Nausea and Vomiting

Nausea is the feeling of wanting to be sick (vomit). Vomiting is when you 'throw up'. The contents of your stomach rise up your food pipe (oesophagus, or gullet) and spill out of your mouth or nose. Nausea and vomiting are controlled by a vomiting centre in your brain. Nausea and vomiting may be due to drinking too much alcohol, food poisoning or a tummy bug (viral infection). But you should get medical advice if you vomit repeatedly for more than 48 hours or feel unwell or weak. If you vomit blood or have unexplained problems like weight loss or difficulty swallowing, you should see your GP urgently. The most common causes are mentioned below.

What are nausea and vomiting?

Nausea is the feeling of wanting to be sick (vomit). Vomiting is way the body gets rid of the stomach's contents. It may be due to irritation of the stomach lining by alcohol, food poisoning or a tummy bug (viral infection). In most cases, the nausea and vomiting settle down within 48 hours. But nausea and vomiting may also be caused by a direct effect on the vomiting centre of the brain. This explains the nausea and vomiting that often accompany migraines, the early stages of pregnancy, inner ear infections and some medication like chemotherapy medicines.

Who is affected by nausea and vomiting?

Nausea and vomiting can affect all ages. It is a very common symptom with many possible causes. Some causes are more likely in different age groups - for more information see below.

Outbreaks of vomiting may be caused by viruses such as norovirus. This is a group of highly infectious viruses which cause nausea, then vomiting and watery diarrhoea. The vast majority of people recover within 48 hours. Babies and very elderly people may become dehydrated and need to be hospitalised. Over half a million people are estimated to be affected every winter in the UK.

People being treated for cancer with chemotherapy may experience nausea and vomiting.

Elderly people who start to vomit unexpectedly may have an underlying urinary tract infection or pneumonia. Repeated vomiting can cause loss of water from the body (dehydration), especially among the very old and very young.

What investigations will be advised?

The doctor will want to know how long your nausea and vomiting have lasted and whether you have any other symptoms. The doctor will particularly ask about symptoms which may suggest an underlying serious condition. These are known as 'red flags'.

Your doctor will want to know

  • Did it start suddenly or develop over time? Did anything trigger it? How long has it lasted?
  • When do you vomit? Is it worse when you move your head?
  • Do you feel feverish?
  • Are you coughing up blood or bile?
  • Do you feel ill? Do you have a fever, weight loss or tummy (abdominal) pains? Headaches?
  • How much alcohol do your drink?
  • When was your last period? Could you be pregnant?
  • Have you started any new medication recently?

'Red flag' symptoms that may suggest serious underlying disease

  • Vomiting up blood or bile.
  • Weight loss.
  • Severe tummy (abdominal) pain.
  • High fever, neck stiffness, reluctance to look at light.
  • Increasing weakness/loss of consciousness.
  • Continuous or worsening vomiting after 48 hours.
  • This information will help the doctor to make a diagnosis. Your doctor will examine you. He or she will check your temperature, chest and abdomen. You may be asked to produce a urine sample and have a blood test. You may be asked to do a pregnancy test. Further tests of your stomach and abdomen may be advised. Referral to a specialist is possible.

What causes nausea and vomiting?

Gastroenteritis

Gastroenteritis is an infection of the gut. It causes diarrhoea, and may also cause vomiting, tummy pain and other symptoms. In most cases the infection clears within a few days, but sometimes takes longer. The main risk is loss of water from the body (dehydration). The main treatment is to give your child lots to drink. This may mean giving special rehydration drinks. Also, once any dehydration is treated with drinks, encourage your child to eat as normally as possible. For more information see separate leaflets called Gastroenteritis in Children and Gastroenteritis in Adults.

Urine Infection

Urine infection in children is common. It can cause various symptoms, including vomiting. A course of antibiotics will usually clear the infection quickly. In most cases, a child with a urine infection will make a full recovery. Sometimes tests to check on the kidneys and/or bladder are advised after the infection has cleared. Your doctor will advise if your child needs these tests. This depends on your child's age, the severity of the infection, and whether it has happened before. See separate leaflet called Urine Infection in Children for more detail.

Pregnancy

Many women have nausea and vomiting during the first 12 weeks of pregnancy. In most cases it is mild and does not need any specific treatment. In more severe cases, an anti-sickness medicine is sometimes used. A rare form of extreme vomiting in pregnancy (hyperemesis gravidarum) can result in loss of water from the body (dehydration) and even require a short hospital stay. For more information see separate leaflet called Sickness and Vomiting of Pregnancy.

Migraine

Migraine causes attacks of headaches, often with feeling sick or vomiting. Treatment options include avoiding possible triggers, painkillers, anti-inflammatory painkillers, antisickness medicines, and triptan medicines. A medicine to prevent migraine attacks is an option if the attacks are frequent or severe. For more information see separate leaflet called Migraine.

Labyrinthitis

Labyrinthitis and vestibular neuritis are most commonly caused by a viral infection that affects the inner ear. These conditions typically cause intense dizziness, often with vomiting (vertigo). In most cases the symptoms gradually ease and go within a few weeks as the infection clears. Medication may help to ease symptoms. There are some less common causes which may have a different outlook and treatment. See separate leaflet called Labyrinthitis and Vestibular Neuritis for more detail.

The inner ear is also responsible for motion sickness. Motion sickness is caused by disturbance of the inner ear which controls balance. Many people develop nausea and vomiting on a boat or long car ride.

Medication

Chemotherapy medicines used to treat cancer tend to cause less nausea and vomiting than in the past and the symptoms can be well controlled. But many medicines, including chemotherapy ones, can cause nausea. Be sure to mention any new medication or dietary changes to your doctor who may be able to suggest substitutes.

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Less chance of swelling

Less likely to develop swelling of your feet, ankles or hands.

Other causes

Appendicitis, inflammation of the pancreas (pancreatitis), kidney stones and infections, and gallstones - these can all cause severe tummy (abdominal) pain and nausea and vomiting. If severe, call for an ambulance.

Blockage - repeated and severe vomiting may be due to a blockage anywhere along the gut (intestine). This could be a twisted loop of bowel, cancerous growth or non-cancerous narrowing. This is an emergency and you need to call an ambulance.

Raised pressure in the brain - meningitis, brain tumours and head injuries can increase pressure in the brain, which can cause nausea and vomiting. Call for an ambulance if you suspect meningitis in your child.

Kidney or liver failure and uncontrolled diabetes - these can cause nausea and vomiting. A blood test should help to diagnose these rare causes.

Eating disorders - some people make themselves vomit as part of an eating disorder (bulimia or anorexia).

What treatments may be offered?

Treatment will depend on the likely cause of your nausea and vomiting.

You will be strongly encouraged to cut down alcohol if you drink too much.

You will be offered advice if you're pregnant but medication is usually not offered unless you're lacking in water in your body (dehydrated).

You may be referred to a specialist for further tests. Most cases will be managed by your doctor but you may be referred for further investigation and treatment at a hospital.

What can you do if you develop nausea and vomiting?

  • Try not to panic.
  • Call 999 if the vomiting is severe and you are weak or have severe tummy (abdominal) pain.
  • See your doctor urgently (within a few days) if you develop 'red flag' symptoms.
  • See your doctor if your vomiting lasts for more than 48 hours and is not improving.

How can I avoid nausea and vomiting?

Careful hand washing and hygiene help to prevent the spread of tummy (abdominal) bugs. Thorough cooking and food hygiene minimise the risk of food poisoning. Avoid excessive alcohol and get help if you are dependent on alcohol. People who have migraines may be able to identify triggers that they can try to avoid - for example, foods like cheese.

What is the outlook (prognosis)?

This depends on the underlying cause but is generally very good. People who have alcohol-related vomiting on a regular basis must address their alcohol dependence. Most nausea and vomiting are due to short-lived viral infections, do not need special treatment and should get better within a week.