Almost every one of us must have experienced hiccups in our lifetime.
A hiccup is a repeated involuntary contraction of the diaphragm (the muscle that separates the chest from the abdomen) followed by a sudden closure of the vocal cords. This checks the inflow of air and produces the characteristic “snap” or “hic” sound.
Eating or drinking too quickly, having very hot or freezing foods, spicy food, alcohol and carbonated beverages are common causes of getting hiccups. Babies also may get hiccups after feeding, crying or coughing. However, many times a reason for hiccups cannot be identified.
Hiccups are usually harmless and settle by themselves in a few minutes. Breath-holding, drinking a glass of water or eating sugar are common ways to stop hiccups.
However, in some cases, prolonged hiccups that last for days or weeks may be suggestive of some underlying disorder. It is essential to identify the cause and treat it accordingly.
The only symptom of hiccups is a slight tightening sensation in your chest, abdomen, or throat that causes the hiccup sound.
The hiccup reflex involves the synchronized action of the
Diaphragm: It is a large muscle located below the lungs that demarcates the chest from the abdomen. It contracts rhythmically and continually to aid in respiration.
The muscles that open and close the windpipe
The nerves that act upon the diaphragm
If any of the nerves involved in this cycle are triggered, for whatever reason, the diaphragm may contract involuntarily, allowing the air to be drawn into the lungs. As a result, epiglottis( the top of the windpipe) closes, resulting in the distinctive cough-like ‘hic’ hiccup sound.
On the basis of the duration hiccups can be classified as:
Acute hiccups: Less than 48 hours duration
Persistent hiccups: Last over 2 days
Intractable hiccups: Last over a month
Conditions that may cause damage or irritation to the nerves that control the diaphragm including Gastroesophageal Reflux Disease(GERD), sore throat, goiter, tumor or cyst.
Certain medications can cause hiccups, such as-
Certain procedures that require the use of instruments can mechanically irritate the nerves that control the diaphragm and induce hiccups. For eg. abdominal or chest surgery .
Some of the conditions that may prompt frequent or prolonged attacks of hiccups include:
It is prevalent for babies under 12 months to get hiccups. Newborns and infants may experience hiccups more frequently during or after feeding as they may swallow food too quickly or overfeed.
This can lead to stomach distension, and when the stomach distends, it pushes against the diaphragm, which causes it to contract and cause hiccups.
Hiccups can be a sign of an infant being full. Therefore, pediatricians typically recommend short feeds with burping breaks.
Your baby will usually stop hiccupping within 5 to 10 minutes, but if your baby's hiccups do not stop within a couple of hours, you should see your doctor.
Note: Generally, hiccups are a sign of healthy growth and development.
No specific test is required in the diagnosis of hiccups, but in the case of persistent or intractable hiccups, it is important to detect any probable underlying illness.
A physician may ask for the history of the current sickness that includes the length of the hiccups, any treatments used, and their relevance to a recent condition or operation. They may also ask about your past medical history, including information about known gastrointestinal and neurologic disorders, and drug history that also includes details concerning alcohol use.
During the physical exam, the doctor may perform a neurological exam to check your-
Balance and coordination
Muscle strength and tone
Reflexes
Sight and sense of touch
While no specific evaluation is required for acute hiccups, the following lab tests might be suggested for diagnosis of long term hiccups:
These tests may help to identify abnormalities inside the chest, neurological changes or lesions causing hiccups.
The majority of hiccup bouts are self-limiting and pass quickly. However, if they persist even after 2 days, it can be because of an underlying condition. Doctors that can help diagnose and treat hiccups include:
General physicians
Otolaryngologists
Gastroenterologists
Neurologists
Pulmonologists
An otorhinolaryngologist is a surgical doctor for the management of conditions of the head and neck.
A gastroenterologist is specialized in the diagnosis and treatment of the gastrointestinal tract disorders.
A neurologist specializes in the treatment of disorders affecting the brain, spinal cord, and nerves. A pulmonologist is a doctor who treats disorders of the lungs.
When to see a doctor?
Contact a doctor if the hiccups last for more than 48 hours, return frequently, or are interfering with your life. Consult them right away if you experience the following symptoms along with the hiccups:
If you are facing such an issue, consult a professional immediately. To book a consultation
Hiccups are very common and usually resolve on their own. Try these tips to prevent hiccups by making some changes in your habits:
Do’s:
Don'ts:
Say goodbye to ‘hic’ or hiccups. Read about hiccups in a nutshell.
The doctor will want to know if your hiccups are caused by a medical condition or medication you are taking. If the underlying problem is treated or you switch medications, the hiccups should go away. The underlying cause determines the pharmacological treatment, which may include:
1. For nasal symptoms: Nebulized 0.9% saline (2 mls over 5 minutes)
2. To reduce gastric irritation: Proton pump inhibitors can be given. They include:
3. To reduce gastric distension (enlargement): Medications include:
4. Antiflatulent: These medications are used to treat or prevent excessive intestinal gas. They include-
Simethicone
Peppermint water
Carminative agent
1. Dopamine antagonists: These medicines can relax the diaphragm muscle or its
nerve supply and may stop persistent hiccups. They include:
2. GABA agonist: Baclofen is the medication of choice as it helps relax muscles.
Note: Caution is advised in the elderly and patients with kidney dysfunction.
3. Local anesthetic: Low-dose of lignocaine infusion or nebulization help stop hiccups.
4. Antiepileptic: These help relax the nerve supply to the diaphragm and relieve hiccups. The most commonly used drugs include:
5. Calcium channel blocker: These blockers, such as nifedipine, can help control hiccups.
More invasive options might be attempted only in case of extreme cases of hiccups. These include the following:
Hiccups usually resolve on their own. However, if the hiccups don't stop, here are some tips that can help. Not many studies evaluate the effectiveness of these hiccup remedies. However, they are backed by anecdotal evidence. Additionally, some of the most common remedies stimulate your vagus or phrenic nerves, which are connected to your diaphragm.
Here are some tips that can be helpful in toddler or infant hiccups.
Explore our extensive range of anti-colic feeding bottles.
It is always advisable to seek the child's pediatrician's consent before starting these tips.
Frequent episodes of acute hiccups, persistent and intractable hiccups, can significantly impact the quality of life and cause physical pain, humiliation or psychological distress.The following complications are associated with them:
Strong hiccups can also cause:
Acupuncture can be explored as an alternative treatment option for persistent and intractable hiccups. It stimulates the nerves that are responsible for hiccups.
Some case studies show that acupuncture may effectively treat persistent hiccups, even when conventional forms of treatment don’t work.
Although there is insufficient evidence evaluating the safety and effectiveness of acupuncture in resolving hiccups, some people have been able to cease their long-term hiccups with this therapy, so it may be worth a shot.
A carotid sinus massage may be suggested to manage chronic hiccups. This involves rubbing the main carotid artery in the neck by the healthcare provider.
Hiccups are usually harmless and resolve themselves in a few minutes. Simple home remedies also come in handy to manage them.
However, chronic or prolonged hiccups can be highly stressful, annoying and disrupt daily routines. They can make sleeping difficult or wake you up in the middle of the night. If the condition lasts for a long time, the lack of sleep can cause a loss of energy throughout the day, leading to exhaustion. All these factors can negatively impact a person's quality of life.
To cope with the condition, getting plenty of rest, eating and drinking small amounts regularly, and being aware of potential complications are critical.
Take prescribed medications on time. Keep yourself busy and distracted. Develop a hobby. Join support groups facing the same challenges.
Maintain regular contact with your doctor throughout treatment to avoid the recurrence of hiccups and complications associated with chronic hiccups.
