Vomiting

Vomiting is a forceful expulsion of your stomach’s contents through your mouth. While often uncomfortable and distressing, it’s usually your body’s way of protecting itself by removing harmful substances. Understanding what causes vomiting and how to manage it can help you feel better faster.

Table of contents

• What is vomiting?
• Common causes of vomiting
• Related symptoms
• When to seek medical help
• Possible complications
• Treatment and management
• Home care and self-care measures
• Prevention strategies

What is vomiting?

Vomiting, also known as emesis or throwing up, is the forceful expulsion of the contents of your stomach through your mouth. It happens when muscles in your belly, chest, neck, and head work together to push whatever is in your stomach upward through your esophagus (the tube connecting your mouth to your stomach) and out of your mouth^[1][2].

Vomiting is not a disease or condition itself. Rather, it is a symptom of many different illnesses and situations. It often works as a protective reflex that helps your body get rid of harmful substances such as viruses, bacteria, toxins, or foods that your body cannot tolerate^[3][11].

Vomiting is different from spitting up, which is common in babies and involves the easy, non-forceful flow of milk or food from the stomach. It is also different from regurgitation, which is the non-forceful expulsion of stomach contents into the esophagus without the strong muscle contractions involved in vomiting^[5][8].

The process of vomiting typically happens in three steps. First comes nausea, which is the unpleasant feeling of being sick to your stomach or needing to throw up. Nausea often precedes vomiting but does not always lead to it. Second is retching, also called dry heaving, which involves some of the movements of vomiting but without actually bringing anything up. Finally comes the actual vomiting, where stomach contents are forcefully expelled^[8][13].

Common causes of vomiting

Vomiting can be caused by many different conditions and situations. It can be short-term (acute) or long-lasting (chronic). Acute vomiting typically lasts up to 7 days, while chronic vomiting continues for 4 weeks or longer^[3][11].

The most common causes of sudden, short-term vomiting include gastroenteritis (stomach flu or stomach bug), which is an infection of the digestive tract often caused by viruses such as norovirus or rotavirus. Bacteria such as Salmonella, Shigella, or Campylobacter can also cause gastroenteritis. Food poisoning is another frequent cause, occurring when bacteria release toxins into improperly stored food^[1][3].

Other common causes of vomiting include:

• Motion sickness or vertigo (a spinning sensation)
• Pregnancy-related morning sickness
• Medication side effects, including chemotherapy drugs
• Drinking too much alcohol
• Migraine headaches
• Severe pain, such as from appendicitis
• Effects after surgery or anesthesia
• Stress and anxiety
• Poisoning from swallowing toxic substances

Less common but more serious causes include blockages in the digestive tract (gastrointestinal obstruction), increased pressure on the brain from injuries or swelling, inflammation of organs such as the pancreas or gallbladder, peptic ulcers, delayed stomach emptying (gastroparesis), and certain chronic conditions such as cyclic vomiting syndrome^[1][4][7].

Cyclic vomiting syndrome is a condition characterized by repeated episodes of vomiting that can last up to 10 days. It usually affects children between the ages of 3 and 7, occurring in approximately 3 out of every 100,000 children. The condition is typically coupled with nausea and extreme lack of energy^[1].

Related symptoms

When you vomit, your abdominal muscles undergo strong contractions to force stomach contents upward. Vomiting can sometimes be forceful, with projectile vomiting sending stomach contents more than a meter away^[11][17].

Several symptoms commonly accompany vomiting:

• Nausea—the unpleasant sensation that you are about to vomit. Once you have vomited, the feeling of nausea may ease or go away completely
• Mouthwatering or increased saliva production before vomiting
• Abdominal pain or stomach cramps
• Diarrhea, especially when vomiting is caused by gastroenteritis
• Fever
• Tiredness and weakness
• Cold sweats and paleness
• Dizziness or lightheadedness

The appearance and content of vomit can provide clues about its cause. Vomit containing recognizable food that comes up several hours after eating may indicate problems with stomach emptying or obstruction. Bile-stained vomit (greenish-yellow in color) can indicate issues with the small intestine or complications after stomach surgery. Blood in the vomit, which may appear red or look like coffee grounds, usually indicates bleeding from the upper digestive tract and requires immediate medical attention^[1][8].

When to seek medical help

While many cases of vomiting resolve on their own, certain situations require immediate medical attention. You should seek emergency care by calling emergency services or going to the nearest emergency room if you experience:

• More than a small amount of blood in the vomit
• Severe headache or stiff neck
• Confusion or decreased alertness
• Rapid breathing or pulse
• Chest pain
• Severe abdominal pain or cramping
• Blurred vision
• High fever and stiff neck
• Vomit that has a fecal odor or contains fecal material

You should contact your healthcare provider promptly if you:

• Have been vomiting for more than one day (adults) or 24 hours (children over age 6), or a few hours (infants and young children)
• Suspect food poisoning
• Show signs of dehydration, such as extreme thirst, dry mouth, infrequent urination, dark-colored urine, weakness, or dizziness upon standing
• Cannot keep any liquids down
• Have a small amount of blood in the vomit
• Have severe belly pain
• Have vomiting with fever above 101°F (38°C)
• Have vomiting with diarrhea
• Experience unexplained weight loss along with ongoing vomiting

For infants and young children, parents should seek medical help if the child shows signs of dehydration, such as dry mouth, sunken eyes, decreased urination, no tears when crying, or sunken soft spots in babies. In boys, swelling, redness, or pain in the scrotum is also a reason to contact a doctor. Newborns who have forceful vomiting should be evaluated promptly^[4][5][7].

Possible complications

The most common complication of vomiting is dehydration, which occurs when your body loses more water than it takes in. Prolonged and excessive vomiting depletes the body of fluids and can alter the balance of important minerals and salts called electrolytes. Dehydration can be particularly dangerous for infants, young children, and older adults, and can become life-threatening if left untreated^[1][2].

Other potential complications include:

• Aspiration—when stomach contents enter the respiratory tract during vomiting. This can cause choking, difficulty breathing, or aspiration pneumonia (a lung infection). The risk is higher in people who are under the influence of alcohol or sedatives, or who are unconscious or lightly anesthetized
• Mallory-Weiss tear—a tear in the lining of the esophagus caused by forceful vomiting, which can result in bleeding
• Tooth enamel damage from repeated exposure to stomach acid
• Esophagitis—inflammation of the esophagus
• Malnutrition and unexpected weight loss when vomiting is chronic

Cyclic vomiting syndrome, when left untreated, can lead to serious complications including severe dehydration, tooth decay from stomach acid, esophagitis, and tears in the esophagus^[1][2][13].

Treatment and management

Treatment for vomiting depends on the underlying cause. In many cases, especially when vomiting is caused by a viral illness or minor food-related issue, the condition will resolve on its own without specific medical treatment. However, management focuses on preventing complications and relieving symptoms^[3][4].

Your healthcare provider may recommend antiemetic medications (medicines that prevent or reduce nausea and vomiting). These are available both over-the-counter and by prescription. Over-the-counter options include:

• Dimenhydrinate (Dramamine)
• Meclizine (Bonine, Antivert)
• Scopolamine patches (Transderm Scop)
• Bismuth subsalicylate (pink bismuth)

Prescription medications that may be used include:

• Ondansetron (Zofran)
• Promethazine (Phenergan)
• Doxylamine succinate (Diclegis, Bonjesta) for pregnancy-related nausea

Antiemetic medicines usually start working 30 to 60 minutes after you take them. For some situations, such as after chemotherapy, your doctor may recommend taking these medicines regularly on a schedule rather than waiting until you feel sick^[10][12].

If vomiting is severe or persistent, you may need additional treatments such as:

• Intravenous (IV) fluids—fluids given through a vein to treat dehydration when you cannot keep liquids down
• Oral rehydration solutions—special drinks containing the right balance of salts and sugars to replace what your body has lost
• Tube feeding—delivering liquid nutrition directly to your stomach through a special tube if you cannot eat by mouth
• Treatment of the underlying condition causing the vomiting

Non-medication approaches that may help include relaxation techniques such as deep breathing, guided imagery, meditation, hypnosis, and listening to music. Aromatherapy using peppermint oil has been shown to reduce the frequency and severity of nausea in some studies. You can inhale peppermint oil, rub it on your skin (after diluting it), or place a small amount on a cold cloth and put it on your head^[15][16].

Home care and self-care measures

Many simple strategies can help you feel better when you are vomiting or feeling nauseated:

Fluid replacement: After vomiting stops, it is important to replace lost fluids. Start by taking small sips of clear liquids such as water, diluted juice, clear broth, flat ginger ale or lemon-lime soda (leave the can or bottle open to get rid of carbonation), sports drinks, ice chips, or popsicles. Sip drinks slowly and avoid drinking large amounts at once. Take whatever you feel you can tolerate. Cold liquids often work better than warm ones^[4][15].

What to eat: Once you can keep liquids down without vomiting for several hours (typically 3 to 8 hours), you can gradually start eating small amounts of bland, easy-to-digest foods. Good options include:

• Crackers, especially saltine crackers
• Plain toast or bread
• Rice
• Bananas
• Applesauce
• Plain pasta or noodles
• Plain potatoes
• Gelatin or Jell-O
• Plain yogurt
• Dry cereal

Start with 6 to 8 small meals throughout the day instead of 3 large ones. Eat slowly and stop if nausea returns^[4][20].

What to avoid:

• Greasy, fried, or fatty foods
• Spicy foods
• Foods with strong smells
• Very sweet foods
• Dairy products if they make you feel worse
• Caffeine and alcohol
• Carbonated drinks (unless flat)

Other helpful tips:

• Rest quietly. Too much activity can make nausea worse
• Sit up after eating. Do not lie flat for at least two hours after meals
• Get fresh air by opening a window or going outside
• Avoid strong odors from cooking, perfume, or smoke
• Wear loose, comfortable clothing
• Rinse your mouth with water or a mixture of baking soda, salt, and warm water after vomiting to remove the bad taste
• Try sucking on hard candies or eating sour foods like pickles or lemons
• Watch a movie or listen to music to distract yourself
• If pregnant, try eating crackers before getting out of bed in the morning

Some people find that ginger helps reduce nausea. You can try ginger tea, ginger ale, ginger candies, or other forms of ginger^[7][15][18].

Prevention strategies

While not all cases of vomiting can be prevented, several strategies may help reduce your risk:

To prevent infections that cause vomiting:

• Wash your hands thoroughly and often, especially before eating or preparing food and after using the bathroom
• Avoid close contact with people who have stomach flu or food poisoning
• Store and prepare food safely to prevent food poisoning
• Drink clean, safe water

To prevent motion sickness:

• Take motion sickness medication before traveling if you are prone to motion sickness
• Sit in the front seat of cars or in the middle of boats where motion is less noticeable
• Look at the horizon or a fixed point in the distance
• Get fresh air when possible
• Avoid reading or looking at screens while in motion

To prevent medication-related vomiting:

• Take medications with food when possible (check with your doctor first, as some medicines must be taken on an empty stomach)
• Ask your doctor about antiemetic medications if you will be receiving chemotherapy or other treatments known to cause vomiting

General prevention measures:

• Avoid eating large meals. Eat smaller, more frequent meals instead
• Limit alcohol consumption
• Identify and avoid foods or situations that trigger nausea for you
• Manage stress through relaxation techniques
• Stay hydrated throughout the day

If you have a chronic condition that causes vomiting, work closely with your healthcare provider to manage that condition effectively. This may help reduce episodes of vomiting^[3][11].