Hiccups - Causes, Risk Factors, Treatment, Complications, and Prevention

Introduction:

Hiccups are contractions of the diaphragm muscle that occur in a repetitive and uncontrolled fashion. The diaphragm is the muscle that is present just below the lungs and demarcates the chest from the abdomen.

It helps regulate breathing as its contraction helps in the intake of oxygen, and its relaxation helps in expelling carbon dioxide. When the diaphragm contracts out of rhythm, it causes hiccups. The medical term for hiccups is singultus.

What are Hiccups?

Hiccups are the rapid and uncontrollable jerks occurring in the diaphragm, which is a smooth muscle and is positioned between the chest and the abdominal cavity, where it forms the main part of the breathing mechanism. These intermittent involuntary spasms, on the other side, lead to unconscious quick swallows that result in the characteristic hic sound, preceded by the air entering the body and the closing of vocal cords.

How Does It Occur?

Most of the time, hiccups begin and stop abruptly, and there is no associated reason. These episodes last only for a few minutes and then stop on their own. Persistent hiccups are those that last longer than 48 hours. If the hiccups last longer than two months, they are considered difficult to manage.

What Are the Different Types of Hiccups?

Here are some common types:

• Acute Hiccups: They are transient and self-limiting too and they usually last between a few minutes and a few hours and resolve spontaneously. They arise at the least expected times. They may be due to factors such as eating fast, drinking carbonated drinks, or of sudden excitement.

• Persistent Hiccups: When hiccups are still being experienced for more than a day but less than a month, they are classified as persistent. In this case, the bumpy ride can be blamed on many issues including GERD, nerve damage, or phrenic or diaphragmatic irritations among others.

• Intractable Hiccups: Refractory hiccup is typically used to describe a soundless hiccup that lasts more than one month. They can be tremendously irritating and can be symptomatic of something more serious like psychiatric conditions such as epilepsy, metabolic disorders, or some medicines.

• Reflex Hiccups: These are the glitches that come as a consequence of certain stimuli that one can take as having spicy food, alcohol, or sudden changes in temperatures. A prevalent feature of an allergic response is that it is usually brief and the symptoms disappear as soon as the causal agent disappears.

• Psychogenic Hiccups: Psychogenic hiccups are a type of hiccups that rule out the presence of physical organ problems and attribute the cause to emotional or psychological factors. They may emerge in the wake of stressful events, or when the person experiences anxiety or other negative emotions. Usually, more than the nightly headaches, the psychological issue that is responsible for this must be treated to be able to fully heal.

• Idiopathic Hiccups: The idiopathic hiccups may continue for a long time and sometimes without any reason or cause identified. Sometimes they are difficult to treat, and only after extensive medical examination is it possible to confirm that are they not a consequence of some other underlying problem.

• Synchronous Diaphragmatic Flutter (SDF): Suffering from, "singultus alternans," the patient does not only experience frequent contraction of the diaphragm muscles but of other respiratory muscles as well resulting in the characteristic rapid, involuntary chest wall movements. It is a rarity that incidentally occurs either in connection with neurological diseases or respiratory conditions.

What Causes Hiccups?

Some of the possible causes for hiccups that last short term include:

• Overeating.

• Eating very hot or very cold foods.

• Consumption of spicy food.

• Alcohol consumption.

• Consumption of carbonated beverages, like sodas. Various causes can be associated with hiccups, although there is no proven specific cause for the same.

• Any sudden change occurring in air temperature.

• Excitement.

• Stress (emotional stress).

Long-lasting hiccups, usually more than 48 hours, are classified based on the irritant that causes them. Most of the cases get hiccups due to irritation of the nerve that supplies the diaphragm, and the causes include the following:

• Eardrum irritation.

• Goiter.

• Throat irritation.

• GERD (gastroesophageal reflux disease).

• Tumor or cyst in the esophagus.

Other causes include CNS (central nervous system) disorder which may lead to uncoordinated effects in the body. Following are some of the CNS damages that may contribute to hiccups:

• Meningitis.

• Stroke.

• Multiple sclerosis.

• Tumors.

• Neurosyphilis.

• Hydrocephalus.

Long-lasting hiccups can be due to the following causes:

• Alcohol and tobacco overuse.

• Post-surgical reaction to anesthesia.

• Consumption of certain drugs like steroids and tranquilizers.

• Kidney failure.

• Diabetes.

• Malformations of arteriovenous flow.

• Electrolytic imbalance.

• Cancer.

• Chemotherapy.

Sometimes, even it can be iatrogenic, that is, due to certain procedures like:

• Catheter usage to reach heart muscles.

• Esophageal stent placement.

• Tracheostomy.

• Bronchoscopy.

What Are The Risk Factors For Hiccups?

Hiccups can occur in anyone and at any age, even in a fetus. But, the following factors can put a person at risk of developing it more commonly than others:

• Male.

• Intense emotions and anxiety.

• People who have received general anesthesia.

• Post-surgery, especially abdominal surgery.

• Overeating and eating too fast.

• Drinking alcohol and smoking.

• Certain medications such as steroids or opioids.

• Consuming carbonated drinks.

• Eating spicy food.

• Sudden temperature changes.

What Causes Newborn Hiccups?

Newborn hiccups, though quite common, are generally without serious consequences. Several factors can contribute to newborns experiencing hiccups:

• Immature Nervous System: Newborns are characteristically born with immature central nervous systems including the nerves that control the diaphragm. These could be the reason why they wrestle with hiccups.

• Feeding: There are times when hiccups can happen while feeding and after feeding as well, especially when the child feeds too fast, or when airways get blocked by the baby swallowing air as he/she is nursing or bottle feeding.

• Gastroesophageal Reflux: This happens when the stomach’s contents are seen to flow back into the esophagus resulting in irritation and then hiccups.

• Temperature Changes: When we go from a place with constant changes in temperature to a different place, hiccups can sometimes be triggered. This leads to hiccups in newborn babies.

• Overfeeding or Swallowing Air: While breastfeeding, feeding with bottles or excessive amount of air swallowing during a child’s feeding may be the reason for persistent hiccups in the infant.

• Stress or Excitement: Hiccups can, under these conditions (emotional stress or excitement), similarly be triggered in a newborn baby.

What Tests Help Identify the Cause of Persistent Hiccups?

When you visit your physician for persistent and irritating hiccups, certain tests may be performed along with history taking and physical examination, which are as follows:

1. Blood tests.

2. LFT - Liver function tests.

3. Chest X-ray.

4. CT (computed tomography) scan.

5. MRI (magnetic resonance imaging).

6. Endoscopy.

7. Echocardiogram.

8. Bronchoscopy.

How Can Hiccups Be Treated?

Most of the time, hiccups are not an emergency, but if it is prolonged in nature, they may cause discomfort in day-to-day life. It is advisable to contact your physician in case you have hiccups for more than 48 hours to get it diagnosed and treated at an early stage.

There are various ways to manage hiccups. The short-term hiccups take care of their own, but long-term hiccups may require certain management. Certain home remedies can be tried to stop it, but they are not proven methods. The following are the methods that can be tried at home:

• Breathing into a paper bag.

• Consumption of one teaspoon of granulated sugar.

• Holding the breath.

• Consumption of one glass of cold water.

• Pulling the tongue.

• Lifting the uvula with a spoon.

• Purposefully gasping or belching.

• Bringing the knees to the chest and maintaining this position for some time.

• Valsalva Maneuver: Close your mouth and nose and exhale forcefully.

• Relaxing and breathing in a slow and controlled manner.

Hiccups that exist longer than 48 hours require medical consultation, and the doctor may go ahead with gastric lavage, which is stomach pumping, or carotid sinus massage, which is nothing but rubbing the main carotid artery in the neck.

The main treatment of hiccups lies in managing or treating the underlying cause. If there is no obvious cause, it can be managed using certain anti-hiccup medications like:

• Chlorpromazine and Haloperidol.

• Benzodiazepines.

• Gabapentin.

• Benadryl.

• Baclofen.

• Nifedipine.

Sometimes, invasive procedures may also be required, which are as follows:

1. Nasogastric intubation. In this, there is the insertion of a tube into the stomach via the nose).

2. Blocking the phrenic nerve using anesthetic medication.

Also, a diaphragmatic pacemaker can be implanted surgically. It is a battery-powered device that helps stimulate the diaphragm and regulate breathing.

What Are the Complications of Hiccups?

Yes, long-term hiccups may cause certain complications, which are as follows:

1. Difficulty sleeping.

2. Malnutrition.

3. Tiredness or exhaustion.

4. Loss of weight.

5. Dehydration.

6. Discomfort and distress.

7. Social and emotional impact.

What Are the Ways to Prevent Hiccups?

As such, there are no proven ways to prevent hiccups, but the following methods can be followed to prevent the triggers that can cause hiccups:

1. Avoid overeating.

2. Avoiding the consumption of carbonated beverages.

3. Self-protection from sudden temperature changes.

4. Avoiding the consumption of alcohol.

5. Stay calm. Avoid intense emotion, anger, or anxiety.

Conclusion:

Hiccups are normal but persistent hiccups can lead to disruption in normal life. Also, if not managed on time, it may cause certain complications. It is important to consult your physician in case of any doubts or if you are suffering from continuous hiccups. Online medical platforms have made the consultation process easy. Hence, consult a specialist or physician to know more about hiccups.