Nausea is that uncomfortable feeling like you’re about to throw up. It might come with sweating, a faster heartbeat, or just wanting to tune out the world. Vomiting is when you actually throw up stomach contents forcefully. These two often go together, but you can have nausea without vomiting, or (less often) vomit without feeling nauseous first. Nausea can be more annoying than vomiting because it lingers. Sometimes people confuse vomiting with regurgitation, which is when food comes back up from your esophagus with little effort – like in acid reflux.
Retching is like vomiting but without anything coming out; it often happens right before you vomit.
Your stomach and brain work together to digest food smoothly. The upper gut (stomach and intestines) is controlled by nerves from your brain, your gut’s own “mini-brain,” and muscle cells. When everything’s normal, your stomach has a steady rhythm – about three contractions per minute to mix and move food.
Nausea often starts when this rhythm gets messed up. It can speed up (called tachygastria) or slow down (bradygastria). For example, in motion sickness, the fast rhythm builds as you feel queasy. Fixing the rhythm with medicine can ease the nausea, but not all nausea comes from this.
Vomiting is your body’s way of getting rid of toxins or bad stuff you’ve eaten – like a built-in protection system. It can be triggered by signals from your gut nerves, brain chemicals, or even direct irritants. Key parts include:
- Nerves from your gut sending alerts to the brain.
- A “chemoreceptor trigger zone” in the brain that senses drugs, toxins, or hormones.
- A central control area in the brain that coordinates the vomit reflex.
Chemicals like serotonin, dopamine, and substance P play big roles in starting the process. The vomit starts with your lower esophagus and stomach relaxing, then a big backward wave from your intestines pushes contents up. Finally, your diaphragm and belly muscles contract to force it out.
Understanding this helps explain why things like infections or meds can set it off – they’re messing with these signals.
Causes can be split into acute (sudden, short-term) and chronic (lasting a month or more).
Acute Causes (Come on quickly, often resolve in days):
- Infections like gastroenteritis: Second only to colds for making people miss work. Viruses like norovirus or rotavirus are big culprits, causing vomiting and diarrhea. Bacteria (e.g., from food poisoning) or parasites are less common but can hit hard. If others who ate the same food are sick, it’s likely shared germs.
- Food poisoning: From bad food – symptoms start within hours. Staphylococcus or Bacillus bacteria cause quick onset (under 6 hours).
- COVID-19: Can cause nausea, vomiting, or diarrhea before respiratory symptoms.
- Motion sickness or dizziness: From boats, cars, or ear problems affecting balance.
- Medications: Many drugs like antibiotics, pain pills, antidepressants, or chemo can trigger this. Long-term cannabis use can lead to repeated vomiting episodes.
- Pregnancy: “Morning sickness” affects many, but it can happen anytime.
- Other: Alcohol overuse, migraines, or GERD (stomach acid backing up into your esophagus).
Serious Acute Causes (Need quick medical help): Heart attack, stroke, blocked intestines, or pancreatitis.
Chronic Causes:
- Functional disorders: Like chronic nausea vomiting syndrome – bothersome nausea at least once a week, not explained by other issues, lasting 3+ months.
- Delayed stomach emptying (gastroparesis): Food moves too slowly out of the stomach, often from diabetes or surgery.
- Cyclic vomiting syndrome: Intense episodes of vomiting that come and go, sometimes linked to migraines.
- Other: Peptic ulcers, eating disorders, or brain issues.
Tips and Tricks:
Don’t wait for symptoms to worsen – start these steps right away for relief:
1. Stay Hydrated: Vomiting makes you lose water and salts, leading to dehydration (feeling tired, dry mouth, dizziness, dark urine). Sip clear fluids every 15-30 minutes – aim for 8-10 cups a day. Use oral rehydration solutions (like Pedialyte), sports drinks, or broth to replace salts. Avoid plain water alone if vomiting a lot.
2. Eat Smart: Start with liquids like soup, gelatin, or popsicles. Move to bland, high-carb foods: crackers, bread, rice, or bananas (the BRAT diet: bananas, rice, applesauce, toast). Avoid fatty, spicy, or dairy foods – they can worsen nausea. Eat small meals often.
3. Try Ginger: It calms the stomach. Sip ginger tea or chew ginger candies.
4. Rest and Relax: Lie down in a quiet, cool room. Avoid strong smells like perfume or cooking odors. Deep breathing (inhale slowly through nose, exhale through mouth) can help, especially for chronic cases.
5. Over-the-Counter Help: Antacids for acid-related nausea, or motion sickness pills like dimenhydrinate. But check with a doctor first if you have other health issues.
6. Avoid Triggers: Take meds with food (unless the label says otherwise). For motion sickness, sit in the front seat or focus on the horizon.
If symptoms persist, your doctor might prescribe anti-nausea meds like ondansetron or prochlorperazine, or do tests like an upper endoscopy or stomach X-ray.
Vomiting can lead to dehydration, low potassium (causing weakness), or acid-base imbalance.
Call your doctor if:
- Symptoms last >1-2 days or are severe.
- You vomit blood/coffee grounds or have black/tarry stools.
- Chest/belly pain, high fever (>101°F), stiff neck, severe headache, confusion, or dizziness.
- Signs of dehydration: Thirst, cramps, little urine, or feeling very tired.
Prevention is key, especially for infection-related cases:
- Hand Hygiene: Wash often with soap and water for 20 seconds, especially after bathroom use or around sick people.
- Food Safety: Wash fruits/veggies, cook meats fully, avoid unpasteurized milk, and clean utensils after raw food contact.
- For other causes: Manage migraines or motion sickness with doctor-recommended strategies.
Taking these steps can cut your risk dramatically – one simple habit like hand washing prevents countless illnesses.
Nausea and vomiting don’t have to control your life. With these tips, you can manage most episodes at home, but always listen to your body.
For personalized advice or if you suspect a GI issue like GERD or gastroparesis, consult an expert like Dr. Krishna Rayapudi, MD, DABOM, a trusted Gastroenterologist serving the greater Columbus area of Ohio.
Krishna Rayapudi, M.D.
