Rumination syndrome

What is rumination syndrome?

Rumination syndrome is characterized by both voluntary and involuntary regurgitation and further chewing of one’s partially digested food. Once again chewed the individual either ingests it for a second time or expels it. The syndrome does not involve retching in order to regurgitate, it also is free of nausea and a relatively effortless practice for example it may occur with e belching sensation. Regurgitated food does not taste bitter to the individual as most would imagine. The term rumination has its origins in the Latin word ‘ruminare’ which essentially means to chew the cud. Researchers have suggested that gastric expansion with food is followed by abdominal compression and relaxation. These actions allow for the contents of the stomach to indeed be regurgitated and again chewed.

Health risks/implications of rumination

Rumination may induce the following conditions; halitosis (extremely bad breath), malnutrition, weight loss, growth failure, dehydration, electrolyte imbalance, gastric disorders, respiratory distress, Dental cavities, Pneumonia, chocking and death. Rumination is thought to be the primary cause of death in 5%-10% of individuals with the condition. These rates are of 12%-50% for those whom are institutionalized for mental retardation also suffering rumination.

Prevalence

In adults and children with mental retardation, rumination has been diagnosed, although it has also been reported in those with a considered ‘normal’ level of intelligence and development. Rumination is most common in infants and the onset of rumination among such individuals is commonly between 3-6 months. The prevalence among adults of normal development cannot be confirmed due to the secretive nature of the syndrome. Society inflicts secrecy among sufferers as it would be considered a ‘disgusting habit’ and certainly one judged and quite possibly ridiculed. Whereas for children they are less aware of what is accepted and not, they are thus easier to diagnose.

Rumination is more much more common among individuals with severe mental retardation than in those with only mild retardation. Rates of between 6%-10% have been seen among institutionalized individuals with these mental defects.

Diagnosis of rumination

A diagnosis of rumination requires that;

The behaviour must persist for at least 1 month, with evidence of normal functioning prior to onset.1Rumination occurs within a few minutes post consumption and may continue for 1-2 hours.Behaviours typically occur daily and may persist for many months or years.

Causes of rumination

There are a few theories that attempt to explain the underlying causes of rumination syndrome;

Abnormal mother-infant relationship where the infant is turns to internal gratification as a result of either under stimulating environment or to escape an over stimulating environment.Boredom, lack of occupation, chronic family dysfunction, and maternal psychopathology.Increase in ruminating behaviours following positive reinforcement, for example; pleasurable sensations produced by the rumination or attention from others after rumination.Negative reinforcement when an undesirable emotion for example anxiety or stress is removed by the rumination.There appears to be a positive correlation between gastro esophagealreflux (GER) and the onset of rumination.Rumination has been associated with depression and anxiety.Proposed physical causes; dilatation of the stomach, hyperactivity of the sphincter muscles in the upper portions of the alimentary canal, cardiospasm, pylorospasm, increased gastric acidity, Achlorhydria, insufficient mastication, pathologic conditioned reflex.

Treatment of Rumination;

Initially one needs to identify the point at which rumination was developed and the reasoning behind it. For example if it is as a result of psychosocial occurrences then therapy may be implemented to rectify these problems. If it is dues to physical occurrences then medications would need to be prescribed, perhaps in addition to psychotherapy. For example if rumination appears to be a result of high acidity in the stomach, then medication to reduce that may well be a good starting point.

Relaxation techniques for the oesophageal sphincter are commonly practiced as part of a recovery, or control basis. A) Learned, voluntary relaxation. B) Simultaneous relaxation with intra abdominal pressure. C) Adaptations to the belch reflex.

Consulting a doctor if one feels they are suffering from rumination is important, the health risks for this syndrome can be very dangerous.

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