Hiccups
What are hiccups?
Hiccups (also known as hiccoughs or singultus) are involuntary contractions or spasms of your diaphragm muscle. Your diaphragm is a dome-shaped muscle that sits beneath your lungs which helps you breathe. Three things happen simultaneously when you have the hiccups:
1. your diaphragm muscle contracts suddenly
2. your larynx (or voice box) contracts at the same time
3. the flap at the top of your windpipe (epiglottis) quickly shuts
When these three things happen together, you get the typical ‘hic’ sound of hiccups.
Almost everyone will experience hiccups at some time in their life. Hiccups are usually harmless and often go away within a few minutes.
What causes hiccups?
The exact cause of hiccups is unknown. However, they seem to occur when your diaphragm is irritated in some way. Factors that increase the likelihood of hiccups include:
eating too quickly or overeating
eating hot and spicy foods
drinking too much alcohol
carbonated drinks
hot drinks
indigestion
stress, fear or excitement
irritated stomach
smoking
swallowing air, particularly when chewing gum or sucking on candy
pregnancy
What about persistent hiccups?
Fortunately, most hiccups go away within a few minutes. However, in rare cases hiccups may last for 48 hours or more. These are defined as persistent or chronic hiccups and may be caused by an underlying injury, condition, or medication.
Medical conditions that may cause persistent hiccups include:
heartburn or gastro-oesophageal reflux disease (GORD)
oesophagitis (inflammation of the oesophagus)
pneumonia
pleurisy
asthma
kidney disease
chest or abdominal surgery
overactive thyroid
brain injury caused by stroke, tumour, or trauma
disorders of the central nervous system, including multiple sclerosis and stroke
diabetes
damage or irritation to the nerve serving the diaphragm muscle, caused by:
sore throat or laryngitis
tumour, cyst or goitre
reflux
a hair or other foreign matter touching your ear drum
Medications that can contribute to persistent hiccups include:
anaesthetics
corticosteroids
chemotherapy
medications used for anxiety, blood pressure, pain relief, and seizures
What are complications of hiccups?
Hiccups are usually just a nuisance and go away within in a few minutes with no long-term complications. However, persistent or chronic hiccups may lead to:
fatigue
weight loss
malnutrition
insomnia
psychological distress such as anxiety or depression
gastrointestinal problems, including vomiting
When to see a doctor?
If your hiccups continue for 48 hours or more, you should visit your doctor, as there may be an underlying condition causing your hiccups. You should also visit your doctor if your hiccups are causing you distress, or making it hard for you to eat or breathe. To determine the cause, your doctor may order a number of tests. These include:
Physical neurological exam
Physical neurological exam– these will test your balance and coordination, muscle strength, reflexes and sensory abilities.
Laboratory test
Laboratory test– these blood tests will help identify underlying issues such as infection, diabetes, kidney disease.
Imaging test
Imaging test–X-rays, CT scans and/or an MRI will help your doctor see if there are any abnormalities affecting your diaphragm, or surrounding nerves.
Endoscopic test
Endoscopic test– This test requires a thin tube with a camera be placed down your throat so your doctor can see if there are any problems with your windpipe or oesophagus.
Persistent or chronic hiccups, may be treated with:
treating the underlying disorder causing the hiccups
changes to current medications and dosages
medications such as tranquilisers, muscle relaxants, anti-seizure medications, pain medications or stimulants
acupuncture
physical manoeuvres or therapy
nasogastric intubation (inserting a tube into the nose)
nerve block
surgery to sever the nerves servicing the diaphragm
Depending upon the underlying cause of your persistent hiccups, you might also be referred to a specialist, such as a gastroenterologist or neurologist for further treatment.
Most of the time, hiccups will go away by themselves with no need for any treatment or intervention. There are many strategies promoted as ‘cures’ for hiccups, although evidence for these is more anecdotal than scientific. Strategies you could try include:
slowly sip cold water
hold your breath, and then release it slowly when you are unable to hold it any longer
breathe deeply into a paper bag
drink hot water and honey
gargle with water
sit down with your head over your knees
get someone to scare you
Hiccups can be caused by numerous factors, including medication. At MediADVICE we can help you manage your health with a Medication Review, where one of our pharmacists will review your medication and discuss which ones may be contributing to your hiccups, and how we can best help you manage them. Our friendly pharmacists can also provide advice on products that may assist with other digestive symptoms, or may refer you to your doctor for further treatment.
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