wretching

Wretching, commonly spelled as retching in medical and common usage, refers to the involuntary, often rhythmic contractions of the stomach and esophagus that accompany nausea and the urge to vomit, without expulsion of gastric contents.

Symptoms include a nauseous sensation, increased saliva, gagging, throat tightening, abdominal and diaphragmatic contractions, and a tendency to dry heave. Patients may feel lightheaded or dizzy; vomiting may follow in many cases, but not always.

Common causes include acute gastroenteritis, food poisoning, pregnancy (especially early pregnancy), motion sickness, toxins or medications (such as chemotherapy, opioids), anxiety or distress, and first signs of a systemic illness. Less commonly, retching may occur in response to strong odors or gastric distension.

Pathophysiology involves stimulation of the vomiting reflex pathway, including the chemoreceptor trigger zone in the brainstem and vagal afferents from the gut, leading to coordinated abdominal and diaphragmatic contractions without immediate expulsion.

Diagnosis is clinical, based on history and absence of contents expelled. Management emphasizes treating the underlying cause and preventing dehydration: small sips of clear fluids, oral rehydration solutions, and antiemetic medications such as ondansetron or metoclopramide as appropriate. Severe or persistent retching, inability to retain fluids, or signs of dehydration require medical evaluation.

See also: nausea, vomiting, and emesis.