Nausea and vomiting
What goes down might come up
Nausea and vomiting are usually symptoms of some other sickness or disorder. They do not always happen together but often do.
In most cases, the reason for the nausea, vomiting, or both is fairly apparent seasickness or exposure to an extremely unpleasant odor. But nausea or vomiting can also signal gastroenteritis or stomach flu, food poisoning, pregnancy, overindulgence in alcohol, or a serious disease. Also, if you have other symptoms such as fever and dizziness, they may indicate a more serious condition, and you should call your doctor.
There are many effective treatments for both nausea and vomiting, but the underlying cause is the most important factor in choosing the right treatment.
The list of causes of nausea and vomiting is endless. A certain odor can make one person vomit while it might not affect another person at all. Drugs for the treatment of other conditions, such as cancer, can cause nausea and vomiting. People with migraines can go through rounds of vomiting. Common infections or equilibrium disturbance, such as motion sickness or vertigo, can also be a cause. Pregnancy often brings on periods of nausea and vomiting, otherwise known as "morning sickness."
The body functions that control the motion-sickness type of nausea and vomiting originate in a part of the inner ear called the semicircular canal. It communicates through a system of nerves to the brain stem, where the vomiting reflex launches into motion. As most of us know, motion sickness can happen to people of all ages; however, it is more common in children under age 7.
The common "stomach flu" is the most frequent cause of nausea and vomiting. If severe pain, high fever, swelling, or dizziness accompanies a bout of nausea, vomiting, or both, your doctor may recommend blood and urine tests. Also, if there is a possibility that a more serious disorder, such as gallbladder problems, pancreatitis, hepatitis, ulcer, or tumor, is the cause, then other scanning and/or imaging studies may be in order.
No one wants to spend his or her day suffering from nausea or vomiting. In some cases, you can prevent both, as in the case of overindulgence in alcohol or food. Knowing your limits in this area can help you avoid the "day after."
Goals of Treatment
The goal of treatment is to reduce any discomfort due to nausea and vomiting, prevent dehydration, and identify and treat any underlying causes.
You can avoid much of the nausea and/or vomiting associated with motion sickness by taking a few precautions and using common sense.
Motion sickness treatments
- Focus on a stationary object on the horizon
- Sit in the front seat of a car, the middle of a boat, or over the wing in an airplane
- Make sure you are breathing fresh air
- Try preventive medications if you know you'll get sick
In the case of nausea and/or vomiting due to overindulgence of food or alcohol, there are more than a few treatments, but the only certain way to completely avoid nausea and/or vomiting is to not overindulge.
Treatments for vomiting, in general, include those for vomiting due to overindulgence
- Avoid solid foods, milk, coffee, and citrus juices
- Consume small amounts of beverages, such as flat ginger ale or cola, diluted non-citrus fruit juices, bouillon, water or crushed ice, and fluid-replacement drinks
- Eat small, frequent meals throughout the day
- Snack on starchy or bland, filling foods before bedtime
- Keep non-spicy crackers to eat before rising in the morning
- Rehydrate your body with water
Some things to keep in mind as the vomiting subsides and you start to feel better:
- Begin to eat only bland, non-oily, non-fatty foods
- Continue to stay away from citrus fruits and juices and coffee until you have fully recovered
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Considerations for Women
Many women will experience nausea and vomiting associated with pregnancy. Commonly called morning sickness, it can actually happen at any time of the day. Symptoms appear early in the pregnancy and usually disappear by the third month. If you have these symptoms, you may want to try the following:
- Eat small, frequent meals throughout the day
- Snack on starchy or bland, filling foods before bedtime
- Keep non-spicy crackers by your bed to eat before rising in the morning
- Hydrate your body with water
Self care & Prevention
Preventing Nausea and Vomiting
To prevent nausea and vomiting, avoid overindulging in food or drink, particularly alcohol.
Stomach flu is very common. Wash your hands, teach your children to do the same, and avoid infected people. Scrupulous hygiene can prevent the spread of infection.
It also helps to learn how to prevent food poisoning, a very unpleasant condition that you can often avoid through proper food preparation and a little bit of precaution. Here are two common types of food poisoning and how to prevent them:
- Salmonella. Salmonella bacteria can survive freezing but not thorough cooking. Salmonella infection usually results in diarrhea, sometimes fever, and only occasionally vomiting. Keep the cooking area sanitary and thoroughly cook all foods. Thoroughly wash your hands before and after handling raw foods to ensure that bacteria do not get passed on. A salmonella infection, when properly treated, can usually be cured within 48 hours. However, it occasionally takes longer.
- Botulism. Food poisoning from botulism is a more serious problem requiring immediate medical attention, but it is uncommon. Botulism is differentiated from salmonella by several symptoms: It is more likely to cause vomiting than salmonella poisoning and less likely to cause fever. Botulism also causes a dry mouth, weakness of arms and legs, and blurred or double vision. But, as is evident in salmonella infections, contaminated or poorly cooked canned foods most often cause botulism. While it is most likely to be home-canned foods that are infected, it occasionally happens with commercially canned foods that are undercooked. Infants under 1 year of age are still developing their gastrointestinal systems, and some uncooked foods, such as raw honey, can cause botulism.
Additional guidelines to help avoid food poisoning:
- If a can is bulging, do not eat the contents
- Do not give infants honey in food, or cough medicine containing honey
- If you have any reason to think that a food has not been properly prepared, do not eat it
- Avoid consuming foods or drinks that may be spoiled or contaminated note expiration dates, look for molds or other signs of rotting, label leftovers with the date, and throw out foods that have been sitting around too long
- Be careful in handling raw meat or eggs these foods may contain infectious bacteria
- Always wash your hands after using the bathroom and before cooking or eating
The following techniques will help with motion sickness:
- Take an over-the-counter motion sickness remedy before going on a trip involving train or boat travel. This will help stop the nausea before it starts.
- Look at distant objects. If you're having motion sickness, look at faraway objects such as the horizon or distant mountains or buildings. Looking at something distant and stationary coaxes the mind's balance center into believing you're not moving either. Avoid focusing on rolling ocean waves, a pitching horizon, or the buildings, trees, and fields that flash by. In cars, prop up queasy infants and children in car seats so they can see easily out the windows.
- Stay in the center of the boat. For seasickness, stay midway between the bow and stern of the boat, the place that rocks the least. Sitting in the front seat of a car or over the wing of an airplane has the same effect on those varieties of motion sickness.
When to Call the Doctor
Nausea and vomiting are usually not causes for you to worry, and in most cases, will soon resolve on their own. Occasionally, these symptoms can be signs of a more serious disorder or disease.
Last updated 25 May 2012
Possible Underlying Causes
Nausea and vomiting may be unpleasant, but in many instances, these symptoms actually serve practical purposes. Whenever something irritates your digestive tract, your body sends a message to the vomit center of your brain, located in a region called the brain stem. Your brain stem is the part of your brain that regulates involuntary bodily functions. If you smell an unpleasant odor or if something you eat disagrees with you, your brain stem sends your body a signal to avoid the offending substance.
In this way, nausea can serve the critical purpose of protecting you from eating contaminated or spoiled food, or from overindulging in food or alcohol. If you have already eaten spoiled food, or if you ate or drank too much, your body may reject the offending substance. When this happens, your brain stem tells the muscles controlling your esophageal sphincter to relax and cause the muscles of your abdomen, diaphragm, and stomach to contract. The result is vomiting.
Motion sickness can also cause nausea and vomiting. For most people, motion sickness is a normal response to the up-and-down, side-to-side, or generally irregular movements in a car, train, boat, plane, or amusement park ride. An imbalance of the fluid in the inner ear's semicircular canals is the cause. When the fluid level shifts because of this motion, your inner ear sends signals to the vomit center. Once the motion sickness has made your body do what it had to do (vomit), and your motion center grows accustomed to the new movement, your recovery is most often as quick as the original onset. Your inner ear is back to normal fluid levels, your nausea has passed, and your vomit center has quieted.
Nausea and vomiting sometimes happen without your ingesting food, smelling unpleasant odors, or being in a moving vehicle. If you feel nausea or vomit for reasons that are not readily apparent, some other factor may be irritating your digestive tract or stimulating your brain stem to react. A variety of illnesses and disorders can cause nausea and vomiting. Therefore, your doctor should perform a thorough examination and take your medical history, if you have these symptoms for unknown reasons, or if they are accompanied by fever, pain, dizziness, or unusual swelling.
Triggers of Nausea and Vomiting
The following factors may trigger nausea or vomiting:
- Consuming contaminated food or drinks (food poisoning)
- Smelling offensive odors
- Overindulging in food or alcohol
- Motion from a car, boat, plane, roller coaster, or other moving vehicle
- An underlying illness or disorder
- Viral infection, such as "stomach flu"
Drugs That Can Cause or Aggravate Nausea and Vomiting
Nausea and vomiting can be side effects of many drugs, from antihypertensive agents to antidepressants to antibiotics. The possibility and frequency of developing nausea and vomiting from the use of a drug depends on your individual sensitivity to it. Based on your past medical history and drug sensitivities, your doctor can prescribe medications that you will be least sensitive to. If you develop nausea and vomiting or other sensitivity reactions to a drug, call your doctor so that he or she may consider an alternative.
Diagnosing the Underlying Cause
In some cases, nausea and vomiting happen for reasons that are not readily apparent. The following conditions may be the underlying causes of nausea and vomiting:
- Infection in the digestive tract
- Migraine headache
- Gallbladder disease
- Pancreatitis (inflammation of the pancreas)
- Peptic ulcer disease
- Some drugs, like chemotherapy medications and tricyclic antidepressants
- Heart attack or other cardiac disorder
- Psychological stress or anxiety
- Disorders of pregnancy, like preeclampsia or ectopic pregnancy
- General anesthesia
- Head injury, stroke, meningitis
Your doctor will want to know all of your symptoms, including their onset and duration. He or she may also perform a physical exam. Your doctor will touch and visually inspect your abdomen, and may order blood, urine, and stool tests. X-rays and ultrasound imaging tests might also be requested.