How to get rid of hiccups? Types, Causes, Treatment

How to get rid of hiccups? Types, Causes, Treatment

How to get rid of hiccups? Types, Causes, Treatment

1. Hiccup- An overview


Hiccup is medically termed as SDF (Synchronous diaphragmatic flutter) [1]. It is an involuntary spasm of the diaphragm and the respiratory organs with a sudden closure of the glottis and the characteristic gulping sound (when the muscle spasms and the vocal cord snaps). Often, the hiccup is rhythmic. Usually, the hiccup is just temporary and minor annoyance.

Almost everyone, young or old and male or female, experiences hiccup at one time or another. Mostly, hiccups come and go away on their own within a minute and without any medication. Hiccups can interfere with daily normal routine activities (eating/ drinking/ talking).

2. Types of Hiccup


Types of Hiccups

 

Type of any disease is determined by the causes/risk factors/signs/symptoms/diagnostic tests which again greatly affect the treatment procedure. Depending on the severity and the length of rime, hiccup can be classified under 2 heads: 

2.1) Mild hiccup

Mild hiccups are those that come and go away without any medication and within a short time. They usually occur when one eats or drinks too quickly/ eats too much/ drinks carbonated beverages/ experiences stress/ consumes very hot or cold drinks or alcohol/ takes anxiety-reducing drugs.

2.2) long-lasting hiccups (persistent or intractable hiccup)

Such types of hiccups are linked to serious medical conditions. They can be stressful and will not go away unless the related conditions (causing the hiccups) are removed. 

Some of the medical conditions include tumor (A tumor is an abnormal growth of cells that serve no purpose. Under normal conditions, the cells in the body grow, die and are replaced by new ones. But the tumor cells grow and do not die. Whereas the body does not need them. When the benign cells deteriorate to malignancy, then it is called cancer ) /cancer/stroke (it is the death of a brain cell due to lack of oxygen caused by the blockade of blood flow to the brain)/ GERD (Gastro-esophageal Reflux disease. It is caused by acid reflux back into the esophagus).

2.2.1) Hiccups in patients with stroke 

Intractable hiccups are uncommon, but an inevitable sequel to the aftermath of ischemic stroke (It occurs when an artery to the brain is blocked. The brain depends on its arteries to bring fresh blood from the heart and the lungs). Intractable hiccups can have a significant impact on post-stroke rehabilitation and can invite a detrimental impact on the patient’s quality of life. Clinical research is suggested within intractable hiccups, so that more can be learned about the disabling cause to the sufferer.

2.2.2) Hiccups in patients with cancer

Everyone in his life experiences hiccups (which come and go away usually without medication). But when hiccups are symptoms of cancer or side effects of cancer treatments, they can persist for a long time. This makes the patient difficult to cope with. In case of the cancer treatment, the hiccups may be experienced if :

the stomach stops working and becomes extended and bloated / one has an infection affecting the chest or esophagus/one takes chemotherapy steroids or pain killer (such as morphine) /the cancer is pressing in the diaphragm/one has symptoms of brain tumor/ kidneys are not working / one has blood chemistry changes/ kidneys are not functioning properly.

3. Symptoms of Hiccup


Symptoms are subjective phenomena observed and experienced by the patient (in contrast the signs are mostly objective phenomena detected by the doctor through suitable test results). Hiccupping is mostly accompanied by the symptoms: slight tightening sensation in the chest/ abdomen/throat.

4. What are causes of hiccups?


causes of hiccups

Causes are the agents directly responsible for the occurrence of the disease. In most cases, it is not clear what causes a particular disease. On the other hand, a risk factor is not necessarily a cause. A risk factor may be anything that increases the likelihood for a patient to develop the disease. For instance, age is a vital risk factor for most of the malignancies, but it cannot be a cause.

Located under the lungs, the diaphragm is a muscle that contracts every time a person takes a breath. This contraction causes the diaphragm to drop-down allowing the lungs to expand and take in air. Hiccups typically occur when the diaphragm suddenly contracts. Shortly after the contraction begins, the vocal cords abruptly close (producing the hiccup sound).

4.1) The most common cause triggering hiccups (that last for less than 48 hours) include:



  • Drinking and eating too much and too quickly

  • consuming alcohol and carbonated drinks

  • excitement and emotional stress

  • swallowing air with chewing gum or sucking candy


4.2) Hiccups (lasting for more than 48 hours) may be caused by a variety of factors which can be grouped under the following heads:


4.2.1) Nerve damage or irritation


A genuine cause of long term hiccups is damage to (or irritation of) vagus nerve (it is the longest among the 12 cranial nerves. It is the nerve that originates from the neck and passes down between the lungs and the heart to reach the diaphragm). Factors that may cause damage or irritation to these nerves include:

  • A hair or something else in the ear touching the eardrum.

  • In the neck, there are found tumors (A tumor is a mass of tissue that is formed as an accumulation of abnormal cells. Under normal conditions, the cells in the body grow/ die and are replaced by are new cells. But the tumor cells grow and do not die. Whereas the body does not need them. A benign tumor is harmless. When it turns into malignancy, it is called cancer), cyst (It is a membranous sac or cavity of abnormal character in the body containing fluids.) or a goiter (It is an abnormal enlargement of the thyroid gland. Symptoms include: cough/ weight gain/ nodule). 

  • Gastroesophageal reflux disease. It is caused by acid reflux back into the esophagus. Some common foods and drinks stimulate acid secretion from the stomach.

  • Sore throat/ laryngitis. It is the inflammation of the voice box. In most cases, the illness gets cured without treatment in about a week. Symptoms can begin suddenly and usually get worse throughout 2/ 3 days. A common symptom of laryngitis is hoarseness.


4.2.2) Central Nervous disorders:


Infection or damage in the central nervous system can disrupt the body’s normal control over the hiccup reflux. Examples include:

  • Encephalitis :In addition to many other conditions, it is reported to be associated with hiccups.

  • Meningitis: It is an inflammation of the membranes surrounding the brain.

  • Multiple sclerosis: It is a potentially disabling disease of the brain and the spinal cord 

  • Traumatic brain injury: It usually occurs on account of a violent jolt in the head (such as bullet in the head).


4.2.3) Drugs and metabolic disorders


It occurs when abnormal chemical reactions in the body alter the normal metabolic process in the body. Examples include:

4.2.3.1) Alcoholism: It is a broad term for addiction to alcohol resulting in mental or physical health problems including hiccups. Calories gained from the consumption of alcohol are considered empty caloriesAlcohol is fundamentally an acid that irritates the vagus nerve and also the esophagus.

Furthermore, alcoholic beverages are carbonated and infused with gas (namely, carbon –dioxide). The carbon-dioxide gas will expand the stomach and therefore, probe the stomach above. The excess gas will make the drunkard profusely burp and also, will trigger a vicious episode of hiccups.

4.2.3.2) Anesthesia: Some people develop hiccups after undergoing general anesthesia (or after a procedure involving abdominal organs).          

4.2.3.3) Barbiturates: It is a drug that acts as a central nervous system depression and can therefore produce a wide range of effects including hiccups.

4.2.3.4) Diabetes: Diabetes is a group of metabolic diseases clinically known as Diabetes Mellitus in which the patient has high blood glucose (which comes from foods taken), either because the body does not produce enough insulin or the cells do not respond to the insulin produced. 

Diabetes is both a cause and a great risk factor for many malignant diseases including hiccups (persisting for more than a week which is difficult to treat).

4.2.3.5) Electrolyte imbalance

It is an abnormality in the concentration of electrolytes in the body which include:

  • Hyponatremia (Low blood sodium level): It can be either cause or effect of hiccups. Other electrolyte related factors causing hiccups are

  • Hypokalemia (Low blood potassium level)

  • Hypocalcemia  (Low blood calcium level)

  • Hypoglycemia (Low blood sugar level)


4.2.3.6) Kidney disease: Hiccups that last for a longer period can also be caused by chronic kidney disease aggravated by the electrolyte imbalance.

4.2.3.7) Tranquilizer: It is also termed as sedatives. It is a drug designed for the treatment of anxiety/ fear/tension and other mental disturbances.

Conclusively, male patients with sedatives undergoing EGD (Esophago-gastro-duodenoscopy) is a procedure used to examine the lining of the esophagus i.e. swallowing tube), are more likely to suffer from hiccups (as compared to those without sedatives). [2]

5. Risk factors of Hiccup



  • Mental or emotional issuesAnxiety/ stress/ excitement has been associated with cases of some short term and long term hiccups.

  • SurgeryOn account of surgery, some people develop hiccups after undergoing general anesthesia or after procedures that involve abdominal organs


6. Complications


Persistent or intractable hiccups can adversely affect daily routine activities including conversation/ delivering lecture/ eating/ drinking/ sleeping /working. Through its constant interruptive nature, hiccups can cause fatigue/ dehydration/ weight lossinsomnia/ psychological stress/ decreased quality of life.

Conclusively, prolonged hiccup may signal a major medical problem. 

7. Prevention


By making some lifestyle changes, hiccups can be prevented by practicing relaxation (such as deep breathing) and avoiding overeating/eating and drinking too quickly/carbonated drinks /spicy foods.

8. How get rid of hiccups?


Most of the hiccups come and go away automatically within a short time and medical emergency is rare. 

8.1) Home remedies


As the 1st line of defense, it is important to apply home remedies.

8.1.1) Breathing and posture technique:


Sometimes, a simple change in breathing and posture can relax the diaphragm to stop or weaken the flow of hiccupping.

  • Practice measured breathingDisruption in the respiratory system with measured breathing is needed. The procedure involves breath in (for a count of 5) followed by breath out (for a count of 5).

  • Hold the breath: One needs to hold a large gulp of air (and hold it for about 10- 20 seconds), then breathe out slowly. The practice needs to be repeated.

  • Breathe into a paper bag: A paper bag is to be placed over the mouth and the nose (followed by slow breath in and breath out).


8.1.2) Hug the knees: One needs to sit down in a comfortable place and bring the knees to the chest (holding the knees for 2 minutes).

8.1.3) Compress the chest: Leaning and bending forward are needed which put pressure on the diaphragm.

8.1.4) One also needs to exhale (by pinching the nose and keeping the mouth closed).

8.1.5) Pull on the tongue: Pulling the tongue stimulates the nerve and the muscles in the throat. One also needs to grab the tip of the tongue and gently pull it forward once or twice.

8.1.6) Press on the diaphragm: The diaphragm separates the abdomen from the lungs. The hands need to be used to apply pressure on the area just below the end of the sternum (breast line).

8.1.7) Squeeze the nose (while swallowing water).

8.1.8) Squeeze the palm: One needs to use the thumb to apply pressure on the palm of the other hand.

8.1.9) Manage the carotid artery: The carotid artery is one of the 2 great arteries carrying blood. There is a carotid artery on both sides of the neck. In the procedure, one needs to lie down turning the head to the left and massage the artery to the right side in a circular motion (for 5- 10 seconds).

8.1.10) Drink ice cream

8.1.11) Drink from the opposite side of the glass

8..1.12) Slowly drink a glass of warm water without stopping the breath.

8.1.13) Drink water through a cloth (or paper towel)

One may cover glass of cold water with a cloth (or paper towel) and sip through it.

8.1.14 One may also suck an ice cube for a few minutes, and then swallow it (once it shrinks to a reasonable size).

8.1.15) One needs to gargle ice water( for 10 seconds) and repeat the procedure

8.1.16) It is also good to eat a spoonful of honey or peanut butter. One needs to allow it to dissolve in the mouth (a bit before swallowing).

8.1.17) Eat some sugar: One needs to put a pinch of granulated sugar on the tongue and let it settle there (for 5- 10 seconds) and then swallow it.

8.1.18) Suck on a lemon: One may add a bit of salt to the lemon slice and then rinse out the mouth with water to protect the teeth from the harmful effect of the citric acid.

8.1.19) Put a drop of vinegar on the tongue

8.1.20) Perform rectal massage: Some proven studies support that people with ongoing hiccups found immediate relief after a rectal massage.

8.1.21) Rubbing the back of the neck: Rubbing the back skin may stimulate the phrenic nerve ( nerve relating to the diaphragm).

8.1.22) Poke the back of the throat with a cotton swab: One needs to gently swab the back of the throat with a cotton swab (until one gag or coughs). The gag reflex may stimulate the vagus nerve.

8 .1.23) It is good to distract to something engaging. Because hiccups often go away on their own when one stops focusing on the hiccups.

8.2) Medication


There are varieties of medications (stated below) that treat the hiccups which can cause side effects. So, before taking the medications, it is wise to talk to the doctor.

  • Braclofen: It is a muscle relaxant.

  • Chlorpromazine: It is a medicine used to treat psychiatric illnesses in addition to hiccups.

  • Haloperidol: It is a type of tranquilizer.

  • Metoclopramide: It is used to treat problems in the esophagus and GERD i.e. Gastroesophageal Reflux Disease.

  • Anticonvulsant drugs: Drugs include Phanytoin/ Gabapentin/ Carbamazepine.

  • Sedatives

  • Pain medications

  • Stimulants


9. Hiccups in the babies


How to get rid of hiccups on babies

9.1) Causes of baby hiccups


Like the adults, the baby hiccups are also caused by the contraction of the diaphragm and the quick closing of the vocal cords. The rapid closure of the vocal cords creates the sound of the hiccups, However, unlike the adults, hiccups do not annoy the babies. Many babies can sleep through a bout of hiccups without being disturbed and the hiccups rarely interferes with the baby’s normal breathing.

9.2) How to get rid of hiccups on babies?


9.2.1) Take a break and burp


Taking a break (from feeding) to burp the baby, may help get rid of the hiccups. Because burping helps get rid of excess gas (which causes the hiccups). Burping is also important as it places the baby into an upright position.

The AAP (American Academy of Pediatrics) suggests burping the bottle-fed baby (after feeding every 2- 3 ounces). If the baby is breastfed, then it is important to burp the baby (after they start sucking breast milk).

Advice: It needs to rub or gently pat the baby’s back (not with force ) when they have hiccups.

9.2.2) Use a pacifier


Baby hiccups do not always start from feeding. When the baby starts to hiccup, it is important to allow them to suck on a pacifier as it helps relax the diaphragm and in consequence helps stop the hiccups.

9.2.3) Feed gripe water


If the baby seems to be in discomfort on account of their hiccups, then feeding gripe water may be tried. (Gripe water is a combination of herbs and water. The herbs include ginger/fennels/cinnamon). Gripe water is fairly a low-risk product.

Advice

  • Before feeding the baby anything new, it is recommended to consult the pediatrician.

  • Usually, the baby hiccup stops of its own. If the hiccup does not bother the baby, then it is wise to allow the baby to continue the course of hiccups.


9.3) Preventing hiccups in the babies



  • In fact, it is difficult to prevent the baby’s hiccups completely as the causes are not always clear.

  • It is important to make sure that the baby is calm during feeding. The implication is that the mother must wait and see that the baby’s hunger is fully satisfied without any interruptions imposed by the hiccups.

  • After feeding the baby, it is also important to avoid heavy activity with the baby (such as, bouncing up and down and participating in high energy game).

  • More importantly, it also needs to keep the baby in an upright position for 20- 30 minutes after each meal.


9.4) When the hiccups in the babies is a matter of concern



  • Hiccup is a normal part of the baby’s growth and development as long as the baby is less than 12 months old and also, the baby is not vomiting with their hiccups. The hiccup is quite normal even if the baby is still in the womb.

  • If the baby hiccups a lot (particularly if the baby gets agitated during hiccupping, it is essential to talk to the doctor, as this could be a sign of other medical problems. It is also important to talk to the doctor if the baby’s sleep gets disturbed by continuous hiccups.


10. Hiccups in the adults


The treatment procedure is the same irrespective of the adults or babies. But the causes of hiccups vary. Unlike the babies, the prime causes of hiccups among the adults are: eating and drinking too much and too quickly in addition to alcohol and carbonated drinks. Hiccups in an adult male are more common (than the females).

11. Hiccups during pregnancy


One may observe fetal hiccups in the 2nd/3rd  trimester (A typical pregnancy period lasts for 40 weeks beginning from the 1st day of the last menstrual period to the birth of the baby. It is divided into 3 stages known as 3 trimesters- the 1st trimester beginning from the 1st to the 12th week/ the 2nd trimester beginning from the 13th to the 26th week / the 3rd trimester beginning from the 27th to the end of pregnancy period). Many pregnant mothers start to feel these jerky motions in their 6th month of pregnancy period. But everyone feels these movements at different times during the particular period. Even though it is difficult to exactly pinpoint why some pregnant women will feel their baby hiccups in the womb, it is considered a good sign and a natural part of pregnancy. However, rarely fetal hiccups may be a sign of something wrong with pregnancy or fetus.

Babies often hiccup in the mother’s womb before they are born. Veritably, the hiccup is not a matter of concern during pregnancy and it causes no distress to the baby at all. The baby hiccup (in the womb) usually lasts for 5-10 minutes. But if the hiccups do not stop within a couple of hours, then it is advised to consult a doctor.

12) Hiccups during sleep


Hiccups during sleep

Hiccup during sleep usually occurs on account of eating or drinking near bedtime. It may also occur due to underlying medical conditions or certain medications. When a large meal is consumed during bedtime, the stomach expands and gets distended pressing upon the diaphragm causing it (diaphragm) to contract. In this way eating a large meal near bedtime can produce hiccups.

Drinking a large number of carbonated drinks at bedtime can also produce hiccups (as the air in those drinks can distend the stomach).

Consuming a large amount of alcohol (before going to bed) is another possible cause of hiccups during sleep. Moreover, alcohol is an irritating substance which may stimulate the nerves in the lining of the stomach that lead to reflux of the contraction of diaphragm.

Reflux of gastric contents often occurs during sleep (especially, if a person eats a large meal just before bedtime and also sleeps in a flat position without raising the head of the bed).

13) Key facts



  • An individual’s hiccup rate is usually found consistent for each hiccup episode (occurring at a frequency of 4- 60 hiccups per minute).

  • In general, the hiccup is more common in children (as compared to the adult) and men (as compared to women)

  • Hiccup is considered persistent (if they last for more than 48 hours)

  • The longest record of hiccups is 6 decades.


14) How to manage persistent hiccups


Persistent hiccup is a frustrating experience for palliative care patients and can have a profound impact on their quality of life. The management of persistent hiccup still presents a great challenge. However, for successful management, further research studies are recommended.

15) Relevant questions and answers (Q= question. A = answer)


15.1) Q: Can heartburn cause a hiccup, if so, why?

A: Yes, it can happen. Why? I can’t say. Consult the doctor. There may be a solution for either heartburn or hiccup or both.

15.2) Q: What should one do if a hiccup occurs during sleep?

A: It needs to be mentioned that during light sleep, the hiccup rate exceeds the breathing rate. Whereas during deep sleep, the breathing rate exceeds the hiccup rate.

Eating a large meal and also, consuming a large number of carbonated drinks near bedtime, can aggravate the problem of hiccups. It is well-advised to avoid these unhygienic eating habits, particularly near bedtime.

15.3) Q: Is hiccup life-threatening?

A: It is misleading to assert that “One must die of hiccups “. Veritably, hiccups occur in limited episodes (that come and go away mostly without any medication). Humans (even mammals) experience hiccups throughout life.

Conclusively, hiccup can be a source of annoyance, but not a concern.

16) Concluding remarks


Some non-medical home remedies might be effective which should be applied as the 1st line of defense.

Hiccup is a common human experience in life. But it can create a great deal of physical and emotional discomfort in end-stage disease.

Diseases are many, bur bad and unhealthy habits are few. Since the risk factor for most of the malignant diseases (including hiccup) is an unhealthy and idle sedentary lifestyle (such as consuming unhealthy foods and drinks in addition to smoking and alcohol), hence it is well advised to keep aloof from all those unhealthy bad habits.

17. TIPS



  • H = Hiccup (is an involuntary spasm of respiratory organs)

  • I = In general, (hiccup is more common in children and males)

  • C = Causes (of hiccups mainly include eating and drinking too much and too quickly)

  • C = Conclusively, (hiccup may be a matter of annoyance, but not a concern)

  • U = Usually, (hiccups come and go away without any medication)

  • P = Prevention (of hiccup is to avoid unhealthy foods and drinks including alcohol)

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