Overcoming Rumination Syndrome

William L. Golden PhD

Rumination syndrome is a gastrointestinal disorder where patients regurgitate food and/or liquids without any effort. The regurgitation is involuntary and not deliberate. Many rumination syndrome patients have been misdiagnosed as having bulimia. However, regurgitation in patients with bulimia is voluntary and intentional. Rumination syndrome patients are also frequently misdiagnosed as having Gastroesophageal reflux disorder (GERD). GERD is when stomach acid backs up into the esophagus and mouth. With rumination syndrome, solid food and/or liquid, that one just ingested, is regurgitated. The time span is different with these two disorders. Regurgitation, as a result of rumination syndrome, occurs shortly after eating, usually within 30 minutes to an hour of eating or drinking something. Acid reflux from GERD occurs hours after eating. Another difference is that GERD responds to medications, whereas rumination syndrome does not respond to any medical treatments.

There is a lot of misinformation about rumination syndrome. It is frequently reported to be most common in mentally handicapped people. My experience, and that of my collaborating gastroenterologist, has been that most of our patients are normal functioning individuals, who may have some stress-related factors, or may have no emotional factors at all contributing to their symptoms. My experience in treating numerous patients with rumination syndrome is that the main contributing factor is hyperventilation. Hyperventilation is either the result of rapid or thoracic breathing, as opposed to slow relaxed diaphragmatic breathing. Another contributing factor is rapid eating. Sometimes what I have observed in patients, with rumination syndrome, is that they eat too fast, swallowing without fully chewing their food and not taking breaths in between swallowing food and liquids.  Some patients with rumination syndrome have underlying medical conditions such as hiatal hernia. For most patients, rumination syndrome is probably the result of unconscious learning.

There is a very simple behavior modification treatment available for rumination syndrome. It involves slow relaxed diaphragmatic breathing. You will know you are breathing diaphragmatically if your stomach rises as you inhale and flattens as you exhale. A good way of checking this out is by lying down on your back with a book, or a box of tissues, on your stomach. As you inhale make the book, or box of tissues, rise as you inhale, and lower as you exhale. Try to minimize or eliminate thoracic breathing. Thoracic breathing is chest breathing. You will know you are engaging in thoracic breathing if your chest is rising, instead of your stomach, when you inhale. So, keep your chest flat as you inhale and exhale. All of the movement should come from the abdomen. If possible, breathe in and out through your nose. Try to breathe at a rate of four seconds to inhale and four seconds to exhale.

The first step is to practice and master the diaphragmatic breathing under ideal conditions; alone, without distractions, lying down. Practice it for two minutes at a time, twice a day under the ideal conditions. After you can breathe diaphragmatically lying down, the next step is to practice breathing diaphragmatically sitting upright. This step is harder because our stomach is naturally more constricted in the sitting position. This may be the reason why people learn bad breathing habits in the first place. Thoracic breathing (chest breathing) is easier than diaphragmatic breathing when in a sitting position. What can make it even worse is if you have a tendency to lean forward, you will constrict your diaphragm even more.  So, make sure you sit upright when are eating.

The next step is to apply diaphragmatic breathing to eating and drinking. This will take conscious effort and attention at first, until you practice it enough. Eventually it will become more natural and easy. Before eating or drinking, while seated at the table, start with a few slow diaphragmatic breaths. Then start to eat. Eat slow, chewing your food fully.  After you swallow, breathe diaphragmatically. Do the same after every swallow of food and liquid. When you complete the meal, take a few slow diaphragmatic breaths before leaving the table.

You should start to see results fairly quickly. The success rate of this simple behavior modification technique is 80- 90%. If you have trouble in controlling the regurgitation, despite using the technique, contact a gastroenterologist. It would be a good idea to contact a gastroenterologist anyway, as a first step, if you have digestive system symptoms. After medical consultation and if you still need help with rumination syndrome, consult a professional with expertise in treating rumination syndrome behaviorally.

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