What are Hiccups?
We all know that anything once is funny, twice is hilarious and anything more than that is annoying. We all had them once and they are nothing else than hiccups. Yes, hiccups! Hiccups are the repetitive and uncontrollable contractions of the diaphragm muscle. Do you know that diaphragm is the muscle that is present just below your lungs? It is the boundary between your chest and abdomen.
What is the role of the diaphragm in our bodies?
The diaphragm regulates breathing. You take in oxygen when your diaphragm contracts and gives out carbon dioxide when your diaphragm relaxes.
The diaphragm contracting out of this rhythm causes hiccups. Each sudden movement of the diaphragm makes the larynx and vocal cords close suddenly. This leads to a sudden rush of air into the lungs and the sound causes hiccups. We also call hiccups as singultus in the medical field.
How do hiccups start?
There is no possible way to predict hiccups. With each gradual movement, the chest tightens which produces the sound of hiccups. You will see that most of the hiccups start and end abruptly. Some hiccups remain for more than a day or a month. The hiccups which last longer more than 48 hours are considered to be persistent. Hiccups that last longer than 2 months are considered intractable. They are very difficult to manage.
What are the causes of Hiccups?
We have shortlisted a number of causes of hiccups. But there is no definitive list of how to control it. Hiccups often come and go for no apparent reason.
Sometimes you will notice that while eating or after eating, hiccups are produced. It means that you have eaten a lot so avoid over-eating.
2) Eating spicy food
Your body produces hiccups when you eat spicily. It is very common in people. It remains for a while.
3) Consuming alcohol
Sometimes alcohol consumption also becomes a reason to produce hiccups. It can be cured by drinking water.
4) Drinking soda and cold-drinks
Sometimes you get hiccups due to these carbonated beverages. It is quite normal.
5) Eating very hot or cold food
A very common reason in people for hiccups. Eating very hot or cold food changes your internal body temperature and causes hiccups. Avoid eating very hot or cold food.
6) Excitement or emotional stress
You will notice some people that they start hiccups when they are way too happy or sometimes stressed. Their mental situation causes these hiccups. It remains for a while and will end when you get normal.
The majority of persistent hiccups are caused by the injury. It can also be due to irritation in the vagus or phrenic nerve. Vagus and Phrenic nerve control the movement of your diaphragm.
These may be affected due to:
- irritation of your eardrum due to any foreign object
- acidity problems
- an esophageal tumor
Other causes of Hiccups
Other causes of hiccups may involve the central nervous system. Your brain and the spinal cord comes under this central nervous system. If by chance your CNS gets damaged then you may lose the ability to control disgorge.
There are many possible ways that your CNS can get damaged. It includes:
- injury in accidents
- neurosyphilis(a brain infection)
Sometimes hiccups remain for a very long time due to some diseases. It can be either diabetes, kidney failure, cancer or Parkinson’s disease.
Hiccups in Parkinson’s disease
Although hiccups may be a non-motor symptom of Parkinson’s disease they have attracted little research attention to date.
According to reports, 20% of Parkinson disease’s patients and 3% of the control subjects reported frequent disgorge. The reported occurrence of disgorge was significantly higher in Parkinson’s disease patients than controls. Almost nine patients noted that disgorge had appeared in the past particularly on the onset of disease.
This indicates that disgorge are more frequent in Parkinson’s disease patients than healthy controls. Further studies are required to determine whether disgorge are associated with intrinsic pathology to dopamine replacement therapy.
Hiccups in cancer
Hiccups are common symptoms seen in patients with cancer. It can be seen either during cancer treatment or in the palliative care setting.
It causes the characteristic sound due to the involuntary clonic movement of the diaphragm and intercostal muscles followed by the sudden closure of the glottis.
Risk factors for hiccups
Hiccups can occur at any age. They can even occur while a fetus is still in the mother’s womb. However, there are several factors that can increase your likelihood of developing disgorge.
You may be more susceptible if you are male and experience intense mental or emotional responses.
Most hiccups are not so serious to worry about. However, prolonged disgorge can be uncomfortable and disruptive to daily life.
You must visit a doctor if you are having disgorge for more than 2 days. They will determine the severity of your disgorge in relation to your overall health conditions.
What you can try at home?
There is a number of ways to treat disgorges. However, none of the ways have been proven to stop disgorge but you can try the following at home.
1) Breathe into a paper bag
2) Eat a teaspoon of sugar
3) Hold your breath
4) Drink a glass of water
5) Pull-on your tongue
6) Lift your uvula with a spoon
7) Bring your knees to your chest and hold this position
8) Relax and breathe in a slow and controlled manner
When to see a doctor?
If you still have hiccups for more than 48 hours then visit a doctor. Your doctor may attempt stomach pumping or carotid sinus massage.
During the physical exam, your doctor may perform a neurological test to check your:
1) Balance and co-ordination
2) Muscle strength and tone
4) Sight and sense of touch
If your doctor suspects an underlying medical condition that may be causing your hiccups then he may recommend you one or more following tests.
Your blood may be checked in sample tests for signs of:
- Kidney disease
These types of tests may be able to detect anatomical abnormalities. They may be affecting the vagus nerve, phrenic nerve or diaphragm.
Imaging tests may include:
- Chest X-ray
- CT scans
- MRI scan
- Echocardiogram to assess heart function
These tests use a thin and flexible tube that contains a tiny camera. It is passed down your throat to check for problems in your esophagus.
In most cases, you will see that disgorge go away on their own without any medical treatment. If an underlying medical condition is causing your hiccups then treatment of that illness may eliminate the disgorge. The following treatments may be considered for disgorges that have lasted longer than two days.
These are some drugs that may be used to treat long term disgorges:
A single dose of Baclofen is good for the treatment of intractable disgorge.
It is a dimethylamine derivative of phenothiazine. It is a tested drug.
It can also help you to disappear persistent disgorge.
It is generally not recommended but it also helps you in getting rid of disgorge.
The recommended dose of gabapentin is 100mg 3-4 times daily.
It is also recommended to getting rid of disgorges.
Surgical and other procedures
If less invasive treatments are not effective, your doctor may also recommend an injection of an anesthetic to block your phrenic nerve to stop hiccups.
Another option is to surgically implant a battery-operated device to deliver mild electrical stimulation to your vagus nerve. This procedure is most commonly used to treat epilepsy but it has also helped control persistent disgorge.
There are also more options to treat extreme cases of disgorge. They include:
1) nasogastric intubation- In this, a tube is inserted into the stomach through your nose
2) an anesthetic injection to block your phrenic nerve
3) surgical implantation of a diaphragmatic pacemaker
Possible complications of untreated hiccups
Long term hiccups can be uncomfortable and even harmful to your health. If left untreated, small problems can also lead to big problems. It can also disturb your sleeping and eating patterns. It can lead to exhaustion, mental stress and weight loss.
Preparing for your treatment
While you may initially consult your family doctor about your persistent disgorge, he may refer you to a specialist if you severe disgorge.
What you can do?
You may want to write a list including:
- detailed descriptions of your symptoms
- information about medical problems you have had
- information about the medical problems of your family
- all the medications and dietary supplements you take
- ask all doubts from your doctor
What to expect from your doctor
Your doctor may ask you:
- When did your disgorge start?
- How often do they occur
- Is there anything that worsens them?
- What medications are you taking?
- Have you had a sore throat?
- Have you had chest pain, cough or difficulty in breathing?
- Do you have headaches or other neurological symptoms?
How to prevent hiccups
There is no proven method for preventing hiccups. However, you can try to reduce your disgorge in the following ways.
1) Don’t overeat-
Overeating causes disgorge. If you will control your eating habit then you will experience fewer disgorge.
2) Avoid carbonated beverages-
Consume less carbonated beverages which will reduce your disgorge.
3) Say no to alcohol and drugs-
It is also not good for your health. So for your health and to reduce hiccups, avoid the intake.
4) Remain calm and try to handle anxiety and emotional reactions
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