likely to experience nausea due to hormonal changes in pregnancy. A history of motion sickness or migraines is a known risk factor for developing nausea after surgery. Environmental triggers can include strong odors, disturbing sights, extreme heat, or riding in a moving vehicle. Psychological factors such as intense anxiety or fear can also activate the vomiting center in the brain.
Prevention Strategies
Primary prevention focuses on hygiene and avoiding known triggers. Washing hands frequently is the most effective way to prevent the spread of viruses that cause stomach flu. Practicing food safety by cooking meats thoroughly and refrigerating food promptly helps prevent food poisoning. To reduce motion sickness, individuals can sit in the front seat of a car or look at a stable horizon. When nausea is related to medication, taking the drug with food may help, provided it is not contraindicated. While not all causes can be prevented, staying hydrated and managing stress can help reduce the frequency and severity of episodes.
Diagnosis, Signs, and Symptoms
Signs and Symptoms
The primary symptoms are the subjective feeling of sickness in the stomach, known as nausea, and the involuntary, forceful expulsion of stomach contents, known as vomiting. These are often preceded or accompanied by autonomic nervous system responses such as increased saliva production, sweating, pale skin, and a rapid heartbeat. Some individuals experience dry heaves, or retching, where the muscles contract as if to vomit but nothing is expelled. If vomiting persists, signs of dehydration may develop, including dry mouth, extreme thirst, decreased urination, dark urine, and dizziness when standing.
Diagnosis and Exams
Clinicians typically identify the cause of nausea and vomiting through a medical history and physical examination. They will ask about the onset and duration of symptoms, recent dietary choices, and any accompanying pain or fever. The physical exam often focuses on the abdomen to check for tenderness, swelling, or masses, and an assessment of hydration status. If the cause is not immediately clear or if symptoms are severe, diagnostic tests may be ordered. These can include blood tests to check for infection and electrolyte imbalances, and a urinalysis to assess dehydration. In women of childbearing age, a pregnancy test is standard. For suspected structural problems, imaging tests like an abdominal ultrasound, X-ray, or CT scan may be used to identify obstructions or other abnormalities. The differential diagnosis is broad, distinguishing between common issues like viral infections and serious conditions such as appendicitis, meningitis, or bowel obstruction.
Treatment and Management
Medical Treatments
Treatment strategies focus on addressing the underlying cause of the nausea and vomiting while managing the symptoms to prevent complications. Medications called antiemetics are commonly used to suppress the urge to vomit and are particularly effective for motion sickness, post-surgical nausea, and side effects of chemotherapy. If the cause is a bacterial infection, antibiotics may be prescribed, although they are not used for viral gastroenteritis. In cases of severe dehydration where the patient cannot keep liquids down, intravenous (IV) fluids may be administered in a clinic or hospital to rapidly restore water and electrolytes.
Lifestyle and Self-Care
For many cases, home management is sufficient to aid recovery. It is often recommended to stop eating solid foods for a few hours to let the stomach rest. Hydration is the most critical step; individuals should take small, frequent sips of clear liquids such as water, broth, or electrolyte replacement solutions. As the stomach settles, bland foods can be gradually reintroduced, such as crackers, toast, rice, or bananas, while avoiding dairy, caffeine, alcohol, and spicy or fatty foods. Rest is also important, as activity can worsen symptoms.
When to Seek Medical Care
While most episodes resolve on their own, professional care is necessary in certain situations. Red-flag symptoms that require immediate attention include vomit that contains blood or looks like coffee grounds, severe abdominal pain, a stiff neck, or confusion. Medical advice should be sought if vomiting lasts longer than two days in adults or 24 hours in children, or if there are signs of severe dehydration such as sunken eyes or a lack of tears in crying children. Routine follow-up may be needed for chronic conditions to adjust treatment plans.
Severity and Prognosis
Severity and Disease Course
Nausea and vomiting can range from mild, short-lived annoyances to severe, debilitating conditions. Acute cases, such as those caused by a virus or food poisoning, typically follow a short course, resolving within 24 to 48 hours. Chronic nausea can persist for weeks or months, often fluctuating in intensity, and is associated with conditions like gastroparesis or cyclic vomiting syndrome. The severity is often judged by the patient's ability to retain fluids and maintain daily activities.
Prognosis and Complications
The prognosis is generally favorable, with most individuals making a full recovery once the precipitating factor is resolved. However, persistent or uncontrolled vomiting can lead to complications. The most significant short-term risk is dehydration and electrolyte imbalance, which can affect heart and muscle function. Repeated vomiting can damage the esophagus, causing tears known as Mallory-Weiss tears, or erode tooth enamel due to stomach acid. In rare cases, aspiration of vomit into the lungs can occur, leading to pneumonia. Early treatment and proper hydration significantly reduce the risk of these complications and improve the overall outcome.
Impact on Daily Life
Impact on Daily Activities
Nausea and vomiting can be highly disruptive to daily life, often requiring time off from work or school. The fear of vomiting in public can lead to social anxiety and avoidance of travel or social gatherings. For those with chronic nausea, the constant sensation of sickness can suppress appetite, leading to weight loss and nutritional deficiencies, as well as fatigue that hinders physical activity. The unpredictability of the symptoms can make planning daily tasks difficult and stressful.
Coping Strategies
Managing life with these symptoms involves practical planning and adaptation. Eating smaller, more frequent meals rather than three large ones can help keep the stomach settled. Keeping a diary of symptoms can help identify and avoid specific food or environmental triggers. carrying a "survival kit" with water, mints, and a bag can provide peace of mind when leaving the house. Relaxation techniques, such as deep breathing exercises or meditation, can also help reduce the stress that often exacerbates nausea.
Questions to Ask Your Healthcare Provider
Patients can better manage their condition by asking specific questions during their appointments.
- What is the specific cause of my nausea and vomiting?
- Are there over-the-counter medications that are safe for me to take?
- What signs of dehydration should I watch for in myself or my child?
- Are my current prescription medications contributing to these symptoms?
- When can I return to my normal diet and activities?
- At what point should I go to the emergency room?
Common Questions and Answers
Q: Is it better to vomit or try to hold it in?
A: If the urge to vomit is strong, especially due to a stomach virus or food poisoning, it is usually better to let the body expel the contents to remove toxins. However, for motion sickness or medication side effects, trying to settle the stomach with rest and medication is appropriate.
Q: Can anxiety or stress cause vomiting?
A: Yes, intense emotional stress or anxiety can trigger the release of neurotransmitters that stimulate the vomiting center in the brain, leading to nausea and potential vomiting.
Q: How long does the stomach flu usually last?
A: Viral gastroenteritis, or the stomach flu, typically lasts for one to three days, though some symptoms like fatigue or mild nausea can linger slightly longer.
Q: Why do I feel nauseous but cannot vomit?
A: Nausea is a sensation generated by the brain that does not always reach the threshold to trigger the physical vomiting reflex. This is common in migraines, early pregnancy, or cases of mild irritation.
Q: Are ginger ale and crackers actually helpful?
A: Yes, ginger has natural anti-nausea properties, and bland, starchy foods like crackers are easy to digest and can help absorb stomach acid, making them effective home remedies for many people.