How To Stop Hiccups - Types, Causes, Symptoms, Treatments

Table of content

1. Hiccup- An overview

A hiccup is medically termed an SDF (Synchronous Diagrammatic Flutter). It is an involuntary spasm of the diaphragm and the respiratory organs with a sudden closure of the glottis and the characteristic gulping sound (when the muscle spasms and the vocal cord snaps). Often, the hiccup is rhythmic. Usually, a hiccup is just a temporary and minor annoyance.

Almost everyone, young or old and male or female, experiences hiccups at one time or another. Mostly, hiccups come and go away on their own within a minute and without any medication. Hiccups can interfere with daily activities (eating/ drinking/ talking).

2. Types of Hiscup

The causes determine the type of disease, risk factors, signs, symptoms, and diagnostic tests, which significantly affect the treatment procedure. Depending on the severity and the length of time, hiccups can be classified under 2 heads: 

2.1) Mild hiccup

Mild hiccups come and go away without any medication and within a short period. They usually occur when

• One eats or drinks too quickly
• Eats too much
• Drinks carbonated beverages
• Experiences stress
• Consumes very hot or cold drinks or alcohol
• Takes anxiety-reducing drugs

2.2)  long-lasting hiccups (persistent or intractable hiccups)

Such types of hiccups are linked to severe medical conditions. They can be stressful and will not go away unless the related conditions (causing the hiccups) are removed. Some medical conditions include:

• Tumors: A tumor is an abnormal growth of cells that serve no purpose. Under normal conditions, the cells in the body grow, die, and are replaced by new ones. But the tumor cells grow and do not die. Whereas the body does not need them. When the benign cells deteriorate to malignancy, then it is called cancer
• Cancer
• Stroke: is the death of a brain cell due to lack of oxygen caused by the blockage of blood flow to the brain
• GERD: Gastro-esophageal Reflux disease. It is caused by acid reflux back into the esophagus.

2.2.1) Hiccups in patients with stroke 

Intractable hiccups are uncommon but inevitable sequels to the aftermath of ischemic stroke (It occurs when an artery to the brain is blocked. The brain depends on its arteries to bring fresh blood from the heart and the lungs). Intractable hiccups can have a significant impact on post-stroke rehabilitation and can have a detrimental impact on the patient’s quality of life. Clinical research is suggested within intractable hiccups so that more can be learned about the disabling cause of the sufferer.

2.2.2) Hiccups in Patients with Cancer

Everyone in his life experiences hiccups (which come and go away, usually without medication). But when hiccups are cancer symptoms or side effects of cancer treatments, they can persist for an extended period. This makes the patient challenging to cope with. In the case of cancer treatment, the hiccups may be experienced if:

• The stomach stops working and becomes extended and bloated
• One has an infection affecting the chest or esophagus
• One takes chemotherapy steroids or painkillers (such as morphine)
• The cancer is pressing in the diaphragm
• One has symptoms of a brain tumour
• Kidneys are not working
• One has blood chemistry changes
• Kidneys are not functioning correctly

3. Hiccups Symptoms

Symptoms are subjective phenomena observed and experienced by the patient (in contrast, the signs are primarily objective phenomena detected by the doctor through relevant test results). Hiccupping is mainly accompanied by the symptoms: slight tightening sensation in the chest/ abdomen/ throat.

4. Hiccups Causes 

Causes are the agents directly responsible for the occurrence of the disease. In most cases, it is not clear what causes a particular disease. On the other hand, a risk factor is not necessarily a cause. A risk factor may be anything that increases the likelihood of a patient developing the disease. For instance, age is a vital risk factor for most malignancies, but it cannot be a cause.

Located under the lungs, the diaphragm is a muscle that contracts every time a person takes a breath. This contraction causes the diaphragm to drop, allowing the lungs to expand and breathe air. Hiccups typically occur when the diaphragm suddenly contracts. Shortly after the contraction begins, the vocal cords abruptly close (producing the hiccup sound).

4.1) The most common cause triggering hiccups (that last for less than 48 hours) include:

• Drinking and eating too much and too quickly
• Consuming alcohol and carbonated drinks
• Excitement and emotional stress
• Swallowing air with chewing gum or sucking candy

4.2) Hiccups (lasting for more than 48 hours) may be caused by a variety of factors  which can be grouped under the following heads:

4.2.1) Nerve damage

Nerve damage or irritation, a genuine cause of long-term hiccups, is damage to (or irritation of) the vagus nerve (it is the longest among the 12 cranial nerves. It is the nerve that originates from the neck and passes down between the lungs and the heart to reach the diaphragm). Factors that may cause damage or irritation to these nerves include:

• A hair or something else in the ear touching the eardrum.
• In the neck, there are found tumors (A tumor is a mass of tissue formed by accumulating abnormal cells. Under normal conditions, the cells in the body grow/ die and are replaced by new cells. But the tumor cells grow and do not die. Whereas the body does not need them. A benign tumor is harmless. When it turns into malignancy, it is called cancer), a cyst (It is a membranous sac or cavity of abnormal character in the body containing fluids.), or a goiter (It is an abnormal enlargement of the thyroid gland.  Symptoms include: cough/ weight gain/ nodule). 
• Gastro-esophageal reflux disease is caused by acid reflux back into the esophagus. Some common foods and drinks stimulate acid secretion from the stomach.
• Sore throat/ laryngitis: it is the inflammation of the voice box. The illness is usually cured without treatment in about a week. Symptoms can begin suddenly and usually get worse over a period of 2/ 3 days. A common symptom of laryngitis is hoarseness.

4.2.2) Central Nervous disorders

Infection or damage in the central nervous system can disrupt the body’s standard control over hiccup reflux. Examples include:

• Encephalitis: Besides many other conditions, it is reportedly associated with hiccups.
• Meningitis: It Is an inflammation of the membranes surrounding the brain.
• Multiple sclerosis: It is a potentially disabling disease of the brain and the spinal cord 
• Traumatic brain injury: It usually occurs on account of a violent jolt in the head (such as a bullet in the head).

4.2.3) Drugs and metabolic disorders

It occurs when abnormal chemical reactions in the body alter the normal metabolic process in the body. Examples include:

• Alcoholism: It is a broad term for addiction to alcohol resulting in mental or physical health problems, including hiccups. Calories gained from the consumption of alcohol are considered empty calories. Alcohol is fundamentally an acid that irritates the vagus nerve and esophagus. Furthermore,  alcoholic beverages are carbonated and infused with gas (namely, carbon dioxide). The carbon dioxide gas will expand the stomach and probe the stomach above. The excess gas will make the drunkard profusely burp and, in addition, will trigger a vicious episode of hiccups.
• Anesthesia: Some people develop hiccups after general anesthesia (or after a procedure involving abdominal organs).           
• Barbiturates: It is a drug that acts as a central nervous system depression and can produce many effects, including hiccups.
• Diabetes: Diabetes is a group of metabolic diseases clinically known as Diabetes Mellitus. The patient has high blood glucose (from foods taken), either because the body does not produce enough insulin or the cells do not respond to the insulin produced. Diabetes is both a cause and a significant risk factor for many malignant diseases, including hiccups. (persisting for more than a week which is challenging to treat).
• Electrolyte imbalance: It is an abnormality in the concentration of electrolytes in the body, including Hyponatremia (Low blood sodium level). It can be either the cause or effect of hiccups. Other electrolyte-related factors causing hiccups are Hypokalemia (Low blood potassium level), Hypocalcemia (Low blood calcium level), Hypoglycemia (Low blood sugar level), and Kidney disease: Hiccups that last for a longer period can also be caused by chronic kidney disease aggravated by electrolyte imbalance.
• Tranquillizer: It is also termed a sedative. It is a drug designed to treat anxiety/ fear/tension, and other mental disturbances.

Conclusively, male patients with sedatives undergoing EGD (Esophago-gastro-duodenoscopy) is a procedure used to examine the lining of the esophagus, i.e., swallowing tube), are more likely to suffer from hiccups (as compared to those without sedatives).

5. Risk factors

• Mental or emotional issues: Anxiety/ stress/ excitement have been associated with cases of some short-term and long-term hiccups.
• Surgery: On account of surgery, some people develop hiccups after undergoing general anesthesia  or after procedures that involve abdominal organs

6. Complications 

Persistent or intractable hiccups can adversely affect daily routine activities, including conversation/ delivering lectures/ eating/ drinking/ sleeping /working. Through their constant interruptive nature, hiccups can cause fatigue/ dehydration/ weight loss/ insomnia/ psychological stress/ decreased quality of life. Conclusively, prolonged hiccups may signal a significant medical problem. 

7. Prevention

Making lifestyle changes can prevent hiccups by practicing relaxation, such as

• Deep breathing and avoiding overeating
• Eating and drinking too quickly
• Carbonated drinks
• Spicy foods

8. Treatment - How To Stop Hiccups

Most of the hiccups come and go away automatically within a short time, and medical emergency is rare. 

8.1) Home Remedies For Hiccups

As the 1st line of defense, it is important to apply home remedies.

• Breathing and posture technique: Sometimes, a simple change in breathing and posture can relax the diaphragm to stop or weaken the flow of hiccupping. 
  • Practice measured breathing: Disruption in the respiratory system with measured breathing is needed. The procedure involves a breath in (for a count of 5) followed by a breath out (for a count of 5).
  • Hold the breath: One needs to hold a large gulp of air (and hold it for about 10- 20 seconds), then breathe out slowly. The practice needs to be repeated.
  • Breathe into a paper bag: A paper bag is placed over the mouth and the nose (followed by slow breath in and out).

• Hug the knees: One must sit comfortably and bring the knees to the chest (holding the knees for 2 minutes).
• Compress the chest: Leaning and bending forward are needed, which put pressure on the diaphragm.
• One also needs to exhale (by pinching the nose and keeping the mouth closed).
• Pull on the tongue: Pulling the tongue stimulates the nerve and the muscles in the throat. One also needs to grab the tip of the tongue and gently pull it forward once or twice.
• Press on the diaphragm: The diaphragm separates the abdomen from the lungs. The hands must apply pressure on the area just below the end of the sternum (breast line).
• Squeeze the nose (while swallowing water).
• Squeeze the palm: One needs to use the thumb to apply pressure on the palm of the other hand.
• Manage the carotid artery: The carotid artery is one of the 2 great arteries carrying blood. There is a carotid artery on both sides of the neck. In the procedure, one needs to lie down, turn the head to the left, and massage the artery to the right side in a circular motion (for 5- 10 seconds).
• Drink ice cream
• Drink from the opposite side of the glass
• Slowly drink a glass of warm water without stopping the breath.
• Drink water with a cloth (or paper towel)
• One may cover a glass of cold water with a cloth (or paper towel) and sip through it.
• One may suck an ice cube for a few minutes and then swallow it (once it shrinks to a reasonable size).
• One needs to gargle ice water( for 10 seconds) and repeat the procedure
• It is also good to eat a spoonful of honey or peanut butter. One needs to allow it to dissolve in the mouth (a bit before swallowing).
• Eat some sugar: One needs to put a pinch of granulated sugar on the tongue, let it settle there (for 5- 10 seconds), and then swallow it.
• Suck on a lemon: One may add a bit of salt to the lemon slice and then rinse out the mouth with water to protect the teeth from the harmful effect of citric acid.
• Put a drop of vinegar on the tongue.
• Perform rectal massage: Some proven studies support that people with persistent hiccups found immediate relief after a rectal massage.
• Rubbing the back of the neck: Rubbing the back skin may stimulate the phrenic nerve ( nerve relating to the diaphragm).
• Poke the back of the throat with a cotton swab: One needs to gently swab the back with a cotton swab (until one gag or coughs). The gag reflex may stimulate the vagus nerve.
• It is good to distract to something engaging. Because hiccups often go away on their own when one stops focusing on the hiccups 

8.2) Hiccup Medication

Various medications (stated below) treat the hiccups, which can cause side effects. So, before taking the medications, it is wise to talk to the doctor.

• Braclofen: It is muscle relaxant.
• Chlorpromazine: It is a medicine used to treat psychiatric illnesses and hiccups.
• Haloperidol: It is a type of tranquilizer.
• Metoclopramide: It treats problems in the esophagus and GERD, i.e., gastroesophageal reflux disease.
• Anticonvulsant drugs: Drugs include: Phanytoin/ Gabapentin/ Carbamazepine .
• Sedatives
• Pain medications
• Stimulants

9. Hiccups in the babies 

9.1) Causes of baby hiccups

Like the adults, baby hiccups are also caused by the diaphragm's contraction and the vocal cords' quick closing. The rapid closure of the vocal cords creates the sound of the hiccups; however, unlike the adults, hiccups do not annoy the babies. Many babies can sleep through a bout of hiccups without being disturbed, and the hiccups rarely interfere with the baby’s normal breathing.

9.2) Treatment of baby hiccups

9.2.1) Take a break and burp

Taking a break (from feeding) to burp the baby may help eliminate the hiccups. Because burping helps eliminate excess gas (which causes the hiccups). Burping is also essential as it places the baby in an upright position.

The AAP (American Academy of Pediatrics) suggests burying the bottle-fed baby (after feeding every 2-3 ounces). If the baby is breastfed, it is essential to burp it (after they start sucking breast milk).

Advice: It needs to rub or gently pat the baby’s back (not with force) when they have hiccups.

9.2.2) Use a pacifier

Baby hiccups do not always start from feeding. When the baby starts hiccups, allowing them to suck on a pacifier is essential as it helps relax the diaphragm and, consequently, helps stop the hiccups.

9.2.3) Feed gripe water

Feeding gripe water may be tried if the baby seems uncomfortable due to their hiccups. (Gripe water is a combination of herbs and water. The herbs include ginger/fennels/cinnamon). Gripe water is a relatively low-risk product.

Advice

• Before feeding the baby anything new, it is recommended to consult the pediatrician.
• Usually, the baby hiccup stops on its own. If the hiccup does not bother the baby, then it is wise to allow the baby to continue the course of hiccups.

9.3) Preventing hiccups in the babies

• It is difficult to completely prevent the baby’s hiccups as the causes are unclear.
• It is essential to ensure the baby is calm during feeding. The implication is that the mother must wait and see that the baby’s hunger is satiated without interruptions imposed by the hiccups.
• After feeding the baby, avoiding heavy activity with the baby (such as bouncing up and down and participating in high-energy games) is also essential.
• More importantly, it must keep the baby upright for 20- 30 minutes after each meal.

9.4) When the hiccups in babies are a matter of concern 

• Hiccup is a normal part of the baby’s growth and development as long as the baby is less than 12 months old. In addition, the baby is not vomiting with their hiccups. The hiccup is expected even if the baby is still in the womb.
• If the baby hiccups a lot (mainly if the baby gets agitated during hiccupping, it is essential to talk to the doctor, as this could be a sign of other medical problems. It is also essential to talk to the doctor if the baby’s sleep gets disturbed by continuous hiccups.

10. Hiccups in the adults

The treatment procedure is the same irrespective of the adults or the babies. But the causes of hiccups vary. Unlike babies, the prime causes of hiccups among adults are: eating and drinking too much and too quickly in addition to alcohol and carbonated drinks. Hiccups in an adult male are more common (than the females).

11. Hiccups during pregnancy

One may observe fetal hiccups in the 2nd/ 3rd  trimester (A typical pregnancy period lasts for 40 weeks from the 1st day of the last menstrual period to the birth of the baby. It is divided into 3 stages known as 3 trimesters-  the 1st trimester beginning from the 1st to the 12th week/ the 2nd trimester beginning from the 13th to the 26th week/ the 3rd trimester beginning from the 27th to the end of the pregnancy period). Many pregnant mothers start to feel these jerky motions in their 6th month of pregnancy. But everyone feels these movements at different times during a particular period. Even though it is difficult to pinpoint why some pregnant women will feel their baby hiccups in the womb, it is considered a good sign and a natural part of pregnancy. However, fetal hiccups rarely indicate something wrong with a pregnancy or fetus.

Babies often hiccup in the mother’s womb before they are born. Veritably, the hiccup is not a matter of concern during pregnancy and causes no distress to the baby. The baby hiccup (in the womb) usually lasts 5-10 minutes. But if the hiccups do not stop within a couple of hours, then it is advised to consult a doctor.

13. Hiccups during sleep

Hiccup during sleep usually occurs because of eating or drinking near bedtime. It may also occur due to underlying medical conditions or certain medications. When a large meal is consumed during bedtime, the stomach expands and gets distended, pressing up on the diaphragm, and causing it (diaphragm) to contract. In this way, eating a large meal near bedtime can produce hiccups.

Drinking many carbonated drinks at bedtime can also produce hiccups  (as the air in those drinks can distend the stomach). 

Consuming much alcohol (before bed) is another possible cause of hiccups during sleep. Moreover, alcohol is an irritating substance that may stimulate the nerves in the lining of the stomach, leading to reflux of the contraction of the diaphragm.

Reflux of gastric contents often occurs during sleep (especially if a person eats a large meal just before bedtime and, in addition, sleeps in a flat position without raising the head of the bed.).

14. Key facts

• An individual’s hiccup rate is usually consistent for each hiccup episode (occurring at a frequency of 4- 60 hiccups per minute).
• In general, hiccup is more common in children (as compared to the adult) and men (as compared to women)
• Hiccup is considered persistent (if they last for more than 48 hours)
• The longest record of hiccups is 6 decades: How to manage persistent hiccups Persistent hiccup is a frustrating experience for palliative care patients and can profoundly impact their quality of life. The management of persistent hiccups still presents a great challenge. However, for successful management, further research studies are recommended.

15. Relevant questions and answers (Q= question.  A = answer)

15.1) Q: Can heartburn cause a hiccup? If so, why?

A: Yes, it can happen. Why? I can’t say. Consult the doctor. There may be a solution for either heartburn or hiccup, or both.

15.2)  Q: What should one do if a hiccup occurs during sleep?

A: It must be mentioned that during light sleep, the hiccup rate exceeds the breathing rate. Whereas during deep sleep, the breathing rate exceeds the hiccup rate. Eating a large meal and, in addition, consuming a large number of carbonated drinks near bedtime can aggravate the problem of hiccups. It is well advised to avoid these unhygienic eating habits, particularly near bedtime.

15.3) Q: Is the hiccup life-threatening?

A: It is misleading to assert that “One must die of hiccups. “ Veritably, hiccups occur in limited episodes (that come and go away mostly without any medication). Humans (even mammals) experience hiccups throughout life.  Conclusively, hiccups can be a source of annoyance but not a concern. 

16. Concluding remarks

Some non-medical home remedies might be effective and should be applied as the 1st line of defense.

Hiccup is a common human experience in life. However, it can create great physical and emotional discomfort in end-stage disease.

Diseases are many, but bad and unhealthy habits are few. Since the risk factor for most malignant diseases (including hiccups) is an unhealthy and idle sedentary lifestyle (such as consuming unhealthy foods and drinks and smoking and alcohol), it is well advised to keep aloof from all those bad, unhealthy habits.

TIPS

• H = Hiccup (It is an involuntary spasm of respiratory organs)
• I = In general, (hiccup is more common in children and males)
• C = Causes (of hiccups mainly include eating and drinking too much and too quickly)
• C = Conclusively, (hiccup may be a matter of annoyance, but not concern)
• U = Usually, (hiccups come and go away without any medication)
• P = Prevention (of hiccup is to avoid unhealthy foods and drinks including alcohol)

Resources

• Kohse, Eva K.; Hollmann, Markus W.; Bardenheuer, Hubert J.; Kessler, Jens, Anesthesia & Analgesia, Volume 125, Number 4, October 2017, pp. 1169-1183(15), Wolters Kluwer,  doi: 10.1213/ANE.0000000000002289
• Albert F. Gigot, M.D.; Paul D. Flynn, M.D.; TREATMENT OF HICCUPS, JAMA. 1952;150(8):760-764. doi:10.1001/jama.1952.03680080022004, TREATMENT OF HICCUPS https://jamanetwork.com/journals/jama/article-abstract/319043
• J Biller, 22 June 2018, Neurology of Systemic Diseases, Intractable Hiccups, doi: 10.1007/s11910-018-0856-0
• S Launois, JL Bizec, WA Whitelaw, J Cabane, JP Derenne, Hiccup in adults, European Respiratory Journal 1993 6: 563-575; DOI: 10.1183/09031936.93.06040563