What is intractable vomiting?

Intractable vomiting refers to vomiting that is difficult to control. It doesn’t lessen with time or traditional treatments. Intractable vomiting is often accompanied by nausea, when you constantly feel as if you’re about to vomit.

This condition is concerning because when you can’t keep anything down, it’s difficult to stay hydrated and get enough nutrients. This can make you feel weak and fatigued. Taking steps toward a diagnosis and receiving medical treatment can help.

If you or a loved one is experiencing intractable vomiting and nausea, see a doctor. Your doctor will likely ask several key questions to find out about symptoms and possible potential diagnoses. Some of the most common intractable vomiting causes include:

Acute gastroenteritis

Acute gastroenteritis occurs when an infectious organism irritates the digestive tract, resulting in nausea and vomiting. Some of the most common organisms associated with vomiting include:

If the underlying cause is bacteria or a parasite, your doctor may prescribe treatments. Unfortunately, viruses have no cure other than supportive treatment.

Long-lasting gastroenteritis may require you to receive intravenous fluids and anti-nausea medications to reduce the effects of vomiting. Examples of these medications include ondansetron (Zofran) and promethazine (Phenergan).

Post-operative nausea

Many people can have intractable vomiting after getting anesthesia gases and medications associated with surgery. Because some of the medications can take time to wear off, you may have an extended period of vomiting and nausea.

Some people are known to be at greater risk for post-operative nausea. This includes women, nonsmokers, and those who receive opioid painkillers during or after surgery. This nausea will typically resolve with time.

Increased intracranial pressure

Intracranial pressure (ICP) is the balance between blood, cerebrospinal fluid, and the brain in the skull. If your ICP gets too high, you may start to feel sick. Some common causes of increased ICP include:

The treatment for ICP depends on the underlying cause. It can include medications to reduce swelling as well as the removal of a tumor or blood clot affecting the brain.

Taking chemotherapy and other medications

Some medications, especially chemotherapy drugs, are especially likely to cause intractable nausea and vomiting. Doctors will often try to prevent this by prescribing medications to take before, during, and after chemotherapy treatments. However, they may not be effective in reducing symptoms associated with nausea.

Other medications can also cause intractable nausea and vomiting. These include:

  • antibiotics
  • digoxin
  • anti-seizure medications
  • opiates
  • hormones

Talk to your doctor about how to safely come off a medication, reduce your dose, or switch to comparable treatment if you’re having negative side effects.

Gastric outlet obstruction

Gastric outlet obstruction, which is also known as pyloric stenosis, can affect the stomach’s ability to empty effectively. The pylorus is the portion of stomach that connects the stomach to the small intestine. If digested food can’t pass to the small intestine, the food can build up and nausea can occur.

People with long-term peptic ulcer disease are at greater risk for gastric outlet obstruction. Sometimes, you may require dilation or enlargement of the pylorus to help your stomach empty more effectively.


Gastroparesis is a condition that occurs when your gastric system doesn’t move effectively. As a result, you can feel nauseated and vomit.

A doctor can listen to the stomach and use noninvasive methods, such as ultrasound, to visualize stomach movement and diagnose gastroparesis. Diabetes is a common cause.

Making changes to your diet and taking medications to stimulate gastrointestinal emptying can help.

Hyperemesis gravidarum

This condition is one that affects an estimated 1 percent of pregnant women. With hyperemesis gravidarum, you’ll have severe nausea. It often requires hospitalization for intravenous fluids to prevent dehydration. The condition most commonly occurs within the first nine weeks of pregnancy, but it may continue throughout.

Eating smaller meals and taking medications to reduce nausea can help. However, you should always talk to your doctor before starting any medications to ensure they won’t affect your pregnancy.

Chronic nausea vomiting syndrome

With chronic nausea vomiting syndrome, you have chronic vomiting for three months with co-occurring symptoms that include:

  • nausea that occurs once a day
  • vomiting at least once weekly

A doctor will likely rule out other potential causes through an upper endoscopy. This involves inserting a scope down the throat to evaluate the esophagus. If there are no other potential causes, chronic nausea vomiting syndrome may be to blame.

Cyclic vomiting syndrome

Cyclic vomiting syndrome is a medical condition where you experience episodes of vomiting that last for three to six days, and then symptoms improve. This condition most commonly occurs in children, but it can also take place in adults.

Doctors don’t know what causes cyclic vomiting syndrome, but some theories include food allergies or hormone fluctuations (especially related to a woman’s menstrual cycle). Chronic, high-dose cannabis use is another suspected cause of cyclic vomiting syndrome.

Intractable vomiting can have many potential causes. It’s important to seek treatment before you experience the more severe effects, including dehydration and malnutrition.

Ideally, a doctor can identify the underlying cause and prescribe treatments to help reduce these effects. Contact a doctor as soon as possible to begin the diagnostic process.