Causes, Treatments, and Remedies for Nausea, Vomiting, and Diarrhea

According to the FDA​ there are 48 million cases of foodborne illness in the US every year.

Diarrhea is one of those things that people don't need to see a healthcare provider about unless they are very young, very old or are at risk for other reasons (have a chronic illness like diabetes or immunocompromise), if it they have a severe case (unable to keep down any fluids), have extreme or ongoing pain, the presence of blood, high fever, or if they need a note for work.

For finding relief, it is important to try to discover the cause, treatments, and remedies for nausea, vomiting, and diarrhea

The Stomach

What is Gastroenteritis?  

Gastroenteritis is a very unpleasant illness consisting of stomach and intestinal inflammation, nausea and vomiting, diarrhea, cramps, sometimes gas, and occasionally, fever.   

Gastroenteritis is frequently caused by viruses (usually in the small intestine),  bacteria (typically in the large intestine), or a parasitic infection in either the small intestine, large intestine, or bile duct.

It can be challenging to differentiate between food poisoning and viral/bacterial gastroenteritis. A good history is necessary for diagnosis. When the history is vague or if there is any question, sending a stool specimen to the lab is ideal.

It is essential to ask the right questions.

The Intestine

What's Causing Your Stomach Problem?

Nausea and vomiting are usually symptoms of a viral issue, although bacterial causes are not uncommon. Additionally, gastrointestinal parasitic infections are not as unusual in the US as we would like to hope. Around one million gastrointestinal parasitic infections occur annually, with Giardia being among the most common.

It is important to try to find the cause so you can find a targeted approach to treatment. Additionally, if this is something potentially contagious, you don't want to pass it on to others. Initially, figuring out the cause of a stomach problem can be difficult. So, we ask many of these questions to try to determine the cause:

• Do you have any kids at home? If so, do they have the same problem? Are there stomach problems going around the classroom? This is typically a viral illness (rotavirus or norovirus) passed around in school through food and stool.

• What have you eaten in the last 24 hours? Did you eat out at a restaurant? Did anyone else eating with you get sick? Did it start right after you ate (within 30 minutes to six hours after eating)? Consider food poisoning - Bacterial gastroenteritis. 

• "Did you eat food that had been left out too long—maybe at a picnic or a party? Or did you consume something that was later recalled? You may be dealing with bacterial gastroenteritis (food poisoning).

• Did you travel outside the country? - Bacterial gastroenteritis/dysentery (food or water poisoning)

• What is your occupation? Do you work in a daycare or work in a profession dealing with human waste? - A stomach virus is the most common in this setting

• Are you an outdoor enthusiast? parasitic or bacterial (if eating or drinking tainted water)

• Do you have a cold, flu or COVID? Consider a viral cause of gastroenteritis.

• Are you taking an antibiotic? - Bacterial gastroenteritis. This is a good reason NOT to take antibiotics unless you have to: They mess up the natural flora in your gastrointestinal (GI) tract. Antibiotics may help treat your illness, but they also kill the good bacteria in your gut, leaving your stomach with an overgrowth of bad bacteria.

• Have you started a new medication? Metformin, a diabetic medication, is known to do this (initially, but GI symptoms usually go away after several days); NSAIDS (ibuprofen, naproxen), and chemotherapy. Other medications may cause diarrhea (antidepressants, PPIs (for example, omeprazole/Prilosec, Lansoprazole/Prevacid, and others ), and antacids. Most medications have the potential to cause diarrhea (just look at the side effect profile on the container). If you have just started a new medication and develop nausea, vomiting, or diarrhea, consider that the medication may be the culprit. If you are unable to tolerate your medicines, speak to a healthcare provider who should be able to provide a substitute or symptomatic relief.

  
  

• Have you had frequent bouts of diarrhea over time? Abdominal discomfort and/or diarrhea at least one day a week for at least three weeks or more? Consider IBS-Diarrheal-type (Irritable bowel syndrome-diarrheal type)

  
  

  Causes, Treatments, and Remedies for Nausea, Vomiting, and Diarrhea: General Approaches to Nausea, Vomiting, and Diarrhea

General Approaches: Symptomatic Relief and Supportive Care: Hydration and Electrolytes Are Crucial

Deep Breathing Exercises - Deep breathing exercises sometimes help manage nausea (especially motion sickness). This technique is practiced by taking a deep breath using your diaphragm muscle located just beneath your lower ribs (instead of using neck, shoulder, and upper chest muscles), pausing, and then releasing the breath - repeating this again several times.

Hydration

Dehydration is one of the most threatening aspects of gastroenteritis when there is vomiting and diarrhea. Especially in the very young and very old. It is IMPERATIVE that you stay well hydrated.  

Hydration - Initially try clear fluids, diluted juices, low-sugar electrolyte solutions/sports drinks, and ice cubes. If it is difficult to tolerate, just take frequent sips (don't chugalug - your stomach is angry!). Use anti-nausea medication, if you need to, so you can drink fluids! (see below)

Electrolytes

Be sure to maintain electrolytes (there is an electrolyte loss with vomiting and diarrhea – particularly sodium and potassium) Drink sports drinks – for example, low sugar options like Propel, Gatorade, and Pedialyte.

Slowly, advance your diet as tolerated: Begin with water, clear liquids, and broth and advance to more solids like bananas, rice, apple sauce, and toast (this BRAT diet is an old approach but continues to work well)

Nausea and Vomiting - OTC, Remedies and Prescriptive Treatments

Over-the-Counter Medicines

• Bismuth subsalicylate (common: Pepto Bismol or Kaopectate). These help slow stomach movement and irritation, bloating, and gas (do not take if you have a fever or blood in your stool). Be sure to check the label for contraindications. It may cause a person's stool to be black.

• Emetrol as directed over the counter

Considered Natural Remedies:

• Ginger

• Honey – according to Mayo 

• Peppermint (tea)

• Chamomile (tea)

• Basil

• Lemon Juice in warm water

• Pressure Points from Dana-Farber Cancer Institute

• Probiotics can significantly reduce the duration of diarrhea and perhaps help prevent it. An abstract in Science Direct cites studies of "bacteria (Lactobacillus, Bifidobacterium, 

​       Bacillus, Clostridium butyricum, Streptococcus, Enterococcus) and yeast (Saccharomyces        boulardii)" in the management of an array of human diarrheal diseases. *Some people may not be able to take probiotics, especially those with an immune disorder.

Prescription medication

The following medication may be VERY important in maintaining hydration – again, one of the biggest factors in recovery:

• Ondansetron/Zofran

• Promethazine/Phenergan (more potential side effects than Zofran)

• If you have a bacterial infection, you may be given an antibiotic.

Please Note-if you are of child-bearing age, are sexually active, and have nausea and vomiting only, with no diarrhea, you may want to check to make sure you are not pregnant.

Diarrhea - Treatments and Remedies

Over-the-Counter

It is usually recommended that a person let their diarrhea run its course because it is considered a toxin, and your body needs to get rid of it, BUT, if you just can't take it, you can consider the following:

• Imodium AD (symptom Imodium Multi- has additional ingredients for    ​

• Bulking Agents – Oddly enough, bulking agents, which are used for constipation, it is also used for diarrhea because they expand in the GI tract and sometimes can help diarrhea turn into a more formed stool: Metamucil

• Bismuth subsalicylate (common: Pepto Bismol or Kaopectate). (Read the contraindications on the label). It may cause your stool to become black. Avoid if fever or if you have blood in your stool.

Considered Natural Remedies and Approaches

• Probiotics:  Acidophilus (Lactobacillus acidophilus) and Lactobacillus rhamnosis and   

       Lactobacillus reuteri (*Some people have contraindications to taking probiotics - for example, those on chemo, those with autoimmunity, pregnant, and nursing).

Prescriptive Treatment

• Lomotil (Atropine and diphenoxylate) – Controlled substance

• If you have a bacterial infection, you may be given an antibiotic.

Abdominal Pain - Treatment and Remedies (pain/cramping)

Over-the-Counter

           Pepto Bismol helps some people

Natural Approaches and Herbal Remedies

           Heating Pad to the abdomen (intermittently for 15 minutes at a time)

           Peppermint (caps, teas) antispasmodic

Prescriptive Treatment

            Fairly common:  dicyclomine, hyoscyamine

            Rifaximin, and others

When to See a Healthcare Provider

As mentioned on other pages, if there are complications, you need to see a healthcare provider.

• If you believe you may have a bacterial infection-as above

• If you are unable to keep fluids down for 24-48 hours, especially if you have risk factors like diabetes, older age, and other underlying health conditions.

• If you have blood in your stool or are vomiting blood

• Dark stools (in the absence of taking Pepto Bismol, Aspirin, or Kaopectate) or dark coffee ground-like emesis (vomit) -

• You're dehydrated — signs of dehydration include dry mouth, dark yellow urine (should ideally be straw color), decreased or no urine, and inordinate weakness, dizziness, or feeling faint. Serious cases can lead to severe dehydration, neurological problems, kidney failure, and even death.

• If you have frequent, recurrent bouts of diarrhea

• Severe stomach pain

• Fever above 104 F (40 C)

• When in doubt