What Causes Retching?
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What is retching?
Retching, or dry heaving, is when the body keeps wanting to vomit but can’t. Nothing (or very little) comes up. You may gag and feel uncomfortable.
In medical terms, "retching" is when your diaphragm contracts when trying to vomit but the body is unsuccessful in doing so.
Usually, something triggers your gag reflex. It may be triggered when brushing your teeth or from smelling or eating a food you think is disgusting. It’s also not unusual to retch after you vomit.
Retching can also be caused by motion or morning sickness or may occur with heartburn, indigestion, or gastroesophageal reflux disease (GERD). People who have severe anxiety or are having a panic attack may also suffer from retching.
In some cases, retching may be a sign of a more serious digestive problem. Call your doctor if you also have a fever, chest pain, diarrhea, vomiting blood, or severe abdominal pain.
If you also have upper abdominal pain that radiates to the neck, jaw, and arm, or pain that’s worse with exertion, go to the ER immediately. It may be a sign of a heart attack.
If you retch very forcefully, it can cause a tear in the esophagus that bleeds. This is known as a Mallory-Weiss tear. It is rarely dangerous but can be scary if you start vomiting blood. Usually the tear heals on its own, but in rare cases it can lead to severe blood loss. —Dr. Chandra Manuelpillai
Causes of retching
- Burning pain in the upper abdomen
- Bloating in the upper abdomen
- Feeling uncomfortably full
Also called indigestion, dyspepsia is a range of uncomfortable symptoms that happen after you eat. The discomfort can range from mild cramping to severe pain.
Indigestion can be caused by eating too quickly, overeating, or eating fatty, greasy, spicy, or sugary foods. Certain drinks—including alcohol and anything caffeinated or carbonated—can also cause it.
Some people retch when they eat foods they can’t tolerate. The most common food intolerance is lactose intolerance. Lactose is a type of sugar found in dairy products. It can cause diarrhea, bloating, and indigestion.
Certain medications (antibiotics, pain relievers) and vitamin or mineral supplements can also cause indigestion, particularly if you take them on an empty stomach.
You can help prevent or lessen indigestion by eating smaller, lighter, and not spicy meals. Try eating more slowly and throughout the day. Avoid foods that upset your stomach and taking any irritating medications.
If these steps don’t help, try taking over-the-counter (OTC) medications such as antacids.
If symptoms last longer than 2 weeks or don’t respond to the treatments, call your doctor, who will rule out more serious causes of dyspepsia.
2. Acid reflux and GERD
- Burning in the upper abdomen that radiates to the chest
- Throat irritation or bad taste in mouth
Acid reflux, or heartburn, occurs when the circular muscle (sphincter) between your esophagus and your stomach does not completely close. That allows stomach acid to flow up into your esophagus, causing a burning sensation and a bad taste, which can cause you to retch.
Acid reflux may happen now and then after eating something, like spicy foods or alcohol. Pregnant people may also get it more frequently than usual.
Treating acid reflux
Acid reflux may be treated with OTC antacids.
If you have acid reflux regularly (more than twice a week), it’s called GERD. You should see a doctor, who can rule out other causes and provide medications.
- Pain in your upper abdomen that may get better or worse when you eat
- A feeling of fullness in your upper abdomen after eating
Gastritis is an inflammation of the lining of your stomach. It may happen suddenly (acute gastritis) or gradually (chronic gastritis). Chronic gastritis may lead to ulcers, or sores, in the stomach and the lining of the upper part of your small intestine (duodenum) or both.
Gastritis is often caused by eating spicy, greasy food and drinking alcohol. In addition, medications such as nonsteroidal anti-inflammatories (Advil, Aleve, Motrin) can trigger gastritis.
An infection of H. pylori—the bacteria that causes stomach ulcers—can also lead to gastritis.
Gastritis is treated by avoiding foods and medications that trigger symptoms. Some people may need to take OTC antacids or, if you have an H. pylori infection, you will be given antibiotics.
4. Food poisoning
- Stomach cramps
- Possible dehydration
Food poisoning is an infection of the digestive tract caused by eating contaminated food. Symptoms typically appear within hours of eating but can occur within minutes or several days later.
Treating food poisoning
Food poisoning symptoms usually go away on their own within a day or two. But because it can cause severe vomiting and diarrhea, you may be at risk for dehydration. Call your doctor if you can’t keep anything down or you develop signs of dehydration (such as dizziness and decreased urine).
- Nausea and vomiting
- Crampy abdominal pain
- Possible fever
- Possible dehydration
Gastroenteritis, also called the “stomach flu,” is caused by bacteria or a virus including norovirus, rotavirus, and adenovirus, and the flu.
Treatment may include prescription anti-nausea medication and over-the-counter pain medication. It’s also important to stay hydrated by drinking water and electrolyte replacement drinks (Gatorade) and eating soup.
If you become dehydrated or can’t keep anything down, call your doctor. You may need to be given medications and fluids through an IV.
Retching is usually a symptom of another problem, and usually that primary problem is evident whether it is food poisoning, motion sickness, or pregnancy. But if the primary problem is not obvious, discuss this with your doctor—particularly if it keeps occurring. —Dr. Manuelpillai
6. Morning sickness
- Possible dehydration
Morning sickness is a common symptom of pregnancy, especially during the first trimester. Despite its name, morning sickness can happen at any time of day.
Morning sickness in early pregnancy is probably caused by changes in hormone levels, especially rising levels of a hormone called human chorionic gonadotropin (hCG). This hormone may also make you more sensitive to certain foods and odors. Even foods you normally like may make you gag and retch.
Morning sickness during pregnancy won’t hurt you or your baby. Symptoms improve in many women after about 12 weeks.
Treating morning sickness
Treatment includes avoiding trigger foods and odors, and eating small, regular meals. Over-the-counter therapies—such as ginger, vitamin B-6 supplements, and doxylamine (Unisom)—can also help soothe symptoms. Or your doctor may prescribe anti-nausea medications such as ondansetron (Zofran), metoclopramide (Reglan), or phenergan.
Some women find acupuncture, acupressure, or aromatherapy helpful. Always discuss options like these with your doctor first to make sure they’re safe for you and your baby.
In some cases, morning sickness is so severe that it lasts throughout your pregnancy and interferes with your ability to eat, drink, or perform daily activities. This is called hyperemesis gravidarum. It can cause weight loss and dehydration.
Call your doctor if you have severe vomiting and nausea, are dehydrated, or can’t keep down foods or liquids. You may need medications and fluids through an IV or be hospitalized.
7. Motion sickness
- Dizziness or feeling uneasy
- Cold sweats
Motion sickness is a feeling that you’re spinning, falling, or moving when you’re not. It can happen when you’re traveling in a car, train, boat, or plane. Retching and other symptoms like dizziness develop when your brain misinterprets signals from your sensory organs, such as your ears.
You may be able to avoid feeling sick by staring at a fixed object or area while in motion. If possible, avoid sitting in locations that can make motion sickness worse. These include the lower decks of a boat, riding backward on a train, sitting in the back seat of a car, and sitting toward the rear of a plane.
Treating motion sickness
Some people find relief by wearing acupressure wristbands and bracelets when they travel. These are available at your local pharmacy.
You can help prevent motion sickness by taking over-the-counter medication before you travel. These include antihistamines such as dimenhydrinate (Dramamine), scopolamine, meclizine (Antivert), and promethazine (Phenergan).
- Increased saliva
Many medications have side effects such as nausea, retching, or vomiting. Some of the most common include chemotherapy drugs, general anesthesia, certain antibiotics, supplements, NSAIDs, and opioid medications.
Treating retching from medications
If you’re undergoing chemotherapy, your doctor should know which chemotherapy drugs are most likely to cause symptoms like retching. They may prescribe anti-nausea medication to prevent or treat these symptoms.
For retching caused by other medications, treatment includes pre-medicating before undergoing general anesthesia if you have had a bad reaction in the past and avoiding medications that trigger these symptoms.
9. Anxiety and panic attacks
- Anxious or uneasy feeling
- Numbness and tingling in hands and fingers
People experience different types of anxiety, and their symptoms may vary. Some people feel sick to their stomachs and retch when they have anxiety. You can usually identify what event or situation triggered your anxiety.
A panic attack is sudden severe anxiety. Symptoms are often mistaken for those of a heart attack.
Just as there are many forms of anxiety, there are many types of treatment for it. The main types include psychotherapy and behavioral changes, such as exercising, keeping a journal, and meditating. Anti-anxiety medications may be necessary for some people.
Retching in infants and children
There are several different causes of retching in children and infants. If your child is retching a lot, watch them for signs of dehydration. Call your pediatrician or bring your child to the ER, depending on how serious the symptoms are. If your child is not gaining weight, tell your doctor.
Acid reflux and GERD
The circular muscle (sphincter) between the esophagus and the stomach may not be fully developed in babies, so acids from the stomach are able to flow back up into the esophagus.
Your pediatrician may recommend changes to your baby’s feedings, such as keeping your child upright, providing smaller and more frequent meals, and burping your child frequently. If these changes aren’t helping, your pediatrician may recommend you thicken or change the formula you are giving to your baby. Medication may also be needed.
If your baby has retching along with forceful projectile vomiting, it may be a sign of pyloric stenosis. This occurs when the muscular valve between the stomach and intestines (the pylorus) is thickened and narrowed. This prevents food from passing. Pyloric stenosis can be fixed with surgery.
Bacterial or viral infection
Children who get bacterial or viral stomach infections are much more likely to develop dehydration than adults. To prevent it, it’s important to give your child small, frequent meals and fluids when they’re sick.
Often, younger children develop food allergies when they’re fed formula or when new foods are introduced. However, allergies can occur at any age and can vary from mild symptoms (rash, swelling) to life-threatening anaphylaxis (difficulty breathing, confusion). If your child develops signs of anaphylaxis, call 911.
There are many causes of constipation in children, and sometimes it can cause retching. The main causes tend to be low fiber intake, dehydration, and behavioral issues. The first two causes can easily be treated by increasing your child’s fiber and fluid intake.
Behavioral issues, on the other hand, usually occur when your child is in the process of being potty trained. They may either hold in their stool because they don’t want to use a public bathroom or they don't want to stop playing. This can often be treated by encouraging routine bowel movements at the same time every day.
Other causes of retching in children include anxiety, migraines, and head injury.
Other possible causes
A number of conditions may also cause retching.
When to call the doctor
- Your retching lasts longer than expected or is making it hard to tolerate food and fluids.
- Your symptoms continue despite avoiding triggers or taking OTC medications.
- You develop signs of mild dehydration such as decreased urine, dry mouth, and increased thirst.
Should I go to the ER?
You should go to the ER if you have any of these signs of a more serious problem:
- Severe abdominal pain, particularly if it occurs suddenly or if it starts as general pain and then becomes more specific
- Chest or abdominal pain that radiates to your jaw, neck, shoulder, or arm or is associated with dizziness, sweating, or difficulty breathing
- Vomit that includes blood or a substance that looks like coffee grounds
- Bloody or black diarrhea
- Inability to keep down food or water
- Signs of more severe dehydration such as confusion, dizziness, heart racing, and no urine
Although retching may feel terrible, it is rarely dangerous unless you develop dehydration. The most important thing you can do is to try to prevent dehydration by drinking frequent, small amounts of fluid, preferably water and/or fluids with electrolytes such as Pedialyte. —Dr. Manuelpillai
- Mindfulness, talk therapy, or a combination of methods can help reduce digestive issues caused by stress.
- If something in your diet is making you retch, keep a food diary and jot down when you have symptoms. This can help you identify which foods and drinks affect you.
- Drinking herbal teas, such as those with ginger and peppermint, can soothe digestive issues.
- Taking antacids can relieve indigestion but should only be used sparingly. See your doctor if you find that you need to take antacids frequently or daily, particularly if this occurs for longer than 2 weeks.
Other treatment options
- If you can’t keep fluids down, you may need to receive fluids through an IV.
- In some cases of retching, such as pregnancy or a reaction to medication, anti-nausea medication may be prescribed.
- If retching is due to an obstruction or blockage in your digestive tract, surgery may be necessary.
- Anti-nausea medications can be helpful, but it’s important to use them only under your doctor’s supervision. Taking these medications too often may mask a more serious health problem. Taking anti-nausea medication can actually worsen some conditions, such as a bowel obstruction.
Dr. Manuelpillai is a board-certified Emergency Medicine physician. She received her undergraduate degree in Health Science Studies from Quinnipiac University (2002). She then went on to graduated from Rosalind Franklin University of Medicine and Sciences/The Chicago Medical School (2007) where she served on the Executive Student Council, as well as was the alternate delegate to the AMA/ISMS-MSS Governing Council and the student representative to the Illinois State Medical Society (ISMS) Education and Health Workforce committee. She completed an internship year with UCLA-Harbor Medical Center's Department of Internal Medicine followed by an emergency medicine residency program at Boston Medical Center (2011) while also serving as the resident representative to the Massachusetts Medical Society (MMS) committee on Student Health & Sports Medicine. She then started working at Saints Medical Center (later Lowell General Hospital/Saints Campus and Main Campus) in Lowell Massachusetts where she served as the Continuous Quality Improvement Director for the emergency medicine group, as well as was the representative for the emergency department on the Sepsis, Stroke and PCI Quality Assurance and Compliance Committees. She joined Buoy Health in 2019. She currently works in multiple emergency departments both in the community and academics, as well as previously worked in multiple urgent care centers. She believes this mix of experiences has given her a unique perspective on the care of acute illnesses.