Rumination Disorder Treatment: Prescriptions, Therapies - Verywell Health

Rumination disorder is a feeding and eating disorder and a functional gastroduodenal disorder where a person experiences frequent and effortless regurgitation of food that they have recently eaten. The regurgitation is unconscious but believed to be a learned behavior. The person will re-chew and swallow or spit out the food that is regurgitated.

Treatments for rumination disorder use behavioral, psychological, and quality-of-life interventions, as well as the medical management of a person's symptoms.

The goals of rumination disorder treatment are stopping regurgitating behavior, reducing mealtime stress, and making it easier for a person to engage in social, school, or work activities.

It is very important to involve family and caregivers in treatment for rumination disorder because it often occurs in children, teens, and adults with intellectual disabilities.

Here is an overview of how rumination disorder is treated.

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Prescription Medications

Prescription medication is not the first-line treatment for rumination disorder. Behavioral therapies such as habit reversal strategies, relaxation techniques, and diaphragmatic breathing techniques are typically used first.

However, if these treatments are unsuccessful, a clinician may prescribe certain medications.

Baclofen

Baclofen can be prescribed to people with rumination disorder who are not helped by behavioral interventions.

Baclofen is a skeletal muscle relaxant that may help people with rumination disorder because it reduces the pressure in the lower esophageal sphincter and the abdominal muscle contractions that occur during regurgitation.

Baclofen is usually prescribed at a dose of 10mg taken three times a day.

In 2018, a randomized double-blind, placebo-controlled study found that the 10mg dose of baclofen significantly reduced reflux events for people with rumination disorder.

More research is needed to determine how well baclofen works compared to the behavioral therapies used to treat rumination disorder.

Experts advise clinicians to only prescribe baclofen for patients with the condition when other interventions have not worked.

Other Medications

There is no conclusive evidence that supports using medications other than baclofen to treat rumination disorder.

However, clinicians may prescribe other medications for conditions that often occur alongside rumination disorder, such as anxiety or depression.

A 2020 study found that a tricyclic antidepressant and diaphragmatic breathing and relaxation techniques helped adult patients with rumination disorder.

However, because of how the study was designed, it's not clear if the patients benefitted from the medication, the breathing technique, or both interventions.

Breathing Training

Training in diaphragmatic breathing is the core of rumination disorder treatment. If you are a swimmer, singer, or play a wind instrument, you may already be familiar with "belly breathing" or "opera breathing."

Most people breathe shallow breaths into their chest. With diaphragmatic breathing, you learn to consciously relax and engage the large dome-shaped diaphragm muscle that sits below your lungs. Relaxing and engaging these muscles helps you to fill your lungs and take deeper breaths.

There is more evidence to support the effectiveness of diaphragmatic breathing for helping people with rumination disorder than any other treatment.

It is theorized that people with rumination disorder have an unconscious, habitual contraction of their abdominal wall muscles during regurgitation. By consciously relaxing the diaphragm instead, the habit is counteracted and regurgitation is prevented.

How to Perform Diaphragmatic Breathing

Diaphragmatic breathing can be taught by gastroenterologists, nurse practitioners, psychologists, massage therapists, occupational therapists, physical therapists, and speech therapists.

Each professional may teach diaphragmatic breathing differently, but the instructions will generally include these steps:

1. Lie flat on your back, on a bed or other surface, with your knees bent and feet planted.
2. Place one hand on your chest and one on your belly so that you feel your body move each time you inhale and exhale.
3. Take a deep breath in through your nose and "into your belly" (the hand on your belly should rise while the hand on your chest stays still).
4. As you breathe out through your mouth, the hand on your belly should fall as your diaphragm relaxes.

It can be challenging for some people to learn diaphragmatic breathing. You are learning to consciously engage a deep muscle that we usually only use involuntarily.

Try to be patient and know that it will take time.

Changing up your strategy and using other sensory feedback such as a heavy book on your belly or a belt or resistance band below your ribcage may also help.

Therapies

Several therapies can be used, often together, to help people with rumination disorder.

Behavioral Therapy

Diaphragmatic breathing is usually taught as part of a behavioral therapy program, which is often led by a behavioral health specialist, therapist, or psychologist.

Experts believe that the regurgitation that people experience with rumination disorder is not a disease—rather, it's a behavior that was learned at some point in their life. The behavior then becomes unconscious, and for some people, even a self-soothing habit.

Behavioral Therapy and Diaphragmatic Breathing

Behavioral therapy helps to "undo" the regurgitation habit and regulate a person's post-eating behavior.

As part of behavioral therapy, a person with rumination disorder will first be trained to identify signs or triggers for regurgitation. Then they will learn to use diaphragmatic breathing techniques after eating to help prevent and replace the behavior.

What If It Does Not Help?

If diaphragmatic breathing alone is not immediately helpful, a therapist may use a variety of other strategies to help a person with rumination disorder, such as:

• Alternative self-soothing practices
• Relaxation techniques
• Aversion training
• Sensory distractions after meals (such as chewing gum)
• Exposure therapy to stimuli associated with regurgitation

Biofeedback

Biofeedback uses electromyography to monitor the activity of a person's abdomino-thoracic muscles.

Biofeedback techniques can be part of behavioral therapy and can help a person learn to do diaphragmatic breathing or help reduce abdominal muscle contractions.

What a Biofeedback Session Is Like

Many different machines and systems can be used for biofeedback. A person's experience will vary based on what system their clinician or therapist has available.

If you are having a biofeedback session, your clinician or therapist will start by applying small sensors, with adhesive material similar to a Band-Aid, to various points on your abdomen.

Next, you will look at a computer, tablet, or another electronic device that has a live-feed graph of your muscle activity.

The visual represents your abdominal muscle activity and may give you the sensory feedback that you need to learn diaphragmatic breathing or learn to otherwise control your abdominal muscles.

Research on Biofeedback for Rumination Disorder

A 2014 study that included 28 patients with rumination disorder found that electromyography-guided biofeedback training to control abdomino-thoracic muscles was effective at reducing their regurgitation episodes.

Currently, no evidence compares the effectiveness of biofeedback to diaphragmatic breathing without biofeedback, other behavioral interventions, or medications.

A randomized, placebo-controlled trial is currently underway to explore the efficacy of biofeedback for rumination disorder.

Lifestyle

Rumination disorder can greatly affect a person's quality of life. It can make it harder for them to take part in many everyday activities at home or in public that involve food or eating.

In addition to medical treatment and therapies, there are some small ways that you can adjust your lifestyle to support your rumination disorder recovery.

Lifestyle changes that you might try include:

• Reducing mealtime stress
• Limiting mealtime distractions
• Practicing relaxation techniques such as meditation or yoga
• Improving your posture
• Keeping a food and symptoms diary to monitor frequent triggers

A Word From Verywell

People with rumination disorder frequently regurgitate food 20 to 30 minutes after eating as an unconscious learned behavioral response.

Even though the regurgitation is not always distressing for a person (and may even be a self-soothing behavior), rumination can have health consequences such as heartburn, abdominal pain, as well as malnutrition, electrolyte imbalances, and weight loss.

The disorder can also greatly affect a person's quality of life and activities of daily living, as they may worry about the discomfort of regurgitating food at home or the stigma of regurgitating food when eating in public places like work, school, or social events.

Rumination disorder can be treated. The most popular treatment is diaphragmatic breathing training, which is part of behavioral therapy and is sometimes paired with interventions such as biofeedback. The medication baclofen may also be prescribed when people are not helped by diaphragmatic breathing or behavioral therapy.

Rumination disorder most often occurs in children, teens, and adults with intellectual disabilities. Therefore, it is very important that the treatment approach is collaborative and involves people who care for a person with the disorder. Family members and caregivers play an essential role in helping a person with rumination disorder continue to follow their treatment plan, such as by practicing diaphragmatic breathing at home.