Gemma Renwick made it to 43 without doing something most people barely think about. She had never burped.
For most of her life, it seemed like an unusual quirk. But behind it were years of painful bloating, trapped gas, chest pressure, gurgling noises, and episodes so uncomfortable that she sometimes felt like she couldn’t swallow or breathe properly. Renwick told PEOPLE that she had been told her symptoms could be IBS, acid reflux, or anxiety.
Eventually, she discovered there was a name for what she’d been experiencing: retrograde cricopharyngeus dysfunction (R-CPD), commonly known as “no-burp syndrome.”
Then Renwick started talking about it on TikTok.
Her videos reached thousands of people who recognized their own symptoms, and one response attracted particular attention. Former Little Mix singer Jade Thirlwall commented on one of Renwick’s videos that she finally felt “seen and understood,” adding that being unable to burp had always seemed like a fun fact about herself despite causing problems throughout her life, according to The Independent.
Thirlwall also said the resulting bloating had led to comments about her body while performing and that she was considering the same Botox-based treatment Renwick received, although she had concerns about how it could affect her voice.
@_gemmarenwick I CANT BURP! And apparently there’s millions of us out there and I spent 40 years thinking I was the only one. Please help me spread awareness by sharing my videos, signing and sharing my petition – I will be eternally grateful 🙏🏻
♬ original sound – Gemma Renwick
Gemma Renwick has been documenting her experience with R-CPD, or “no-burp syndrome,” on TikTok, helping bring wider attention to the little-known condition.
Renwick’s story has since taken her from TikTok to national television, including a September 17 appearance on Good Morning Britain. But for people with R-CPD, the inability to burp is much more than an unusual party fact. The trapped air can cause persistent bloating, pain, pressure, excessive gas, and symptoms that interfere with everyday life.
And strangely enough, a Botox injection into one tiny muscle in the throat can sometimes make those symptoms disappear.
What no-burp syndrome actually is
According to Yale Medicine, R-CPD is a rare condition in which people are physically unable to burp or belch. It occurs when the cricopharyngeus muscle, a sphincter muscle at the top of the esophagus, fails to relax when it should, so air cannot exit. Belching is a normal biological process through which the body ejects air from the esophagus and stomach through the throat and out the mouth or nose.
The cricopharyngeus muscle briefly relaxes each time food or liquid passes, opening to let it into the esophagus, then tightens again. Air swallowed with food and drink, plus gas from carbonated beverages, accumulates in the stomach. When enough builds up, it pushes back toward the esophagus and normally triggers that same muscle to open – releasing a burp. In people with R-CPD, this second relaxation simply doesn’t happen. The air has nowhere to go.
Because the air cannot escape upward, it instead travels through the intestines and exits as flatulence, which is often excessive. Meanwhile, gas that remains trapped in the stomach and esophagus creates pressure that builds throughout the day. Cleveland Clinic lists the common symptoms of R-CPD as inability to burp, abdominal bloating, gurgling noises from the neck and chest, and excessive flatulence.
The condition affects both children and adults. The majority of people who present with R-CPD report they have never been able to burp since birth, a claim often confirmed by their parents, suggesting that some people are born with the condition.
Years without a name
One reason so many people go undiagnosed for so long is that the condition only received its formal name recently. R-CPD was formally identified and named in 2019, following a case series published by Bastian and Smithson covering 51 patients treated with botulinum toxin. Before that, the phenomenon had been described in medical literature as far back as 1987, but without a codified name, diagnosis, or recognized treatment pathway, most clinicians had simply never encountered it.
For Gemma, the delay in diagnosis stretched across four decades. Columbia Doctors notes that RCPD sufferers are commonly misdiagnosed with conditions such as acid reflux and IBS, and go undiagnosed for years. According to published research, complaints typically begin during adolescence, with many patients searching for a diagnosis for years before obtaining treatment, reporting symptoms including inability to burp, gurgling noises, flatulence, and a persistent foreign-body sensation in the throat.
Symptoms often worsen after eating or drinking, especially carbonated drinks, and this pushes people to adopt coping behaviors that significantly limit daily life. Northwell Health notes that people with R-CPD sometimes fast before important events like job interviews or celebrations to reduce the risk of symptoms appearing at the worst moment. Many patients also experience significant social anxiety tied to the visible and audible symptoms, particularly gurgling sounds that are difficult to suppress or predict.
The muscle that won’t let go
The cricopharyngeus muscle, also called the upper esophageal sphincter, sits at the junction between the throat and the esophagus. It opens for fractions of a second during each swallow, then closes, and also opens in response to pressure from below – the mechanism that makes burping possible.
In R-CPD, the primary treatment is botulinum toxin injection into the cricopharyngeus muscle, either in an operating room or as an office-based procedure with electromyography guidance. Botulinum toxin, the active ingredient in Botox, temporarily weakens the muscle, helping it relax and preventing it from tightening when air needs to be released. The procedure is performed under general anesthesia.
Gemma underwent exactly this treatment after researching her own diagnosis online and finding videos recommending what some patients colloquially call “throtox” – a portmanteau of throat and Botox. She paid £920 for the private procedure. Within four to five days, she was burping. Within five weeks, she reported that her bloating had resolved entirely.
@_gemmarenwick Spent 43 years like this! Anyone else not able to burp??
♬ original sound – Gemma Renwick
What the research shows
Gemma’s experience aligns with what clinical studies have found. Yale Medicine notes that botulinum toxin injection into the cricopharyngeus muscle is an effective treatment for R-CPD, with most patients experiencing substantial symptom relief.
According to Yale Medicine, the effects of a single Botox injection are expected to last around three months, but symptom relief often lasts six to twelve months or longer. For about 80% of people, the effects are thought to be permanent. For some, however, symptoms return after a period, and an additional injection or a surgical procedure called a partial cricopharyngeal myotomy may be needed.
According to the American Academy of Otolaryngology-Head and Neck Surgery, the most commonly reported adverse effect is transient dysphagia (difficulty swallowing), with rates varying depending on the dose and injection method. Some patients also experience regurgitation or worsening of underlying acid reflux symptoms. In most cases, difficulty swallowing resolves within one to four weeks.
For the first few weeks after treatment, burping can be difficult to control, with patients having little say over when gas escapes. Food may also feel like it passes more slowly through the sphincter, and some people experience increased acid reflux. These side effects tend to decrease over time.
Why does burping keep working after the Botox wears off?
One of the more puzzling aspects of R-CPD treatment is what happens months later. Botulinum toxin’s paralytic effect on muscle tissue lasts roughly three months before the body metabolizes it. Yet for a significant proportion of R-CPD patients, the ability to burp persists far beyond that window.
Researchers have proposed that neural dysfunction may be involved – a failure of the brain to send the correct signal to the cricopharyngeal sphincter to initiate burping. Once burping is re-established with the help of the injection, spontaneous burping appears to sustain itself even after the pharmacological effect has ended.
Northwell Health notes that over three-quarters of patients show this continued response, either permanently or for more than six months, and clinicians acknowledge they don’t yet fully understand why. One working hypothesis is that the temporary window of ability to burp allows patients to reinforce a neurological pathway that was previously suppressed. That remains a hypothesis, and the mechanism is not yet fully understood.
For those who do need retreatment, around 20% require a second injection within 12 months of the first, and about 5% need a third.
What if you’ve never been able to burp?
Most of us don’t give burping much thought. That’s partly because when the system works normally, there’s very little to think about.
Swallowed air builds up. The muscle at the top of the esophagus relaxes. The air escapes.
For someone with R-CPD, that last step doesn’t happen.
The result can be years of bloating, pressure, gurgling, excessive gas, and changing what or when you eat simply to avoid becoming uncomfortable later. For some people, the strangest part may be discovering that these seemingly unrelated problems have been connected all along.
R-CPD is still a relatively newly recognized condition, and awareness remains limited. But treatment research has been encouraging, with many patients regaining the ability to burp after a botulinum toxin injection into the affected muscle.
If you’ve genuinely never been able to burp and regularly experience the other characteristic symptoms, it’s worth bringing that specific combination up with a healthcare professional.
After all, sometimes a strange little thing your body has never been able to do isn’t just a quirk.
Disclaimer: This information is not intended to be a substitute for professional medical advice, diagnosis, or treatment and is for information only. Always seek the advice of your physician or another qualified health provider with any questions about your medical condition and/or current medication. Do not disregard professional medical advice or delay seeking advice or treatment because of something you have read here.
AI Disclaimer: This article was created with the assistance of AI tools and reviewed by a human editor.
Read More: 10 Weird Signs That May Indicate You’re Sleep-Deprived (Beyond Fatigue)