Frequently Asked Questions about Vomiting

NOTE: There was formerly an illustrated and an unillustrated version of this FAQ. The photos that some people regarded as offensive have been removed. So there is no longer an unillustrated version.

Main sections of the Vomiting FAQ:

LOOK FOR THESE SECTION HEADS IN PINK


Q. What is vomiting?

A. Vomiting is the forceful expulsion of the stomach contents through the mouth.

Q. Why do people vomit?

A. Vomiting has many different causes. Some of the more common are viral infection, food poisoning, alcohol overdose, alcoholic hangover, morning sickness, motion sickness, gastritis, and reactions to medications. Less common causes are kidney disease, gastrointestinal cancer, intestinal obstruction, concussion, diabetes, appendicitis, and various diseases of the internal organs.1

Q. What's gastritis?

A. Gastritis is simply inflammation of the stomach. It is frequently caused by chronic alcoholism, but an attack of gastritis can also be brought about by sudden irritation of the stomach, such as by drinking heavily carbonated soda pop on an empty stomach first thing in the morning. If not relieved by vomiting, gastritis goes away when the stomach next empties, which happens approximately every 20 minutes. Gastritis is what people usually mean when they say "something didn't agree with me."

Q. What happens in vomiting?

A. First, let's talk about the bodily functions that lead to vomiting. There are three phases to the vomiting act: nausea, retching, and expulsion.2 Vomiting is ordinarily preceded by nausea. It is not unheard of for a person to vomit without feeling nauseated, particularly in cases of sudden injury or sudden shock, such as witnessing an awful sight or breathing a particularly noxious smell. Vomiting that occurs suddenly and without warning is called precipitate vomiting. But most people experience nausea for a period of time before they vomit.

FACTOID: In a recent Internet survey, 39 percent reported having experienced precipitate vomiting.

NAUSEA

Q. What is nausea?

A. There is no single accepted definition of nausea in medicine. So each person needs to come up with his or her own. For our purposes, nausea is a feeling in the stomach rhythm that all is not well. Specifically, it is caused by contractions contrary to the normal pattern of contractions within the stomach or perhaps the complete lack of contractions. Ordinarily the immediate effect of nausea is to stop a person from eating or drinking further. If you're not sure you're nauseated -- and there are people like this, as we'll discuss later -- ask yourself "how about some [ice cream, BBQ ribs, orange juice, other favorite food] right now?" If the answer is "sure, why not!" then you are definitely not nauseated. Answering something else might suggest a degree of nausea. Nausea may also include pallor, sweating, excessive salivation, and increased respiration.3

FACTOID: In a recent Internet survey, 63 percent say nausea is worse than vomiting.

Q. So if a person is nauseated, will they inevitably vomit?

A. Absolutely not! Just as not every person who feels faint will faint, not every instance of nausea will end with vomiting. Just as a yawn means "get some air" and dizziness means "stop moving around," nausea is the body saying "deal with the stimuli causing you to feel this way."

Q. What are the stimuli that cause nausea?

A. Just about anything can cause nausea! The usual ones are viral illness, food or alcohol poisoning, bodily injury (particularly if the person can see the injury4) unpleasant smells, emotional upset or anxiety, migraine headache, hunger, and medications.

FACTOID: In a recent Internet survey, the average person felt nauseated 15.6 times when they did not vomit in the past year.

Q. What purpose does nausea serve?

A. Nausea is the body's way of teaching a person to avoid the substance or situation that caused it. Although nausea does nothing to remove toxins from the body, it leaves the person with a horrible memory which is apt to be attached to the last thing they ate. Another form of "deal with the stimuli causing you to feel this way."


"Nausea and the realization that one is about to vomit are among the most dreadful conditions that man endures." -- American Academy of Family Physicians


PHYSIOLOGY OF VOMITING

Q. How does a person vomit?

A. The stomach is relatively unimportant in the act of vomiting. The brain is in charge, and muscles adjacent to the stomach do the work. The vomiting center is located in the medulla oblongata, the rear part of the brain. This neural center acts on information supplied by the stomach, the intestines, the gag reflex in the throat, the inner ear, and most importantly, the chemoreceptor trigger zone (CTZ), which is located on the floor of the fourth ventricle in the brain, in case anyone cares. The CTZ takes in data about the presence of toxins in the blood and alerts the vomiting center to go to work when it believes the body has been poisoned. The stomach and intestines can signal for vomiting to occur when they are irritated or overloaded. The function of the gag reflex in the throat -- actually the province of something called the constrictor muscle -- is well known.

The second phase of the vomiting cycle is retching. The contractions of retching feel much like those of the expulsion phase, but retching too does not lead inevitably to vomiting. The vomiting cycle thus can be halted at any point prior to expulsion. In retching, the respiratory and abdominal muscles contract, forcing the gastric contents into the esophagus, but this is not enough to propel them out of the body. At the rest phases between retches, the stomach contents reflux back into the stomach.5 The key distinction between retching and expulsion is the motion of the diaphragm. When vomiting occurs, it is because the diaphragm relaxed suddenly during the retching cycle, enabling the stomach contents to be expelled through the mouth.6

The muscles that do the work are the diaphragm and the abdominal muscles. When the body is ready to vomit, the pyloric sphincter (which separates the stomach from the duodenum) closes, while about 45 seconds before vomiting,7 the lower esophageal sphincter (which separates the stomach from the esophagus) relaxes greatly, pulling the top of the stomach into the shape of an inverted funnel. The stomach contracts to shift contents from the lower to the upper portion.8 The abdominal muscles tighten, and the diaphragm goes down sharply in one or more contractions, squeezing the stomach. With the usual exit from the stomach closed, the contents have nowhere to go but up.

Q. Where exactly is the constrictor muscle?

A. The constrictor muscle is in the back of the throat, right behind the uvula.

Q. Why does vomit taste so awful?

A. It's a myth that stomach acid gives vomit its bad taste. Stomach acid is tasteless, although it does produce a burning sensation if it comes into the mouth through burping, vomiting, or acid reflux. The foul taste of vomit is due to three factors:

  1. Vomit contains butyl acid, a chemical produced in the small intestine, which gives vomit its unforgettable smell and taste
  2. Vomit consists of digested and partly-digested food -- different kinds of food -- mixed together in ways that no one would ever attempt voluntarily
  3. Vomit typically contains no sweeteners; sugars are the first part of food digested, as digestion of them actually begins while they're still in the mouth

Q. Why does vomit look like nothing that has been eaten?

A. Only vomiting occurring shortly after eating would contain anything looking familiar. By the time the stomach contents have been processed by the small intestine, they become unrecognizable glop.

Q. Why is there material from the small intestine in vomit?

A. As mentioned above, stomach acid is very strong. One of the main functions of the stomach is to disinfect that which is entering the body, and it uses a powerful level of hydrochloric acid to soak the food sterile. Ask any heartburn sufferer about the power of stomach acid. In an important step approaching the climax of the vomiting process, the vomiting center issues a command to have the small intestine send a fair portion of its contents back into the stomach. This starts about one minute before vomiting and lasts about 45 seconds.9 (For those who cherish bits of trivia, this is called the retrograde great contraction.) This has the effect of neutralizing the vomit,10 making it less damaging to the esophagus, throat, mouth, and teeth. Some researchers contend that expulsion of the intestinal content is a necessary part of the vomiting act in itself [since the intestine is where the toxin was detected by the CTZ], and that the movement into the stomach puts it in place for being ejected.11 The transfer of intestinal matter also increases the volume in the stomach, which makes vomiting easier.

Q. Increased volume makes vomiting easier?

A. Absolutely. For those who suffer from multiple episodes of vomiting, those later incidents would be soothed greatly if there were material available to be brought up. People who suffer from the "dry heaves" at the end of a vomiting cycle describe them as much more painful and traumatic than the "wet heaves" that open the process. In fact, dry heaves can even damage the esophagus and sphincter, causing bleeding and even tearing.

FACTOID: In a recent Internet survey, 34 percent said they vomit only once during a typical illness, 31 percent vomit twice, 21 percent vomit three times, and 13 percent vomit four or more times. The average is 1.82 times per illness with vomiting.

Q. How should one vomit?

A. Every medical book that has an opinion says that the head should be kept lower than the hips while vomiting. This is to prevent aspiration of the vomit into the lungs. This is especially important while holding a small child who may not know what to do.

In practical terms, this means that one should stand upright and bend over so that the mouth is almost in the toilet. Children should be taught to vomit this way. Anecdotal evidence suggests that most people disregard this advice and either kneel or squat in front of the toilet, positions which do nothing to protect one's airway.

Despite the common sense of it, it makes no difference in terms of efficiency what position the body is in. Medical researchers trying to learn the best way to remove poisons from the body in emergency treatment experimented with people vomiting in the two positions and found that vomiting while lying prone as opposed to sitting made no difference in the volume of material ejected.12

Q. How did those researchers find 20 people who were willing to be induced to vomit in two different positions?

A. Beats me, but you may be interested to know those 20 subjects vomited an average of 660 ml while sitting and 636 ml while horizontal.13

FACTOID: In a recent Internet survey, 64 percent reported having vomited in public.

Q. How is vomiting induced?

A. The two main ways are stimulation of the constrictor muscle with a finger -- bet you knew that -- and ingestion of syrup of ipecac, which has been the emetic of choice for decades now. In the past, people were urged to induce vomiting using a greater variety of emetics, including salt and mustard powder, which are not as effective as ipecac and which can be poisonous themselves if vomiting does not occur. It's a good idea to keep syrup of ipecac on hand in case the poison center ever tells you to administer it to a poisoning victim. The stuff is available over the counter at any drug store.

Q. But isn't ipecac dangerous too?

A. Only if it's abused, as by a bulimic using it regularly. Syrup of ipecac is quite safe in emergency administration, partly because the recommended dose -- 30 ml (2 tbsp) -- will cause vomiting in upwards of 99 percent of patients. In fact, as little as 5 ml (1 tsp) will cause vomiting in over 90 percent of people.

Q. So why is the recommended dose six times higher?

A. Because that 99 percent effectiveness rate is desired, and also because the medical personnel want the patient to vomit repeatedly to ensure that the poison is flushed out completely. Here is an account of an experience with ipecac.

Q. What's the time frame for that repeated vomiting?

A. Subsequent episodes of vomiting, if they occur, are most likely to come at 20-minute intervals, closely corresponding to the cycle of the stomach in emptying the normal way.

Q. How long does it take to vomit?

A. About 20 seconds. Each wave typically takes six seconds and there are usually three or four waves. Having all the vomit come up in one wave is rare, making two the minimum. So those subjects mentioned above who brought up about 22 ounces (640 ml) probably had three waves averaging about a cup (8 oz) each. The first wave is almost always the smallest.

MOTION SICKNESS

Q. You mentioned the inner ear. What's that got to do with vomiting?

A. The inner ear is another place that has the ability to detect toxins in the blood. Many people have suffered dizziness at the same time as nausea and vomiting. This heightens the likelihood that the vomiting was caused by food poisoning or some other kind of poisoning. This is also why people experience nausea and vomiting from motion sickness.

Q. How so?

A. The motion caused by travelling -- especially on a boat -- moves the fluid in the inner ear all kinds of directions at once. As mentioned, one function of the inner ear is to detect poisons in the blood, which cause it to go haywire. In motion sickness, the brain reads the excess stimulation of the inner ear as poisoning, and it responds by causing nausea and vomiting. This was proved by inducing vomiting in dogs by giving them poison. The inner ears of the dogs were then removed and the poison was administered again. None of the dogs vomited. (It is interesting to note that people born as deaf mutes never suffer from motion sickness.)

Q. Why is motion sickness more common on a boat than other forms of transport?

A. Because on a boat people are moved in three dimensions at once while on air and land people are usually only moving in one or two dimensions at a time. The word "nausea" itself comes from the Greek word for seasickness.14

Q. How can I avoid motion sickness?

A. The best way is to plan ahead and take medicine. The most effective is the scopolamine patch, which is worn behind the ear and lasts for days. Most sufferers take Dramamine (or generic equivalent). A more advanced pill is meclezine, sold under the brand names Bonine and Dramamine II. This drug has the advantage of lasting longer than Dramamine and also causing much less drowsiness. The downside of these medications is that they should not be used in conjunction with alcohol, which makes them bad choices for cruise passengers with party spirit.

Sea bands, which are worn around the wrist and provide acupressure, are also popular and some believe them to be effective. These are widely available at boat shops, and there's an FDA-approved model available by prescription, ReliefBand.

If you're feeling seasick, it's best to get out on deck, preferably near the center. Back at the stern is a good place. Keep an eye on distant objects or the horizon. This page has some pretty good -- and frank -- advice.

The important thing to remember is that once you're seasick, there's nothing you can take orally to get well. The vessel's medical officer might give you injections or suppositories after you've been vomiting for a while.

Q. But how can anyone get seasick on such a big ship?

A. Oh man. Remember this: "It's not the size of the boat, it's the motion of the ocean." If you really have to succumb to your queasiness, some people say vomiting off the side and into the water brings a sense of relief not gained by using the bag.

Q. I've seen those bags on airplanes but I've never seen anyone use them. Do people really get airsick?

A. The bags are used much more often on boats, but they are definitely used on planes. The airline industry reports that less than one percent of passengers total get airsick to the point of vomiting, but if airsickness starts in a particular plane, the rate jumps to eight percent. Part of that is the power of suggestion. Vomiting on an airplane is a traumatic experience, especially for a child. It's better to use the bag rather than try to make it to the lavatory and find it occupied.

PROJECTILE VOMITING,
RETCHING,
and "DRY HEAVES"

Q. What is projectile vomiting?

A. Projectile vomiting is that which occurs with so much force that the vomited matter is cast several feet from the body. If it happens after a head injury, it becomes a medical emergency and immediate attention is warranted. It can also be a sign of obstruction of the alimentary canal. Some people project because they build up a lot of pressure in his abdomen by retching repeatedly.

Q. Why does projectile vomiting occur?

A. As mentioned, sometimes it is due to brain injury and needs to be treated as an emergency. Sometimes it's just a result of the body retching more than is needed.

Q. Why is retching needed? Is retching the same as "dry heaves"?

A. Physiologically, retching and dry heaves are the same act. Retching is normal to open a vomiting episode; specifically, retching at least once or twice is necessary to "prime the pump," if you will, before vomiting can happen. This is done to build up the pressure needed to expel the stomach contents from the body. As one retches, pressure builds up in the chest. The key event is when the body has retched enough (built up enough pressure) for vomiting to occur, the diaphragm relaxes, and this transfers the pressure that has built up in the chest to the abdomen, and this pressure then expels the stomach contents through the mouth. This kind of retching is usually not referred to as dry heaving; rather, everyone recognizes it as part of vomiting.

When a person projectile vomits, essentially there has been too much pressure built up during retching and the additional pressure manifests itself in the vomit being cast farther from the body than normal.

What people usually refer to as dry heaves are retches that occur by themselves, generally after one has alrady vomited (although it also occurs before vomiting, or without vomiting), isolated from any vomiting. This is often because there is not enough material left in the stomach to be vomited efficiently. Although it is quite counter-intuitive, one can make this dry heaving less traumatic if one eats or drinks something beforehand (i.e, causes the event to become actual vomiting).

FOOD POISONING

Q. What is food poisoning?

A. Food poisoning is illness caused by tainted or spoiled food. Two of the more-discussed forms of food poisoning are salmonella and e. coli, although staphylococcal food poisoning is probably the most common.15 There are many others, although some are quite rare and only associated with a particular food item, like those caused by shellfish.

Q. What causes food poisoning?

A. The main causes are failure to keep foods at the proper temperature and improper handling. Tainted properly cooked food is actually rather rare, although cases have been documented where food poisoning was caused by contamination at the farm where it was grown. Since most chicken, eggs, and ground beef arrive at your store already contaminated with either salmonella or e. coli, it is wise to serve these foods well done and to wash hands and utensils thoroughly after handling them. Staphylococcal food poisoning is especially dastardly since killing the staphylococci will do no good if they have already produced toxin.

Q. How common is food poisoning?

A. No one knows. Some guesses go as high as 20 - 30 million cases annually in the United States. That's one in every 10 people, every year.

Q. Why does no one know?

A. Because very few people seek medical attention for food poisoning, and even when they do, few of their doctors bother to do lab work, and fewer still report the findings to health agencies. Usually only the clear outbreaks -- when many people who ate the same thing get sick at once -- are investigated. Even a large number of people poisoned won't be detected unless people have some reason to seek medical attention and the medical professionals see a connection.

Q. Does all food poisoning result in vomiting?

A. No, reasonably little of it results in vomiting. Diarrhea and abdominal cramps are much more common symptoms of food poisoning. Having three or more episodes of diarrhea in an illness, and having bloody diarrhea are good indicators that one has been poisoned.

Vomiting is a much more prominent symptom of staphylococcal food poisoning, however.

Q. What is the treatment for food poisoning?

A. Ceasing ingestion of the contaminated food for starters. Most food poisoning clears itself up within a few days by being flushed from the body by vomiting and diarrhea. It's a good idea to seek medical treatment in case of difficulty swallowing, speaking, or breathing; a prolonged inability to retain fluids; fever over 100 degrees; severe or bloody diarrhea; persistent, localized abdominal pain; or dehydration.17

Q. What is ptomaine poisoning?

A. There's no such thing. Decades ago, food poisoning was erroneously believed to be caused by microorganisms called ptomaines, but they are now known to be harmless.

GASTROENTERITIS

Q. What is the stomach flu?

A. "Stomach flu" is actually a misnomer. The term "flu" is short for "influenza," a fairly serious respiratory ailment, and it should properly be used for nothing else. That which people call "stomach flu" is really gastroenteritis, which literally means inflammation of the stomach and intestines. As a result of this abuse of the language, many doctors claim to have no idea what a patient means when complaining of "the flu."18

Q. What causes gastroenteritis?

A. Gastroenteritis is ordinarily a viral condition. As with food poisoning, diarrhea is a more common symptom. There is a bit of overlap between food poisoning and gastroenteritis, since many forms of gastroenteritis can be spread through food handling and preparation. One of the most common forms of gastroenteritis -- and one for which vomiting is a more prominent symptom than most -- is the Norwalk virus, which was once called Winter Vomiting Disease.19

Q. Ugh. I'm glad they don't call it that anymore. What's the Norwalk virus?

A. Named for the town in Ohio where it was first described,20 Norwalk is only the most common and best known of a group of agents that cause what medical science calls acute epidemic nonbacterial gastroenteritis. It's epidemic because it's so easily spread. In rare cases, dozens of people who live, work, or attend school together can come down with the illness at once. More commonly, Norwalk passes from household to household by one family member picking it up at work or school and infecting other family members. Viruses of this kind are waterborne, which means they can't be spread simply by breathing the same air, like the common cold is. But there's a catch: Once the virus becomes aerosolized in the sneezing or vomiting of an infected person, those tiny water droplets stay in the air for a while and the virus is as airborne as the common cold. In a documented case in England, a girl vomited in a classroom and 48 hours later, 14 other people who were in the room vomited as well.21 In another documented case from England involving adults, someone vomited at a banquet, and three days later, 52 of the 126 guests had come down with Norwalk. The closer the diners were seated to the person who vomited, the more likely they were to become ill. (reference) If a child vomits and the parents who care for the child vomit within a few days, it was probably the Norwalk virus or one of its cousins. So it's easy to see how these gastroenteric viruses can affect many people in a community in the space of a few weeks. Not as dramatic as half the students in a dormitory vomiting in a single night, but still an epidemic nevertheless.

Q. Half the students in a dormitory?

A. Yes. There have been many instances like that documented.22 The thing about Norwalk that many people -- especially children -- find traumatic, is that the vomiting it causes can come on quite suddenly and without warning. Many victims report that they weren't able to make it to the bathroom, or even out of bed. This is what doctors writing in the British Medical Journal said in 1936 about one of the first reported outbreaks of the disease:

The chief symptom was that of vomiting, which occurred in 42 of the 52 cases. The sickness came on quite suddenly, so that several of the girls were sick wherever they happened to be in the school or on grounds; but a great many, having gone to bed apparently well, woke up in the morning and were sick before they could get out of bed.23

Note: In Britain, "sick" always means vomiting. In North America, it can mean just about anything.

To illustrate how easily Norwalk can be transmitted and how potent it is, consider this bizarre case from the world of college football. In September 1998, more than half of the Duke University football team came down with Norwalk after eating contaminated sandwiches. (An investigation found that two people who prepared the sandwiches were ill with the virus at the time they were made.) Some of the players vomited on the field during the game, and by doing so they infected members of the opposing Florida State team. This is believed to be so because the players had no contact except on the field and because it was the Duke defensive players who were vomiting in the game and the Florida State offensive players who got ill later. (In case you haven't heard, the offensive line of one team has contact with the defensive line of the other.)

Q. How can I keep from catching this awful virus?

A. The most important thing is to wash your hands frequently during the winter months or when you're around sick people. It's also good to avoid being where people are smoking since exposure to smoke weakens resistance to the virus. During warm months, stay out of unchlorinated water (rivers and lakes) since the virus is spread easily from bather to bather.

Q. How long is a person with Norwalk contagious?

A. For two days after the symptoms end.

EMETOPHOBIA

Q. What is emetophobia?

A. Emetophobia is an irrational or excessive fear of vomiting. The author of this FAQ wrote one about emetophobia earlier. You may read more about emetophobia here.

Some of the questions answered in the Emetophobia FAQ:

FACTOID: In a recent Internet survey, 28 percent of non-emetophobics say they don't mind when someone in their household vomits, and 29 percent don't mind when they see someone vomit in public. But only 9 percent don't mind vomiting themselves and only 3 percent don't mind being nauseated.

EMETOPHILIA

Q. What is emetophilia?

A. Emetophilia is sexual arousal based on vomit or vomiting.

Q. Who practices emetophilia?

A. There are a variety of forms of emetophilia, and the Internet has shed light on this subject to a far greater extent than has ever been known. Only one medical/psychology article published before the Internet became common discusses the phenomenon.24 Most emetophilics seem to be interested only in discussing their vomiting and that of other people. The next order in the fetish is people who collect pictures of people vomiting. The most occupied emetophilics induce themselves and others to vomit to get sexual highs, and some of these people are the ones making the pictures the others collect.

FACTOID: In a recent Internet survey, 17 percent of respondents claimed to have induced themselves to vomit at least once.

Q. Why are some people aroused by vomiting?

A. Vomiting was probably something either arousing or frightening to them at some point prior to puberty. In any case, it aroused powerful emotions, and the emetophilic later called upon these emotions for purpose of sexual gratification. For these reasons, some people have both emetophobia and emetophilia.

Q. Is emetophilia why there is so much vomiting in movies and TV these days?

A. Probably. Since amateurs make photos and videos of people vomiting, it makes sense that professionals would do it too.

Q. Can one tell if a photo or video vomit is real or faked?

A. One more thing the vomiting center does in its process is tell the mouth to open. So if the mouth is puckered, the "vomit" is fake. If the mouth is open, there's a chance it's real. Another thing the body does before vomiting is arch the back so that the head is in the proper position. (Holy cow, I bet you didn't know your body does so many things when you vomit!)

SURVEY RESEARCH ABOUT VOMITING

Q. How often does the average person vomit?

A. Two Internet surveys were conducted for this FAQ.

A survey of non-emetophobics found that the average person reported vomiting 3.79 times in the past year, although the median was only once. The average person said they vomit 1.28 times in a typical year. The median person most recently vomited five months earlier. When we divide their estimated lifetime episodes of vomiting by their age, we find that the median person vomits .7 times per year, or once every 17 months. The average is much higher, raised by a few prolific vomiters to 1.9 times per year, or once every 6.3 months.

Another survey found that emetophobics vomit almost never, with the median emetophobic having most recently vomited 12 1/2 years ago. (Among non-emetophobics, only 8 percent can claim 10 years since their last vomit.) You can learn more about emetophobics and their experience with vomiting here.

Q. Are there any gender differences in frequency of vomiting?

A. Are there ever! In the survey of non-emetophobics, women reported having vomited 4.9 times on average in the past year, while for men the figure was only 1.4 times. The women said a typical year for them is 1.49 illnesses causing vomiting on average while men reported .9 such illnesses. All of the measures find women vomiting more often than men. The median woman most recently vomited 155 days ago; for the median man, it was 189 days. The differences in the average are even more striking. The average woman most recently vomited just over two years ago while for the average man, it was almost four years. This suggests that being a "non-vomiter" (never or rarely vomiting) is much more common for men than for women. (Bear in mind that emetophobics are excluded from these calculations. Nearly all of them are non-vomiters, and there are more women among them than men.)

The average woman claimed to have vomited 93 times in her life, which divided by age works out to 3.1 times per year. The average man reported 30 vomits in his lifetime, or .9 times per year. The median woman reported vomiting 30 times, or 1.1 times per year, and for the median man it was 18 times, or .5 times per year.

FACTOID: In a recent Internet survey, 59 percent of non-emetophobic men said vomiting is worse, but 60 percent of non-emetophobic women said nausea is worse. This might help explain why women vomit more often than men.

Q. What about geographic differences?

A. People in the U.S. vomit less often than people in Europe, and people in Canada less still. People in the American South vomit more than the rest of the country.

Q. What caused those people to vomit?

A. The phobics and non-phobics who answered the survey said their most recent attack of vomiting was caused by the following:
Viral illness 41%
Food poisoning 22%
Excess alcohol consumption 12%
Self-induced 5%
Reaction to medication 4%
Motion sickness 2%
Other 12%

In terms of lifetime causes of vomiting, that is, what has caused them to vomit in their entire lives.
Viral illness 70%
Alcohol 65%
Food poisoning 60%
Pregnancy (female) 40%
Reaction to medications 39%
Motion sickness 38%
Surgery/anesthesia 27%
Self-induced 11%
Induced by another person 5%
Other 22%

Q. Has everyone vomited at some time?

A. It looks like it. In five years of conducting surveys and participating in Internet discussion groups, the author has not once encountered a credible case of a person who has never vomited. (There are some people who have a rare inherited disorder that prevents them from ever vomiting, but that's not the answer you were looking for, right?) The author has encountered many people (see here) who have not vomited since childhood (including himself) but no one who has never vomited even once. Perhaps we can conclude from this that everyone has to vomit during childhood, but some emetophobics can prevent it later in life.

PREVENTING VOMITING

Q. How can one prevent vomiting?

A. The best ways are to wash hands frequently, especially when preparing foods or being around other people; to keep kitchens clean; to eat in clean restaurants; to avoid excess in eating and drinking; and to avoid sick people.

Q. I meant when one is already nauseated.

A. Oh. As has been mentioned, vomiting is not usually inevitable from nausea. Simply relaxing should be the first line of defense -- much nausea is caused by stress and anxiety. Taking small sips of water will give an indication as to the level of stomach upset. If the water seems to inflame things further, lay off. If a little bit of water doesn't hurt, more shouldn't hurt either. (Sometimes the stomach merely needs to be given something to do, in which case the feeling wasn't true nausea but only hunger.)

An escalation of defense might involve taking ginger capsules or Emetrol. Emetrol is really cola syrup, the stuff in your Coke or Pepsi if you took away the carbonated water. If you don't want to buy the stuff -- and it's a little bit expensive -- drinking warm, flat cola (or other soft drinks) is apt to work about as well. (Trouble is, warm, flat, cola is hard to stockpile.) Sucking on ice cubes or an ice pop can help quiet your gag reflex.

If you've tried relaxing, water, Emetrol, ginger capsules, ice cubes, and similar remedies, the next step might be to try -- vomiting. It won't be fun, but it will almost certainly cure your nausea.

Q. NO! I'm not giving up yet! What can I do?

A. It's not well known, but Dramamine (dimenhydrinate), which has been the leading drug for treating motion sickness for generations, is also effective in preventing ordinary vomiting.

And Pepto-Bismol, which has been the choice of tourists suffering from diarrhea around the world, is powerful enough in suppressing the vomiting center that it can actually counteract a small dose of syrup of ipecac.25 (In a clinical study, only 20 percent of subjects whose 5 ml dose of ipecac was followed by Pepto-Bismol vomited compared to 90 percent who took a placebo.)

Q. But couldn't suppressing the vomiting center mean than poisons that would otherwise be vomited will instead be absorbed and cause damage?

A. It's doubtful. One doctor writes that vomiting is practically useless in food poisoning to begin with, because by the time enough poison has been absorbed to trigger vomiting, it's too late for vomiting to do any good.26 And there is a small but fervent clique of emetophobics on the Web who have assiduously avoided vomiting for 5, 10, 20, 30 ... 50 years! They have undoubtedly consumed their share of vomit-inducing poisons. Yet they've suppressed their vomiting centers and remain alive. (See the Emetophobia FAQ for more on this or look up their "vomit streaks.".)

One instance where it would definitely be inadvisable to monkey with the vomiting center is in case of alcohol intoxication. Many cases have been documented where drunks have died when they failed to vomit the alcohol that a normal person would have. It's not clear why this is so; in none of the documented cases did the intoxicated person take a drug to prevent vomiting. And of course, if preventing vomiting had been a priority, presumably the person wouldn't have consumed a lethal level of alcohol!

If you're concerned about interfering with your body's ability to rid itself of toxins, it would be a good idea to simply let the vomiting center do what it wants.

Excess alcohol consumption is the leading cause of vomiting in people between the ages of 14 and 34.

FACTOID: In a recent Internet survey, 72 percent fight nausea and only 28 percent don't.

Q. Are antacids useful in preventing vomiting?

A. Quite the opposite. If you find that taking an antacid reduces your nausea, it is only acting as a placebo. But then a lot of nausea exists only in your head to begin with. As has been mentioned, one function of the stomach is to serve as an acid bath for incoming nutrient. Sometimes the stomach is a bit overzealous in this function, and the acid can become overpowering, especially when the stomach or (usually) the duodenum contain ulcers or the acid makes its way into the esophagus. At these times, taking an antacid can be quite useful in neutralizing the stomach acid. But it is strictly a chemical reaction; the antacid really has no medical effect on the body. So taking an antacid for something other than acid will not help one bit.

Q. But you said it was the opposite of useful in preventing vomiting.

A. Yes. The side effect of reducing the stomach's acid is reducing the stomach's prophylactic function. In this way, the antacid is minimizing the body's ability to suppress poisons and microorganisms. Usually, the only toxins and microorganisms we have to worry about are the ones that can penetrate the body's defenses. When defenses are down, not only are the usual suspects empowered, but bacteria and poisons normally no match for the stomach can become invasive. Take our old enemy the Norwalk virus. In clinical tests, researchers infected some people with Norwalk -- let's not think about what persuaded people to volunteer for those experiments -- and not all of them came down with the erstwhile Winter Vomiting Disease. In another round, the scientists had the subjects take antacid along with the virus, and all of them vomited. People who take prescription acid blockers like Prilosec also report an increase in the amount of nausea, diarrhea, and vomiting they experience.

Q. Yikes! So how can one take antacid and be secure?

No illustrationsA. It's best to save antacid for a few hours after eating when the food will have spent that amount of time in the acid bath. If your need for antacid is more urgent, a brand called Gaviscon might be of assistance. It's not really an antacid. It forms a kind of liquid dam that floats on top inside your stomach to keep stomach juices out of the esophagus. That way your esophagus is protected without impairing the stomach's natural defenses. Gaviscon won't really neutralize the acid though, so you might need real antacid later, but by that time, your stomach will be nearly empty.

Q. What if I really, absolutely refuse to vomit. Can anything be done?

A. Doctors give injections of powerful anti-emetics, namely Compazine, Phenergan, and Tigan to stop vomiting, usually in people who have been suffering from it for a few hours, like those Norwalk sufferers mentioned above. But some emetophobics report that their doctors have given them prescriptions for these drugs in pill form. (No doubt these emetophobics had to hound their physicians and psychiatrists in a major way to get them!)

There is also an operation called a fundoplication performed in severe cases of acid reflux. Most people who have them are unable to burp or vomit for the rest of their lives. We are unaware of anyone having a fundoplication due to emetophobia.

Q. You said I can't get an injection of the anti-emetic unless I've already been vomiting for hours! That's not fair!

A. Hmm... we've heard of emetophobics lie about having been vomiting in order to get a shot that will prevent vomiting.

FACTOID: In a recent Internet survey, the average person fights nausea for 33 minutes before giving in and vomiting. The average emetophobic fights nausea for 20 hours!

WHEN YOU DON'T FEEL LIKE PREVENTING VOMITING

Q. OK. I tried all of that and I'm still nauseated. How can I just put an end to my nausea and vomit?

A. Some texts suggest that all vomiting is in a sense voluntary, that it occurs only "after nausea reaches severe and intolerable levels."27 Here's some advice on how to vomit.

First of all, it's a bad idea to force yourself to vomit with emetics or direct stimulation of the gag reflex. If your body wants to vomit, it won't need that kind of induction. But ... there are things you can do that are more subtle to give yourself a little push.

The thing to do is stop fighting the nausea and let yourself vomit. Since it's easiest to vomit on a full stomach, drinking a glass of water or two is apt to help. If you've been fighting nausea, you've undoubtedly been paying close attention to the movements of the muscles that cause vomiting. You've probably been breathing a lot more shallowly than usual to avoid upsetting your diaphragm.

So go ahead and upset your diaphragm. Take a couple of sharp, deep breaths and then a couple more. If you're as nauseated as you say you are, you are apt to vomit quickly.

Q. How can I know when I'm so nauseated that vomiting is inevitable?

A. As The Doctors Book of Home Remedies II puts it, "if low-key queasiness turns to gotta-go nausea, try to relax -- it is going to happen whether you want it to or not."28 When the mouth waters excessively -- the medical literature calls it hypersalivation -- it's unlikely that you'll be able to turn the tide. (It's a good idea to teach children that they should get to the toilet when they're feeling sick and their mouths water.) And when you feel your tongue lock down (the roof of your mouth is rising too in order to give what's coming more room), you'll be vomiting in less than a minute.

FACTOID: In a recent Internet survey, people reported having vomited a median 23.5 times in their lives. The average respondent was 29.4 years old.

Q. Why does my mouth water before I vomit?

A. For most people, hypersalivation is their signal that vomiting is imminent, and that's useful. The two most common theories are (1) the saliva is useful in coating the teeth to protect them from the acidity of vomit; and (2) the salivation center in the brain is right next to the vomiting center, and the salivation center gets "cross-talk" from the vomiting center being excited, kind of the way adjacent teeth seem to hurt when you've got a toothache.


"If low-key queasiness
turns to gotta-go nausea, try to relax --
it is going to happen
whether you want it to or not."

--The Doctors Book of Home Remedies II


Q. What's the first thing I should do after vomiting?

A. When you or your child experience "wet heaves," you should inspect the vomit to make sure it doesn't contain blood, a fairly rare occurrence. Blood in vomit is usually dark, like coffee grounds. This should be reported to your physician. In the extremely unlikely event it contains fresh blood (which is bright red, of course), this should be considered a medical emergency and dealt with at once. Many people find themselves unable to look at vomit, but if medical intervention becomes necessary for whatever reason, it will be helpful if you can state whether it did or did not contain blood. So it's a good habit to check vomit for blood.

Q. Can I get dehydrated from vomiting?

A. It's not unheard of, although a normal, healthy adult can vomit for more than a day without serious consequences.29 Dehydration is more common when vomiting occurs in combination with severe diarrhea or prolonged time in the sun. The cure for dehydration is hydration -- water. If one is experiencing diarrhea, it's a good idea to lie flat to keep body fluids from flowing to the intestines. Keep an eye on your urine. Deep yellow is a sign of lack of water.30

FACTOID: In a recent Internet survey, 23 percent of women with children have never vomited due to pregnancy.

Q. After I vomit, what can be done to prevent it from recurring?

A. Nothing by mouth for at least one hour.31 Even a little bit of water could trigger another attack. After a few hours, try some water or light beverage like 7UP. When you're ready to try solid foods, remember BRAT. Not your children! Bananas - Rice - Applesauce - Toast.

What's good about vomiting? The feeling afterward is usually one of relief when your nausea instantly disappears. Some people get an all-over feeling of well-being and others may even feel giddy.

Q. Do I have any constitutional rights when it comes to vomiting?

A. Yes! The U.S. Supreme Court ruled in 1952 that forced administration of an emetic as part of a police search was an unconstitutional violation of the 4th Amendment.32

NOTES

  1. Nancy Nugent, How to Get Along with Your Stomach, Boston: Little, Brown, 1978, p. 156.
  2. J.H. Barnes, "The Physiology and Pharmacology of Emesis," Molecular Aspects of Medicine 7: 397-508 (1984).
  3. Ibid.
  4. Nancy Nugent, How to Get Along with Your Stomach, Boston: Little, Brown, 1978, p. 154.
  5. Ibid.
  6. Ibid.
  7. Ivan M. Lang, S.K. Sarna & W.J. Dodds, "Pharyngeal, esophageal, and procimal gastric responses associated with vomiting," American Journal of Physiology 265: G963-972 (1993).
  8. K. Lumsden & W.S. Holden, "The Act of Vomiting in Man," Gut 10: 173-179 (1969).
  9. Ivan M. Lang, S.K. Sarna & W.J. Dodds, "Pharyngeal, esophageal, and procimal gastric responses associated with vomiting," American Journal of Physiology 265: G963-972 (1993).
  10. Ivan M. Lang & S.K. Sarna, "Motor and Myolectric Activity Associated with Vomiting, Regurgitation, and Nausea," in Wood, J.D., ed., Handbook of Physiology: The Gastrointestinal System I: Motility and Circulation, Bethesda, Md.: Bethesda, Md., Physiological Society, 1989: 1179-1198.
  11. Kenneth R. Brizzee, "Mechanics of Vomiting: a Minireview," Canadian Journal of Physiology and Pharmacology 68: 221-229 (1990).
  12. Dan Tandberg & Laura C. Murphy, "The Knee-Chest Position Does Not Improve the Efficacy of Ipecac-Induced Emesis," American Journal of Emergency Medicine 7: 267-270 (1989).
  13. Ibid.
  14. Kenneth L. Koch, "Approach to the Patient with Nausea and Vomiting," in T. Yamada, ed., Textbook of Gastroenterology, Philadelphia: Lippincott, 1995, pp. 731-749, at 731.
  15. Michael Oppenheim, The Complete Book of Better Digestion, Emmaus, Pa.: Rodale Press, 1990, p. 197.
  16. Thomas W. Hennessey, et al, " A National Outbreak of Salmonella Enteritidis Infections from Ice Cream," New England Journal of Medicine 334: 1281-86 (1996).
  17. Debora Tkac, ed., The Doctors Book of Home Remedies, Emmaus, Pa., Rodale Press, 1990, p. 277.
  18. Michael Oppenheim, The Complete Book of Better Digestion, Emmaus, Pa.: Rodale Press, 1990, p. 18.
  19. John Zahorsky, "Hyperemesis Hiemis or the Winter Vomiting Disease," Archives of Pediatrics 46: 391-395 (1929).
  20. Jonathan L. Adler & Raymond Zickl, "Winter Vomiting Disease," Journal of Infectious Diseases 119: 668-672 (1969).
  21. J.D. Gray, "Epidemic Nausea and Vomiting," British Medical Journal 1: 209-211 (1939).
  22. H.C.T. Smith, "Epidemic Vomiting," Journal of Hygiene (Cambridge) 73: 445-455 (1974).
  23. Reginald Miller & Martin Raven, "Epidemic Nausea and Vomiting," British Medical Journal 1: 1242-1244 (1936).
  24. Robert J. Stoller, "Erotic Vomiting," Archives of Sexual Behavior 11: 361-365 (1982).
  25. Marvin M. Goldenberg, et al, "Antinauseant and Antiemetic Properties of Bismuth Subsalicyclate in Dogs and Humans," Journal of Pharmaceutical Sciences 65: 1398-1400 (1976).
  26. Michael Oppenheim, The Complete Book of Better Digestion, Emmaus, Pa.: Rodale Press, 1990, p. 51.
  27. Kenneth L. Koch, "Approach to the Patient with Nausea and Vomiting," in T. Yamada, ed., Textbook of Gastroenterology, Philadelphia: Lippincott, 1995, pp. 731-749, at 735.
  28. Sid Kirchheimer, ed., The Doctors Book of Home Remedies II, Emmaus, Pa.: Rodale Press, 1993, p. 566.
  29. Michael Oppenheim, The Complete Book of Better Digestion, Emmaus, Pa.: Rodale Press, 1990, p. 51.
  30. Debora Tkac, ed., The Doctors Book of Home Remedies, Emmaus, Pa.: Rodale Press, 1990, p. 622.
  31. Sid Kirchheimer, ed., The Doctors Book of Home Remedies II, Emmaus, Pa.: Rodale Press, 1993, p. 566.
  32. Rochin v. California, 342 U.S. 165 (1952).

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