How to Manage Nausea and Vomiting

What are nausea and vomiting?

Nausea and vomiting are upsetting symptoms that can have a big impact on your well-being. They often happen together, but not always.

Nausea is an upset or queasy stomach that makes you feel like you may throw up (vomit). Nausea can also cause you to have more saliva (spit) in your mouth, cold or damp skin, a fast heartbeat, or feel light-headed.

Vomiting is “throwing up” the food and liquid in your stomach through your mouth. Vomiting when there is nothing in your stomach to come up is called dry heaves or retching.

Causes of nausea and vomiting when you have cancer

Your health-care team will work with you to find the cause of your nausea and vomiting so that it can be treated. Some examples of why you may have nausea and vomiting are:

• Cancer
• Headache
• Cancer treatments
• Constipation (or other problems with pooing)
• Infection
• Anxiety
• Pain
• Medications
• Other medical problems

Safety note: If you have a headache and severe nausea and vomiting, contact your physician right away.

When to talk to your health-care team

Ask your health-care team if your treatment can cause nausea and vomiting and what you can do to prevent it. Tell your health-care team if:

• You have any nausea or vomiting
• Your medicine to prevent or control nausea or vomiting is not working

The symptoms listed below may need treatment right away. Speak to your health-care team to get emergency help if you:

• Are not able to keep down any liquids, food or medicine for 24 hours
• Are weak, dizzy and confused
• Have a severe headache
• Throw up blood or dark fluids that look like coffee grounds
• Feel pain when you retch or vomit
• Pee less than normal over 24 hours
• Are constipated (cannot poo)
• Have a fever (temperature taken by mouth above 38.3 C (100.9 F) at any time OR above 38 C ( 100.4 F) for at least one hour)

Managing nausea and vomiting

It is easier to prevent nausea with medicine than to treat it once it has started. Treating nausea and vomiting helps you keep your strength up during treatment. This section describes things you and your health-care team can do to manage your nausea.

Take your nausea medicine

Your health-care team may prescribe medicine to help control your nausea. Always take your nausea medicine when and how your physician or nurse told you to. Talk to your doctor, nurse or pharmacist if you have questions about your nausea medicine.

There are two common ways to take nausea medicine:

1. On a set schedule to prevent and control nausea, even when you do not have nausea, and/or
2. As needed when you begin to feel nauseous
   • Your doctor may call this “rescue medicine”
   • Keep it with you all the time in case you need it

Remember:

• Most nausea medicines take 30 to 60 minutes to start working
• Talk to your health-care team if your medicine does not stop your nausea or vomiting
• Clearly mark your medicine bottles so you can find your nausea medicine quickly and easily when you need it

Medicinal cannabis (marijuana)

You may be curious about trying different forms of cannabis to help treat symptoms and side effects. Some forms may help with nausea and vomiting from chemotherapy. Talk to your health-care team about whether cannabis may help your nausea and vomiting.

What to do if you throw up

Take your nausea medicine. If you throw up between doses of your scheduled nausea medicine:

• Take your “rescue” nausea medicine right away, as directed by your physician, nurse or pharmacist
• Wait 30 to 60 minutes for the medicine to start working
• Take your next dose of scheduled nausea medicine at the usual time

Start drinking and eating slowly. Start with clear liquids such as juice, clear broth, gelatin desserts, ice pops, water or flat soda like ginger ale (pop that no longer has bubbles). Once you can drink liquids without throwing up, start adding solid food back into your diet. Begin with bland, easy-to-digest foods such as cereal, toast, rice, pasta or crackers.

Clean your mouth. Brush your teeth or use homemade mouthwash after throwing up. Do not swallow the mouthwash. Spit it out after rinsing your mouth.

To make your own homemade mouthwash, mix together:

• One teaspoon (5 mL) salt
• One teaspoon (5 mL) baking soda
• Four cups (1 L) of lukewarm water

Rinse and spit to clean your mouth as needed.

Nausea and vomiting can make you more sensitive to tastes and smells

If you have a bad taste in your mouth:

• Keep your mouth clean
• Gently brush your teeth and tongue
• If you have mouth sores, use homemade mouthwash to rinse your mouth instead
• Suck on hard candies, lemon drops, mints or gum
• If you do not have mouth sores, citrus flavours such as oranges and lemons may help the bad taste
  • Avoid citrus if you have mouth sores.

If the smell of food or drinks bothers you:

• Drink liquids from a travel mug with a lid to avoid their smell
• Eat cold or room-temperature food
• Open a window or use a fan to get rid of food smells in the room
• Ask someone else to make meals or buy prepared meals
• Try to get some fresh air.

Eat and drink as much as you can to keep your strength up. Strategies include:

• Eat small meals every two to three hours
• Hunger can make nausea worse; use a small plate so you do not feel pressure to eat larger meals
• Drink at least six to eight cups of unsweetened liquids per day, unless your health-care team told you to limit liquids
• Suck on ice chips, ice pops or frozen fruit if you find it hard to drink
• Eat and drink at least 30 minutes apart so you do not fill up on liquids instead of solid food
• Do not lie down for 30 to 60 minutes after eating
• Take your time while eating

A dietitian can help you find ways to eat and drink well while you are on cancer treatment. Ask your health-care team to refer you to a registered dietitian. You can also visit unlockfood.ca or call 1-866-797-0000 to speak to a registered dietitian for free.

Do calming activities

Relaxing activities can help you feel more in control of your mind and body when you have nausea. These activities may help you relax:

• Deep breathing exercises
• Getting fresh air through an open window or using a fan set on low for a gentle breeze
• Watching TV or a movie
• Listening to music
• Progressive muscle relaxation (deeply relaxing muscles in the body to release stress and tension)

Try complementary therapies

Complementary therapies are therapies you can try along with your regular cancer treatments to help with symptoms or side effects. You may think about trying these therapies to help with your nausea:

• Acupuncture (thin needles put into different points on your body to help relieve nausea and other symptoms)
• Acupressure (pressure put on different points on your body to help relieve nausea and other symptoms)
• Guided imagery (imagining yourself in calm and relaxing places)

Always talk to your health-care team before starting any complementary therapies.

To learn about complementary therapies, talk to:

• Your family physician or nurse practitioner
• A social worker, professional counsellor or spiritual care provider
• A certified or registered provider of the complementary therapy you would like to try

Get help from friends and family

Getting help with daily tasks and feeling cared for is important when you are not feeling well.

Your friends, family and members of your community may be willing to do things to help you cope. Do not be afraid to ask for help.

Friends and family can help you with:

• Grocery shopping
• Cooking and preparing meals
• Household chores

To learn more about online support groups, check out the Canadian Cancer Society’s Peer Support Service.

Key points

• It is easier to prevent nausea than to treat it once it has started
• Always take your nausea medicine the way your physician or nurse explained to you
• Eat and drink what you can to keep your strength up
• Try calming activities and complementary therapies to help your nausea
• Get help from friends, family and your community when you need it

Know when you need to get emergency help. Talk to your health-care team and review the list of emergency symptoms above.

Where to get more information

The Canadian Cancer Society is a trusted source of information. Visit cancer.ca or call 1-888-939-3333. Ask your health-care team for information about managing your nausea and vomiting. Ask who you should contact if you feel that your symptoms need immediate medical attention.

For more information on this symptom, or for guides to help manage other symptoms, visit Managing Symptoms, Side Effects & Well-Being.

If you need this information in an accessible format, contact 1-877-280-8538, TTY: 1-800-855-0511 or [email protected].

This patient guide was created by Ontario Health (Cancer Care Ontario) in collaboration with clinical experts and patients to provide information about nausea and vomiting. It should be used for information only and does not replace medical advice. This guide does not include all information available about managing nausea and vomiting. Always ask your health-care team if you have questions or concerns. The information in this guide does not create a physician-patient relationship between Ontario Health (Cancer Care Ontario) and you.