Feeling sick (nausea) and being sick (vomiting) can be a problem if you’re living with a terminal illness. They can be caused by the illness, or they may be a side effect of treatments or medication. Feeling sick and being sick can reduce your quality of life. And if you’re struggling to eat or drink, they could affect your health and wellbeing too. Anti-sickness medicines (antiemetics) can treat nausea and vomiting, and there are practical things you can do to help.
What are nausea and vomiting?
Nausea is the unpleasant feeling of needing to be sick. It often happens alongside other symptoms, like sweating, feeling cold, looking pale, or having a fast heart rate (tachycardia).
Vomiting is the act of being sick, which means the contents of the stomach being forced out through the mouth. Nausea and vomiting often happen together but they can happen on their own.
Causes of nausea and vomiting
Physical and psychological factors can contribute to nausea and vomiting. Causes of feeling sick and vomiting include:
- medicines, including opioids (strong painkillers) and non-steroidal anti-inflammatory drugs (NSAIDs)
- chemotherapy
- anticipatory nausea and vomiting (which some people may have before chemotherapy treatments)
- metabolic causes, for example, high calcium blood level (hypercalcaemia) and kidney failure
- the stomach not emptying properly (gastric stasis)
- constipation
- inflammation or ulcers in the stomach
- fluid build-up in the abdomen (ascites)
- enlarged liver (hepatomegaly)
- infection
- bowel obstruction.
- illness affecting the brain, such as metastases
- stress and anxiety.
Assessing nausea and vomiting
Healthcare professionals looking after you may want to assess what’s causing you to feel sick or be sick. Finding the cause can help them to decide on the best treatment. To do this, they might:
- take a history
- do a physical examination
- take blood or urine tests.
If you do not want a physical examination, let your healthcare professionals know. This can also be recorded in your advance care plan, if you have one. Advance care plans can also help other members of the healthcare team know what you’d like.
If you are being sick often, your nurse or doctor can also advise on drink and liquids to avoid any risk of dehydration.
Healthcare professionals might ask you some questions to understand more about what’s causing you to feel or be sick. It could be helpful to think about these questions ahead of time. They might ask you:
- how often you feel sick or are being sick, and how long it lasts for
- if it happens at a certain time of day (like first thing in the morning or after a meal)
- if anything makes it better or worse
- how long you’ve been experiencing nausea or vomiting
- what medicines you’re taking
- how often you go to the toilet
- how much you’re managing to eat and drink
- if you have any worries or concerns making you anxious.
Managing nausea and vomiting
After an assessment, your GP or specialist nurse can work out a treatment plan with you. Your care plan might include a combination of medicines, non-medical treatments and practical tips.
Practical tips
Everyone is different, so what works for some people may not work for others. Here are some practical tips you could try:
- Make sure you have a large bowl, tissues and water nearby in case you vomit.
- Eat small snacks often, rather than large meals.
- Drink cool fizzy drinks or flavoured water rather than hot drinks.
- Eat cold food instead of hot food, as strong smells can make you feel sick.
- Avoid greasy or spicy food.
- Choose things that taste OK now, rather than what you used to like to eat or drink. This is because things may taste different to you now.
- If you usually cook at home, think about asking someone else to prepare the food, as cooking smells can be a trigger.
- Avoid wearing perfume or other strong scents. And ask people close to you to avoid wearing perfume or using air fresheners near you.
- Make sure you’re positioned comfortably - sometimes lying flat can make nausea worse.
- Sudden movements, like sitting up quickly, can make nausea worse. Move gently when you’re sitting up or getting out of bed.
- Keep a record of when you feel sick or vomit. This can help the doctor or nurse spot a pattern.
- Try relaxing activities such as listening to music or doing breathing exercises.
Certain foods and drinks can be easier to eat and can help with feeling sick. They include:
- fizzy water or flavoured water
- plain-tasting foods, like mashed potato or rice pudding
- dry biscuits, crackers or toast
- food and drink containing ginger, like ginger ale or ginger biscuits
- boiled sweets and mints
- ice lollies
- cold foods
- salty foods like crisps or salted nuts.
If you are finding it difficult to swallow food, talk to your doctor or dietician about the best foods for you.
Non-medical treatments
Complementary therapies like acupuncture can help with nausea and vomiting. These may be available through your GP or local hospice.
Pressure bands worn around the wrists can help too. You can buy these from most pharmacies.
It might also help if you can find ways to feel more relaxed. This could be listening to music, doing breathing exercises or spending time with someone you feel comfortable with.
Feeling worried, stressed or anxious can make nausea and vomiting worse. Talking to someone you trust about how you’re feeling could help with your worries and improve your symptoms. If anxiety is a major factor in your nausea and vomiting, talking to a counsellor or psychological therapy may be helpful.
If you have concerns about practical issues, speaking to someone who can help, such as an occupational therapist or social worker, might help to lessen your worry and improve your symptoms.
For some people, cognitive behavioural therapy (CBT) can help with anticipatory nausea or vomiting. Anticipatory nausea or vomiting is feeling sick or vomiting before having a treatment like chemotherapy. Speak to your doctor if you are experiencing this to find out if this kind of support might be suitable.
Medicines
There are lots of different types of anti-sickness medicines (antiemetics). You might need more than one type. And it might take a couple of tries to find the best type for you.
You can take anti-sickness medicines as tablets or liquids. If you find it hard to take tablets or you’re vomiting a lot, you can have them as injections, or through a syringe driver (also called syringe pump). A syringe driver delivers medicine on a continuous basis through a tube under the skin.
Anti-sickness medicines work best when taken regularly, not just when you need them. They can be stopped if the cause of the nausea has been resolved.
Reviewing your medicines
Some medicines can make you feel nauseous or sick. If you’re concerned about this, ask your medical team or specialist nurse to review your medicines to see if you can stop taking any.
Do not stop any medicines before speaking with your medical team, GP or specialist nurse.
Getting support
Contact your GP, district nurse or specialist nurse if your symptoms do not improve.
Nausea and vomiting can cause serious complications if they’re not managed, including dehydration, altered blood electrolyte levels and emotional distress.
Ask for extra support from your healthcare team if you’re having trouble swallowing or you cannot take your usual medicines by mouth. They might suggest that you take medicines through an injection or a syringe driver instead.
If you would like to speak to someone about how you’re feeling or for practical information you can contact the Marie Curie Support Line for free on 0800 090 2309. Or you can email us at support@mariecurie.org.uk.
If you think it would help to speak to one of our Information and Support Nurses, please let the Support Line know and they can arrange a call back for you.