Extreme gagging

Extreme gagging

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My nephew is 28 and was born with cerebal palsy.  He is confined to a wheelchair, does not walk or talk and in the last several years, when he started gagging, has been fed through a tube in his stomach.  My sister has taken him to several different doctors without any resolution.  He has been on medication for heartburn, no help.  She started using lowfat ensure, no help.  He also has pain in his shoulder and just resently she found a lump by his neck.  When she presses on the lump it moves.

The gagging seems worse in the morning and he sometimes gags to the point he throws up clear mucus.  Then there are some days when he doesn't gag as much.  So far we haven't been able to figure why that might be when his routine didn't change.

My sister is very worried and does not know where to turn.  My nephew doesn't seem to be in pain except for his shoulder from time to time.  He hasn't lost weight and seems to be ok when he isn't gagging.

Does anyone have any suggestions.

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I have a 2-1/2 yr old daughter that was born with a cleft lip/palate (among other things) and had to have a g-button placed and a Nissin fundoplication at the age of 3 months. From the beginning she had extreme gagging and everyone I asked told me it was "normal" and it may or may not go away. We finally got to a GI DR. that put her on Prilosec and although she still has some gagging it has gotten better.  Hope this helps.

John C Hagan III, MD, FACS, FAAO Jun 08

John C Hagan III, MD, FACS, FAAO 12/20

John C Hagan III, MD, FACS, FAAO 04/18

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When you suffer from anxiety many of the symptoms can be physical. Some people experience a wide range of physical symptoms including anything from headaches to heart palpitations. In this series we will explore the many ways that anxiety can manifest in both physical and mental symptoms and what you can do about it. I thought we would start off this series by discussing the symptom of gagging.
Over the years we have received multiple questions about this particular symptom from members wondering what they can do about their anxiety induced gagging. For example, member Jacob asks, "How can I stop gagging?"
My "full-blown" panic attacks involve gagging and dry-heaving. When I start to get nervous, I can tell it's about to happen (a panic attack) and I start gagging uncontrollably. It's ruining my life!
And member Michael wrote in to tell us, "I feel like, and do gag when I get nervous." He goes on to describe how difficult it is to do things like go to the dentist:
Today I have to go to the dentist, and just the thought of going there and placing those x-ray things in my mouth makes me gag. If I'm around certain people, at times I do the same thing. Is there anything I can do? I have never seen a doctor to discuss this, and feel quite abnormal, even embarrassed.
Judging by the number of follow up comments it is clear to see that Jacob and Michael are not alone in dealing with this gagging problem. In researching this symptom I have found people who write on a variety of forums including those for ears, nose and throat, gastrointestinal, and anxiety health sites looking for some sort of remedy. It can be a very difficult symptom to deal with and especially you are not sure what is causing it in the first place.
The gag reflex is actually very beneficial to our survival as it helps to prevent us from choking or ingesting harmful substances. When the gag reflex is triggered, the muscles of the back of the throat start to contract in order to repel the toxic substance or prevent us from swallowing something which could impair our breathing. Gagging, dry heaves, diarrhea, nausea and vomiting can all be considered nervous system defensive behaviors, having the same purpose of getting rid of potentially harmful substances from our body.
With some people, this gag reflex is considered to be hyperactive and is set off by something other than the normal environmental triggers. One of the possible triggers for an over-reactive gag reflex can be anxiety as stress can fire off chemical signals to stimulate nervous system reactions including gagging or dry heaves.
Are there medical conditions which can cause the symptom of gagging?
If you are dealing with the feeling of chronic gagging, you really need to get this symptom checked out by a doctor first. Anxiety could be exacerbating an already existing medical condition which has been left untreated. It is always wise to rule out any medical cause for physical symptoms you may be experiencing so that the appropriate treatment is given.
Here are some medical issues which can cause gagging:
Multiple Sclerosis: Some MS patients experience what is known as dysphagia, which causes difficulty swallowing. The person may choke or gag after drinking liquids or eating certain foods. The person's speech may also be affected.
Post Nasal Drip: Sometimes the nasal drip caused by having a virus or allergy can cause irritation in the throat to cause you to have to constantly clear your throat or even gag.
An acid reflux problem could also be a culprit behind symptoms of gagging. Jan Gambino, an expert on our acid reflux site, describes the symptoms of acid reflux or GERD:
"If you have frequent symptoms such as heartburn, indigestion, burning, throat pain, difficulty swallowing and irritation to your esophagus, the doctor may diagnose G astroe sophageal R eflux D isease or GERD."
There may be other medical causes for the symptom of an over-reactive gag reflex, so you want to allow your doctor to investigate first, before assuming that it is caused by anxiety. In one case I read about, the patient's gagging was due to a physical anomaly of having an oversized "nasal concha" or turbinate. Turbinates control air-flow through your nasal passages and moisturize the air as it flows. In this person's case, the enlarged turbinate was restricting airflow as well as pressing down into the nasopharynx and soft palate, triggering his gag reflex. It took an Ear, Nose, and Throat specialist to discover this structural cause.
My doctor has determined that my gagging is not caused by medical reasons, now what? If you have been thoroughly checked out by doctor and/or any specialists to rule out a physical or medical cause for your symptom of gagging, there is a strong possibility that your hyperactive gag reflex may be caused by anxiety.
In reading about this problem from some of our members on Anxiety Connection, it does seem like a very hard issue to cope with especially when it interferes with everyday life. Things like eating out or going to the dentist may provoke a gagging response. You may feel a loss of control not knowing where or when the symptom may occur. The fear of it happening may actually become worse than the symptom itself. Some people may feel that losing the ability to control their gag reflex is destroying their life.
In researching for this article I found that many anxiety sufferers who have this gagging symptom may have been dealing with this since a very young age. Some people use remedies such as drinking a lot of fluids, sucking on candy, chewing strong flavored gum such as peppermint, or eating salty snacks. But for many, the homespun remedies don't work very well all the time.
If you feel that your gagging and/or dry heaves are caused by anxiety it makes sense to treat your anxiety. Here are some things you can do:
Figure out the triggers which set off your gag reflex. You may have to keep a journal and write down which circumstances seem to provoke this symptom in order to look for patterns. We have an article to help you to understand panic attacks and triggers.
One relaxation technique which may help is to learn how to control your breathing. Our Dr. Walcutt teaches how to use breathing techniques to feel calm and relaxed.
Another relaxation technique which may reduce the anxiety which is causing you to gag is called Progressive Muscle Relaxation. Psychologist Jennifer L. Fee walks us through the step by step process of tensing and relaxing muscles to achieve a sense of well being and calm.
Seeking the help of a qualified mental health therapist may be one of the best methods of treating your anxiety related symptoms. There are also many options of anxiety medications which may relieve the somatic symptoms associated with anxiety disorders.
There is research to show that hypnotherapy can be an effective method to treat an over-reactive gag reflex caused by anxiety. In a 2002 report entitled, " Psychic aspects of the overactive gag reflex (gagging) in connection with a clinical case " it is suggested that hypnosis therapy can be an effective treatment to augment any therapy designed to decrease anxiety induced gagging behaviors. Hypnotherapy seems to be used with good results especially for those who suffer from gagging during dental procedures. In a case study published in a 2005 issue of the International Journal of Clinical and Experimental Hypnosis , hypnopuncture (a a combination treatment of hypnosis and acupuncture) was used successfully to treat a patient suffering from an severe gag reflex.
Now we would like to hear from our members. Do you suffer from an over-reactive gag reflex caused by anxiety? How do you cope with this symptom? Let us hear your story as it could help someone else who is going through the same thing. Your thoughts, stories, and opinions are very important to us.
These articles were written by a longtime HealthCentral community member who shared valuable insights from her experience living with multiple chronic health conditions. She used the pen name "Merely Me."
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