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Hiccups

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When a person has hiccups, or singultus, the diaphragm undergoes several spasmodic contractions that repeat over the course of several minutes. The process occurs when the diaphragm muscle contract several times in succession and a good amount of air suddenly enters into the lungs. To stem this influx of air, the epiglottis or vocal cords abruptly close. This action creates a “hic” sound that is known as a hiccup. In medical terminology, a hiccup is called a synchronous diaphragmatic flutter (SDF).

A person who has the hiccups will experience several brief and irritating spasms that occur in the diaphragm. These spasms can be as brief as a few seconds or as long as several minutes.

HICCUPS SYMPTOMS

Hiccups are accompanied by a sound that has been described as “hic”, and this sound comes right after a mild tightening that is felt in the throat, chest, and stomach. There are some people who produce only four hiccups within the space of a minute, while others can make as many as 60 hiccups in the same amount of time. While hiccups are not a fatal or even serious condition, a person who has been hiccupping for over 48 hours will need to seek medical attention to determine the cause of the hiccups.

HICCUPS CAUSES

Hiccups can be caused by a number of factors. Any instances of irritation that occurs in the nerves connecting the neck to the chest can result in persistent hiccups. Hiccups are also associated with many other illnesses, such as pneumonia, or from the accumulated build-up of harmful substances in the bloodstream, as in the case of kidney-related ailments.

Some cases of hiccups stem from disorders of the central and peripheral nervous system. Hiccups that occur due these disorders are the result of injuries or irritants to the phrenic nerves and vagus nerves. Disorders relating to toxicity and metabolism that affect the nervous system may lead to hiccups, as well.

When a person drinks carbonated or alcoholic beverages, there will be a tendency to hiccup. Chemotherapy has been shown to affect 30% of patients with the hiccups. In these instances, chemotherapy treatment is directed at tumors that may be situated near parts of the anatomy which, when irritated, cause hiccups.

Other cases of hiccups are caused by a person eating too fast due to taking in a good amount of air along with food. Eating too much fatty food, or drinking too much is also seen as some of the other culprits of hiccups. When related to intake of food and drink, researcher believe that hiccups are a reflexive action of the diaphragm to keep a person from choking.
hiccups
Image: Hiccups


Hiccups may be caused by other factors such as hunger, burping, eating spicy food, coughing, consuming a hot meal and then drinking a cold beverage, excessive alcohol consumption, vigorous laughing, abnormal intake of air while smoking, electrolyte imbalance, talking or speaking for an extended period of time, throat clearing, a vitamin deficiency, the use of opiate drugs, sobbing or crying loudly, certain infections such as laryngitis, eardrum irritations, surgery involving general anesthesia, diabetes, seizures, vomiting, and a lack of oxygen.

HICCUPS DIAGNOSIS

By themselves, hiccups give no cause for alarm. They are very rarely considered a medical emergency. However, if a person exhibits chronic and persistent hiccups that last for longer than 3 hours to the point that the condition interferes with eating and sleeping, they should consult a doctor as soon as possible. This is particularly true if the hiccups are accompanies by intense abdominal pain and the spitting up of blood, necessitating immediate medical intervention.

Based on the patient's medical history and thorough physical examination, the doctor will make a diagnosis depending on the cause of the hiccups. It is very rare that the doctor will order laboratory testing unless it has been established that the hiccups are a result of a more serious medical condition.

Hiccups that are experienced by otherwise healthy individuals are likely to go away leaving no serious side effects. In these cases, the only concern that healthy people have is the social embarrassment they experience whenever they are visited by a case of the hiccups.

HICCUPS TREATMENT

Most hiccups resolve by themselves without the need for any medical intervention. In most cases, people sometimes forget about hiccups, causing them to go away by themselves. However, there are several home remedies that are effective in reducing the duration of hiccups.

Psychosomatic home remedies center around the theory that physical relaxation or distraction from hiccups will eventually cause them to disappear. These remedies involve swallowing, altering or controlling one's breathing, and eating food to remove any irritants that may have caused the hiccups in the first place.

Other more popular home remedies for hiccups include drinking a lot of water, holding one's breath for as long as one is able, placing a tablespoon of sugar at the back of the tongue, or startling a person who has the hiccups. The latter is thought to be effective due to the jolt a startle gives to a hiccupping person, thereby jostling the diaphragm and ending a bout of hiccups.

Holding one's breath is believed to stop the hiccups through building up a certain level of carbon dioxide in the blood. Drinking water or pulling on one's tongue will stimulate the vagus nerve, which extends from the stomach to the brain, hence stopping the hiccups. Other people use smelling salts to effectively get rid of these irritating and annoying diaphragm spasms.

Sedatives have also been used effectively to render a person lethargic or unconscious, thus getting rid of hiccups. Digital massage of the rectum has also been recommended. For people who hiccup due to hypokalemia or hyponatremia, underlying ailments caused by an electrolyte imbalance, drinking carbonated beverages with salt can restore the balance of potassium and sodium in the system. Intranasal vinegar administration also works by stimulating the nasopharynx where the hiccup reflex arc is found in order to halt the hiccups.


For hiccups that occur in a chronic and persistent manner, such as the 2007 case of a fifteen-year-old girl who suffered from severe hiccups for 5 weeks, the doctor may prescribe certain medications to relieve the contractions. Chlorpromazine or Phenytoin, that are usually prescribed for convulsions, and Baclofen, an anti-spasmodic drug, have been found to be effective against hiccups.

In more severe cases, doctors may recommend surgery to incapacitate the phrenic nerve that stimulates the diaphragm. However, this is considered as a last resort treatment when all conservative medications fail.

There is an experimental procedure that is currently being studied by neurosurgeons at the Health Sciences Center of the Louisiana State University involving a vagus nerve stimulator. This device is implanted within the patient's upper chest where it sends out rhythmic emanations of electricity towards the brain through the patient's vagus nerve. This procedure is being tested to cure cases of chronic and intractable hiccups.
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