Answering common questions about vomit

No one likes to think about throwing up, but it happens to just about everyone.

People often use the terms nausea, vomiting, retching and dry heaving interchangeably. They actually describe different phases or severities of vomiting, though, and they’re a little subjective.

I see many patients with gastroparesis (a disorder in which the stomach doesn’t empty food quickly enough), cyclic vomiting syndrome and cannabinoid hyperemesis syndrome in my outpatient practice, so I encounter symptoms of nausea and vomiting on a weekly basis.

Here, I answer common questions about tossing your cookies:

What are nausea, vomiting, retching, dry heaving and rumination?

• Nausea is the feeling of discomfort or unease in the stomach that often happens before vomiting. It’s a sensation that you might feel like you’re about to throw up, but it doesn't always lead to vomiting.
• Vomiting is the forceful expulsion of stomach contents through the mouth. It’s a physical act, typically triggered by nausea.
• Retching refers to the involuntary, spasmodic movement of the stomach muscles, but without actually throwing up. It's like an attempt to vomit, but nothing comes out, or only small amounts of liquid or mucus come out.
• Dry heaving is similar to retching, but it typically involves more throat and abdominal muscle contractions. With dry heaving, there’s no food or liquid coming out.
• Rumination is when the food you ate comes back into your mouth persistently. You might spit, re-chew and/or swallow after it comes up. Regurgitation is effortless and not preceded by nausea or retching.

When should I go to the emergency department for vomiting?

If you see any blood in your vomit, you should head to the emergency department. That includes red blood, dark-black digested blood or dark brown bits that look like coffee grounds.

You should head to the ED if you begin to feel signs of dehydration, such as lightheadedness or feeling like you’re going to pass out.

If you have intense abdominal pain with vomiting, you could have pancreatitis, a gall bladder infection, an obstruction in the bowels, a kidney stone or another severe condition, in which emergency care is warranted.

You should also go to the ED if you experience persistent vomiting along with an inability to pass gas for more than 24 hours. This could be a sign of a small bowel obstruction, which requires immediate medical attention. In severe cases, the vomit may contain fecal material, which can appear and smell like dark brown stool.

When should I call my doctor about vomiting?

Call your doctor if you have vomiting that seems out of the ordinary for you or lasts longer than 24 hours.

There’s a difference between acute and chronic vomiting:

• Acute vomiting typically happens because of a temporary trigger, such as a virus, being seasick, etc. While unpleasant, it doesn’t require medication.
• Chronic vomiting can happen on and off for weeks, months or years. It requires different treatment than acute vomiting. This type of vomiting may be triggered by another condition, such as migraine, anxiety or depression, cyclic vomiting syndrome, severe acid reflux, a blockage in the digestive system, severe constipation or gastroparesis.

If you experience chronic or intermittent vomiting, you likely know the pattern of symptoms. For example, with gastroparesis, the vomiting happens usually two to three hours after eating.

In cyclic vomiting syndrome and migraine, vomiting happens in cycles every few months with warning symptoms like lightheadedness, nausea, fatigue and blurred vision.

What does it mean if my vomit is green/yellow/blue/orange/brown?

As a doctor, it doesn’t make much difference to me if it’s green or yellow or contains spit or bile, as long as it doesn’t contain blood. The color doesn’t tell me what underlying condition you might have or what treatment you might need. It may just indicate what you ate earlier.

The color of blood in vomiting can vary from coffee grounds to bright red or black clots. Any such color change means you should get immediate medical attention.

The things a gastroenterologist looks for in vomiting has more to do with other symptoms of common underlying conditions that cause vomiting. I look at whether you have pain elsewhere in your body, blurry vision or other co-existing symptoms. Vomiting is hard to treat because we need to pinpoint its trigger, and a patient may have two or three underlying conditions triggering it.

Is it ever a good idea to make myself throw up, when it seems like I might feel better afterward?

Technically, it’s not possible to choose to vomit or not — vomiting is a reflexive mechanism. But I don’t recommend trying to hold it in if you’re in a safe place to vomit. And it’s true that if you’re vomiting because of nausea, you may feel better afterward.

However, inducing vomiting (causing yourself to throw up on purpose) is typically a bad idea. If you don’t actually have to vomit, you’re inviting some of the side effects that can come along with vomiting. Those include the risk of aspiration (choking) or electrolyte disturbances. There’s also the very rare but real risk of esophageal rupture as a result of vomiting.

Gastroenterologists discourage the making yourself throw up, whether by putting your finger down your throat or using emetic agents, such as warm salt water. While warm salt water has historically been used as a home remedy to induce vomiting, most doctors don’t recommend it.

Are there effective home remedies to help me stop vomiting or to help feel less nauseated?

There aren’t many home remedies for nausea or vomiting that are backed by scientific evidence. If you’re able to keep any food down, it’s best to stick to saltine crackers, juice or ginger ale versus a heavy meal, which is harder to digest. And drink water between vomiting episodes whenever possible. It’s easier said than done, but staying hydrated is important.

Some people use ginger, known for its anti-nausea properties. You can consume it in the form of ginger tea, ginger ale (with real ginger), or small amounts of crystallized ginger. While the benefits aren’t clear, you can try it to help you feel better.

The key is taking in plenty of liquids to stay hydrated, whether that’s water or a sports drink or similar electrolyte solution.

If you can make your surrounding environment calm, that can also help. I typically recommend doing deep-breathing exercises if you can — counting from one to five while taking deep breaths.

What can I do to prevent vomiting from recurring?

Knowing what to eat can be a game of trial and error, but I recommend maintaining hydration and trying small, light meals.

Most of my patients with chronic vomiting identify their triggers as those associated with migraine headaches, including noise, flashes of light, sleep deprivation and certain foods.

Try to avoid:

• Eating too much too quickly, or consuming foods that are rich, greasy or spicy, because these can overwhelm your digestive system, leading to nausea and vomiting.
• Drinking excessive amounts of alcohol, which can irritate the stomach as well and lead to nausea and vomiting.

Allergic reactions to certain foods (e.g., shellfish, peanuts) can also lead to vomiting and are often accompanied by other symptoms like hives, swelling or difficulty breathing. So, it is important to identify your specific triggers and avoid consuming the foods you’re allergic to.

What can I do to help my body recover from episodes of vomiting?

Rehydrate properly

Vomiting can cause a significant loss of fluids and electrolytes (sodium, potassium, chloride), which are essential for proper bodily function.

• Start by drinking small sips of water as soon as you feel able to tolerate it. Avoid drinking large amounts quickly, as this could trigger further vomiting.
• Use an oral rehydration solution or electrolyte drink (such as Pedialyte, Gatorade or coconut water) to replenish lost fluids and electrolytes. This can help restore your body’s hydration and balance.
• Avoid sodas, juices and caffeinated beverages, as they can worsen dehydration and irritate the stomach.

Start eating slowly

Once you can tolerate fluids without vomiting, you can gradually introduce bland, easy-to-digest foods. This will help avoid further irritation to your stomach and allows your body to regain strength.

Follow the BRAT diet, consisting of:

• Bananas
• Rice (plain white rice)
• Applesauce
• Toast (plain)

These foods are bland and less likely to irritate the stomach.

Gradually increase complexity: As you start feeling better, you can slowly reintroduce other bland foods like boiled potatoes, crackers or clear broths.

Rest and take it easy

Vomiting often leads to fatigue and weakness, so your body needs time to recover. Get plenty of sleep and take naps throughout the day. Your body needs energy to heal. Once you’re feeling better, keep physical activity to a minimum. Overexerting yourself too soon can lead to further fatigue or even trigger another vomiting episode.

Soothe your stomach

Vomiting can irritate the stomach and esophagus, so it's important to try to calm the digestive system and reduce inflammation. Try:

• Ginger tea or ginger ale (with real ginger)
• Peppermint tea or sucking on peppermint candies, which can help soothe nausea and calm the stomach
• Chamomile tea, which is gentle on the stomach and can help reduce nausea and stomach discomfort

Cannabinoid hyperemesis syndrome and vomiting

With the legalization of cannabinoids in many states throughout the United States (including Ohio), it’s important to highlight the relationship between the long-term use of marijuana and recurrent or cyclic vomiting called cannabinoid hyperemesis syndrome.

Many patients use marijuana to reduce nausea because tetrahydrocannabinol (THC), its active chemical, affects receptors in the central nervous system. However, long-term daily marijuana use can desensitize receptors, leading to cannabinoid hyperemesis syndrome.

This syndrome is characterized by recurrent nausea, vomiting and abdominal pain. Many patients experience symptom relief while taking hot baths.

Cannabinoid hyperemesis syndrome is a recognized complication of long-term marijuana use and typically requires you to stop using marijuana for at least six months to see symptoms resolve.