POTS and Gastrointestinal Symptoms
Yes, a "sinking feeling" in the stomach (epigastric discomfort/nausea) is a recognized symptom of POTS, but tremors after episodes are not typically described as a core feature of the syndrome. 1
Gastrointestinal Manifestations in POTS
POTS commonly presents with gastrointestinal symptoms that can be categorized as:
- Positional symptoms (occurring with orthostatic changes): nausea, abdominal discomfort, bloating
- Non-positional symptoms (present continuously): gastroparesis, constipation, diarrhea, anorexia 2
The "sinking feeling" you describe aligns with the nausea and abdominal discomfort that affects a substantial proportion of POTS patients. In one study, 34% had normal gastric emptying, 18% had delayed emptying, and 48% had rapid gastric emptying—meaning two-thirds of POTS patients with GI symptoms had abnormal gastric function 3. The sensation of epigastric discomfort or nausea is listed among the common multisystem symptoms in POTS 1.
Tremors: Not a Typical POTS Feature
Tremors after episodes are not described in the major guidelines or comprehensive reviews as a characteristic symptom of POTS 4, 1, 5. The typical symptom constellation includes:
- Lightheadedness/dizziness
- Palpitations
- Fatigue and exercise intolerance
- Cognitive dysfunction ("brain fog")
- Nausea and GI symptoms
- Sleep disturbance 1
Important Caveat
If tremors are present, consider:
- Hypersympathetic state: POTS involves excessive sympathetic activation, which could theoretically cause tremulousness, though this is not formally documented as a core feature
- Anxiety/panic symptoms: These commonly co-occur with POTS and can manifest as tremors
- Alternative diagnoses: Tremors warrant evaluation for other conditions (thyroid disease, medication effects, neurological disorders) 4
Clinical Implications
When evaluating a patient with suspected POTS who reports both GI symptoms and tremors:
The GI symptoms fit the POTS profile and should be addressed through standard POTS management (increased salt/fluid intake, lower-body compression, structured exercise) 1
The tremors require separate consideration—perform thyroid function tests, review medications (stimulants, norepinephrine reuptake inhibitors can exacerbate symptoms), and assess for anxiety disorders 4
Look for co-morbid conditions: Mast cell activation syndrome and hypermobile Ehlers-Danlos syndrome frequently co-exist with POTS and can contribute additional symptoms 2
The Canadian Cardiovascular Society guidelines emphasize that a detailed autonomic review of systems and careful medication history are critical to distinguish true POTS symptoms from mimics or medication effects 4.