Hiccups are sudden, involuntary contractions of the diaphragm which occur at the same time as a contraction of the voice box (larynx) and total closure of the glottis, effectively blocking air intake. The glottis is the middle part of the larynx, where the vocal cords are located.
Hiccups may also be spelled "hiccoughs" and are medically known as SDF (synchronous diaphragmatic flutter) or singultus.
Hiccups can often occur for no apparent reason. It's common to get a bout of hiccups every now and again and there is no need for alarm should you get one. In the majority of cases, hiccups resolve without any treatment within a few minutes.
Hiccups can occur individually or in bouts and commonly happen rhythmically, meaning that the interval between each hiccup is relatively constant. Most people find them to be a minor nuisance. However, prolonged hiccups can became a serious medical problem and require treatment. Prolonged hiccups affect men much more than women. When attacks last longer than a month, the hiccups are termed intractable.
Here are some key points about hiccups. More detail and supporting information is in the main article.
- Experts are still divided on why hiccups occur.
- Some medical conditions such as stroke and asthma are associated with a higher incidence of hiccups.
- Prolonged cases of hiccups can lead to complications such as insomnia and depression.
- Cases of hiccups that last for longer than 48 hours should be referred to a doctor.
- There are many tips that are known to help patients with hiccups.
- For prolonged cases of hiccups, drugs such as muscle relaxants can be prescribed.
- Some causes of hiccups can be avoided, such as alcohol and eating too quickly.
- Most cases of hiccups resolve without treatment.
Causes of hiccups
Experts have yet to reach a definitive conclusion on what the mechanisms are that cause hiccups, or why they occur. According to studies, the following circumstances, conditions and illnesses have been associated with a higher risk of developing hiccups:
- Hot food has irritated the phrenic nerve. The phrenic nerve is near the esophagus.
- When there is gas in the stomach, which presses against the diaphragm.
- Too much food is eaten.
- Food is eaten too rapidly.
- There is a sudden change in temperature.
- Fizzy drinks are consumed.
- Some people get hiccups after eating spicy foods.
- After eating dry breads.
- Many people anecdotally report hiccups after consuming alcoholic beverages.
- Some medications, such as opiates, benzodiazepines, anesthesia, corticosteroids, barbiturates, and mythyldopa are known to cause hiccups.
Some medical conditions are linked to a higher incidence of hiccups, such as:
- Gastrointestinal conditions, including IBD (inflammatory bowel disease), a small bowel obstruction, or GERD (gastro-esophageal reflux disease).
- Respiratory conditions, such as pleurisy, pneumonia or asthma.
- Conditions which affect the CNS (central nervous system), including a traumatic brain injury, encephalitis, a brain tumor, or stroke.
- Conditions which irritate the vagus nerve, such as meningitis, pharyngitis or goitre.
- Psychological reactions, including grief, excitement, anxiety, stress, hysterical behavior, or shock.
- Conditions which affect metabolism, including hyperglycemia, hypoglycemia, or diabetes.
Possible complications of hiccups
If a patient has prolonged hiccups, complications may develop, including:
- Weight loss - in some cases the hiccups are not only long-term, but occur at short intervals, making it hard for the patient to eat properly.
- Insomnia - if the prolonged hiccups persist during the sleeping hours, the patient will find it hard to get to sleep, and/or stay asleep.
- Fatigue - people with prolonged hiccups may become exhausted, especially if they cannot sleep or eat properly.
- Communication problems - persistent hiccups may make it harder for the patient to communicate orally.
- Depression - patients with long-term hiccups have a considerably higher risk of developing clinical depression.
- Post-surgical wound healing - if the patient is hiccupping all day long, post-surgical wounds will probably take much longer to heal. Some patients may have a higher risk of developing infections, or start bleeding after surgery.
Hiccups that last less than 48 hours do not usually need any medical attention, because they resolve on their own. If your hiccups persists for longer, you should check with your doctor.
After talking to the patient about their hiccups, when they began, how often they occur, etc., the doctor will probably perform a general physical exam and then a neurological exam to check the person's:
- Sense of touch
- Muscle strength
- Muscle tone.
If the doctor, usually a GP (general practitioner, primary care physician) at this point, believes an underlying condition may be the cause, the following diagnostic tests may be ordered:
- Blood tests - to check for infection, kidney disease or diabetes
- Imaging tests - to determine whether there are any anatomical abnormalities which may be affecting the phrenic or vagus nerves or the diaphragm. This may involve taking a chest X-ray, a CT scanor an MRI scan.
- Endoscopic test - the doctor inserts an endoscope, a flexible tube with a small camera at the end, down the patient's throat to check the windpipe or esophagus.
- An electrocardiogram (ECG) - this test checks for heart-related conditions by measuring electrical activity in the heart.
Treatments for hiccups
In the vast majority of cases, hiccups require no medical treatment and will go away after a few hours or a couple of days at the most.
Tips for getting rid of hiccups
According to the National Health Service (NHS), UK, the following steps have been known to help some patients with hiccups:
- Sip ice-cold water slowly.
- Hold your breath for a short time, breath out, then do it again three or four times - do this every 20 minutes.
- While you swallow, place gentle pressure on your nose.
- Place gentle pressure on your diaphragm.
- Gargle with very cold water.
- Bite on a lemon.
- Take some granulated sugar and swallow it.
- Have a tiny bit of vinegar (enough to taste).
- Breathe into a paper bag (note: you should never cover your head with the bag).
- Sit down and hug your knees as close to your chest as you can for a short period of time.
- Lean forward so that you gently compress your chest.
If you have an underlying condition which may be causing the hiccups
If the underlying condition or illness is treated and/or controlled, the hiccups will likely resolve. In some cases, the patient may be referred to a specialist.
Medications to treat hiccups
For prolonged hiccups which may be interfering with the patient's quality of life, the doctor may prescribe a drug. The following medications may be prescribed if no underlying health condition is diagnosed:
- baclofen (Lioresal) - a muscle relaxant
- chlorpromazine - an antipsychotic medication which can alleviate hiccups
- gabapentin - originally used for the treatment of epilepsy, now commonly prescribed for neuropathic pain. It can help alleviate the symptoms of hiccups.
- haloperidol - an antipsychotic drug which can also alleviate hiccups symptoms
- metoclopramide (Reglan) - an anti nausea medication, known to help some patients with hiccups.
The doctor will usually prescribe a low-dose two-week course of medication. The dosage may gradually be increased until the hiccups are gone. Medication course length depends on the severity of hiccups, the patients' general health, and their age.
Some of the causes of hiccups are preventable.
- Avoid abrupt changes in temperature
- Avoid drinking alcohol
- Avoid fizzy drinks
- Avoid having large meals
- Do not eat too rapidly.