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

Introduction:

Hiccups are the 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 the carbon dioxide. When the diaphragm contracts out of rhythm, it causes hiccups. The medical term for hiccups is singultus.

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 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.

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-hiccups 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 helping in stimulating the diaphragm and regulating breathing.

Are There Any Complications?

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.

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 changes in temperature.

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.