<
Diagram showing the sensory pathways between the stomach and the vomiting centre
in the brainstemNausea
Nausea is the name given to the feeling that precedes vomiting. It is often felt as a 'heaviness' in the throat or upper middle region of the abdomen (epigastrium), and may come in waves. Nausea may or may not be followed by retching and/or vomiting. Accompanying autonomic changes cause the person to feel cold and to sweat.
Questions Received:
Responses:
Two years ago I started having nausea. It is not constant, however, I am just about guaranteed five out of seven days of nausea. I have not vomited. I have had tests for ulcers and all sorts of blood tests. I am told I have very mild anemia and that I have developed a hypothyroid condition. Could either of these two conditions create my nausea? My doctor is at a loss and the medication I am on doesn't seem to do a thing. What about colon cancer - or any other cancer? Would it show up on the test for the ulcer?
1st September 1999
The problem with a symptom such as nausea is that it is non-specific and can be associated with a variety of situations. Acute medical problems such as digestive upsets and infections can trigger nausea, as can longer-term conditions such as hormonal imbalances and tumour development. Certain drugs can cause nausea. Even emotional events and psychological factors can result in feelings of nausea - "nauseating smells" and "sickening sights" for example. All of this makes it very difficult for a physician to pinpoint the cause of nausea accurately in a patient. For you the problem is a persistent one since you have experienced nausea on and off for two years, and it will require some careful detective work to home in on the cause. Some of the clues you may be able to identify for yourself, while others may require further clinical testing and the help of your doctor.
In many people, the feeling of nausea originates from the initial third of the digestive tract - perhaps an irritation of the lining of the oesophagus, stomach, or duodenum by an infectious organism or a chemical toxin, or damage to the lining resulting in the formation of an ulcer.
<
Diagram showing the sensory pathways between the stomach and the vomiting centre
in the brainstem
This is why your doctor has carried out tests to see if you have an ulcer. Problems with the liver can also sometimes produce nausea. You did not specify which tests were made, but it seems unlikely that the same tests would be able to detect colon cancer. If you think you have symptoms that are suggestive of a problem affecting the large intestine then it will be necessary to discuss these with your doctor and arrange for suitable tests.
As mentioned above, nausea can have a variety of causes, some of which are not related to the digestive system. Anaemia can indeed produce nausea, particularly if it has a rapid onset, although in your case the anaemia is apparently mild and thus would seem to be less likely as a cause. Hormonal changes and imbalances can also on occasion produce nausea - think of morning sickness during early pregnancy - so it is not impossible that hypothyroidism may be linked in your case. Hopefully it will be possible to correct both these imbalances by appropriate treatment and then see if the nausea resolves. You mentioned that you are currently taking medication - is that for these two conditions or is it to suppress the feeling of nausea?
Other sources of nausea include problems with the balance system (inner ear) and brain. If all the tests relating to your digestive system give normal results, then it will be worth extending the search to these other potential causes. This is where careful observation will help. Try to keep a record of when the feeling of nausea occurs and see whether it is linked with other events such as headaches (nausea is sometimes associated with migraine), the intake of particular types of food (for example fatty foods), the intake of medicines (several drugs used in the treatment of heart conditions can cause nausea), the time of day (uraemia produces nausea in the morning, as does gastritis caused by alcohol), and the relationship with physical activity or feelings of stress or anxiety. This sort of information will help your doctor locate the origin of your problem, and will also reveal whether the situation is becoming worse or improving over a longer time scale.
It is possible sometimes to soothe a feeling of nausea. For example, sips of sweetened liquids that are non-acidic can help to calm the stomach. Avoid activity when you are feeling nauseous, and if possible sit down or lie down slightly propped up. When travelling in a car sit in the front seat and look forward - try and avoid looking out of the side windows or down at reading materials.
Can you tell me the symptoms of a stomach ulcer? I have been feeling nauseous for approx. 3 months each time I eat something. Sometimes nausea is brought on even by the thought of just eating something.
21st March 2000
We are not in a position to diagnose your particular problem. If you are concerned by your symptoms, it will be worthwhile to visit your doctor to see whether there is a medical problem and if so to decide on the best treatment. The following notes are for information only:
Stomach (Gastric) Ulcer
The symptoms of a gastric ulcer can be quite variable but include a burning or cramping pain in the upper abdomen 1 to 2 hours after taking food, perhaps a feeling of nausea sometimes followed by vomiting, and a general feeling of fatigue. The pain can sometimes be relieved by taking more food, but for some people the pain is made worse by this. There tends to be an associated weight loss.
Duodenal Ulcer
The symptoms of duodenal ulcer tend to be more consistent than those of gastric ulcer. The pain is a steady, gnawing, burning, aching, or hunger-like discomfort high in the midline of the abdomen or slightly to one side or the other. The pain usually begins 2 to 3 hours after a meal, and nausea and vomiting may develop. The pain is usually relieved immediately after taking food or antacid preparations. There may be a gain in weight.