Hiccups are repeated diaphragm spasms paired with a ‘hic’ sound from the closing vocal cords. A spasm is a sudden involuntary contraction. Involuntary means anything that happens without our will. That means a hiccup occurs without our will or conscious control. The medical term for hiccups is singultus, which comes from the Latin word for “gasp” or “sob.” American Charles Osborne has
the Guinness World Records as he had hiccups for 68 years, from 1922 to February 1990.
Diaphragm and Vocal Cords:
There is a dome-shaped, muscular and membranous structure below the rib cage and between the thoracic (chest region) and abdominal (stomach region) called a diaphragm. It's primarily useful in breathing or respiration. There are muscular infoldings to create voice in the throat region called vocal cords. Contraction of the diaphragm, followed by the closure of vocal cords within about a quarter of a second, causes the "hic" sound. In other words, two things happen during hiccups, that's (1) the diaphragm pulls down between breaths, making the person suck in air, and (2) the glottis (space between the vocal cords) closes to stop more air from coming in.
Occurrence:
Hiccups may occur in a person of any age - babies, children, and adults. They are more common in men, that too for a longer duration. Hiccups may occur individually or in bouts. The rhythm or the time between hiccups is relatively constant. They may happen one time or repeat several times a minute. The hiccup process happens very quickly, and the person may return to normal within minutes to a couple of hours without any treatment.
Types of Hiccups: There are three kinds of hiccups. They are
1) Mild hiccups: those that go away in a short time.
2) Persistent hiccups: those that last for a few days.
3) Intractable hiccups: those that last for a month or more.
Causes of Hiccups:
It’s not clear why hiccups occur. But there might be several reasons, including low levels of carbon dioxide in the blood and irritated nerves.
Mild hiccups may happen due to the following reasons:
1) eating and drinking too quickly
2) drinking too cold or too hot substances
3) eating too much (fatty or spicy food, especially)
4) taking carbonated beverages or alcohol.
5) stress, including excitement and fear
6) over-stretching of the neck.
7) taking medications for acid reflux, most benzodiazepines, including diazepam (Valium), alprazolam (Xanax), and lorazepam (Ativan).
Levodopa, nicotine, and ondansetron (Zofran) may also cause hiccups.
8) Inhaling toxic fumes during some anesthetic procedure
9) after undergoing some surgery
10) sudden changes in temperature
11) Plasmodium vivax malaria
Persistent hiccups and intractable hiccups may be caused due to pneumonia, gastrointestinal disorders, heart stroke, abnormalities in the diaphragm, hepatitis, cancer, brain tumors, etc.
Hypotheses Concerning Hiccups:
The Burping Reflex Hypothesis: hiccups were evolved to facilitate greater milk consumption in young mammals.
Phylogenetic (Evolutionary) Hypothesis: the hiccup is an evolutionary remnant of earlier amphibian (tadpole larva) respiration.
Hiccup Troubles:
A hiccup causes unexpected abdomen, shoulder, throat, or full-body tremors. It may cause painful interruptions in normal breathing, with sudden momentary pain of the throat, chest, or abdomen. Persistent hiccups cause eating and sleeping troubles.
Remedies: They include folk, physical, home, lifestyle, and medical remedies.
Folk Remedies: Folk or superstitious remedies include
(i) drinking a glass of water upside-down,
(ii) head standing (an inversion posture of standing on the head),
(iii) being frightened by someone,
(iv) breathing into a bag,
(v) eating a large spoonful of peanut butter and
(vi) placing sugar on or under the tongue.
Physical and Home Remedies:
(1) increasing the partial pressure of CO2 and inhibiting diaphragm activity by holding one’s breath or rebreathing into a paper bag,
(2) pulling knees up to the chest and leaning forward,
(3) holding breath,
(4) breathe into a paper bag,
(5) sipping cold water,
(6) gargling with ice water,
(7) swallowing sugar, dry bread pieces, crushed ice, etc
8) downing water,
9) gently pulling on the tongue,
10) gently rubbing eyeballs,
11) gagging - sticking a finger down the throat,
12) biting on a lemon,
13) breathing smelling salts,
14) stop or give breastfeeding for babies as per the situation, etc.
Lifestyle Remedies:
(i) avoiding gas-producing food items and carbonated drinks
(Ii) eating smaller and split meals
When to consult a doctor?
(i) Get hiccups for two days or more
(ii) Have difficulty in breathing, eating, or sleeping
(iii) When the hiccups happen simultaneously as symptoms like a headache, trouble keeping the body balance, or numbness.
(iv) When associated with abdominal pain, fever, shortness of breath, vomiting, coughing up blood, or feeling as if the throat is going to close up.
Diagnosis:
During the physical exam, the doctor performs some neurological tests to know the following:
(i) body balance, chemical and nervous coordination
(ii) strength and tone of muscles
(iii) reflexes (a reflex is an involuntary and nearly instantaneous movement in response to a stimulus)
(iv ) sight and sense of touch
If once the doctor suspects an underlying medical problem, they will recommend any or many of the following tests to know about the condition of the vagus nerve (it runs from the brain through the face and thorax to the abdomen), phrenic nerve (from the brain to diaphragm) and diaphragm itself.
1) Laboratory tests: Blood tests to check diabetes, Infections, Kidney disease, etc.
2) Imaging tests: include chest X-ray, Computerized Tomography (CT scan), Magnetic Resonance Imaging (MRI), or Endoscopic tests ( introducing a thin, flexible tube with a tiny camera into the throat to check for problems in your esophagus or windpipe).
Medical Treatment:
Metoclopramide and steroids with ramosetron might prevent hiccups.
Hiccups are treated medically only in severe, persistent, and uncontrollable causes. Drugs like baclofen, chlorpromazine (Thorazine), haloperidol (Haldol), and metoclopramide (Reglan), gabapentin, etc., may be used.
Note: Don't take any drug without a qualified doctor's prescription.
Surgical and other procedures (for persistent hiccups only):
(i) an anesthetic may be given to block the phrenic nerve to stop hiccups.
(ii) surgical implantation of a battery-operated device to deliver mild electrical stimulation to the vagus nerve.
Alternative Medicine: acupuncture (Chinese method where thin needles are inserted into the body) and hypnosis (verbal repetition and mental images to heighten focus and concentration).
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