What Is Hiccups, Why Do They Occur, and How to Get Rid of Them?

The diaphragm is the muscle that separates the chest from the abdominal cavity and plays a crucial role in breathing. A spasm of this muscle causes the vocal cords to close temporarily, resulting in the "hic" sound. Hiccups are uncontrolled, repetitive spasms or sudden movements of the diaphragm. Eating too much, drinking alcoholic or carbonated beverages, or sudden excitement can lead to hiccups. For most people, hiccups typically last only a few minutes and resolve on their own.

What Are Hiccups?

Hiccups are the result of repetitive spasms of the diaphragm caused by the closure of the vocal cords. The diaphragm is a muscle that separates the chest and abdominal cavities, which is a vital part of the breathing process. The diaphragm moves downward when inhaling and upward when exhaling. The phrenic nerve connecting the diaphragm and the vagus nerve connecting the brain to the stomach are essential components of the breathing process. Hiccups occur as a reflex caused by the sudden spasmodic contraction of the diaphragm, which leads to the characteristic sound created by the abrupt closure of the glottis, resulting in a rush of air expelled forcefully from the lungs. The hiccup reflex consists of an afferent (sensory) limb, a central connection, and an efferent (motor) limb. Depending on their duration, hiccups can be classified as transient (lasting seconds or minutes), persistent (lasting more than 48 hours), or recurrent. Persistent or recurrent hiccups are more likely to be associated with an underlying medical condition and may require medical testing.

What Causes Hiccups?

The exact cause of hiccups is not fully understood, but several theories exist. There are several possible reasons for the occurrence of hiccups, including low carbon dioxide levels in the blood and irritated nerves. Possible causes include:

• Sudden excitement
• Emotional stress
• Overeating
• Eating too quickly
• Drinking carbonated beverages
• Temporary bloating due to swallowing air
• Sudden temperature changes
• Alcohol
• Fear
• Various medications
• Chewing gum
• Smoking
• Metabolic issues
• Nerve damage
• Very hot or very cold drinks

In some cases, especially with persistent hiccups, an underlying medical condition may be the cause. Gastroesophageal reflux disease is an example of such a condition, and if suspected, various checks should be performed by a doctor. Long-term hiccups may also result from damage or irritation to the vagus nerves or phrenic nerves that supply the diaphragm. A tumor, cyst, or growth on the thyroid gland in the neck can cause damage to these nerves. Damage to the central nervous system due to a tumor, infection, or injury can also be among the reasons for the development of the hiccup reflex. Additionally, long-term hiccups can occur when the body's metabolism is not functioning properly.

Diagnosis of Hiccups

When a person visits a healthcare institution due to hiccups, the first step is to take their medical history and perform a physical examination. If no issues are found during the medical history and physical examination, no special evaluation is necessary for acute hiccups. Testing is not required unless there are persistent hiccups lasting more than 48 hours or frequent recurring short hiccup episodes. For patients with longer-lasting hiccups without a clear cause, tests may be needed, possibly including serum electrolytes, blood urea nitrogen (BUN), creatinine levels, chest X-rays, and EKGs. In more advanced cases, upper gastrointestinal endoscopy and esophageal pH monitoring may be requested. If the results of these tests are abnormal, an MRI of the brain and a CT scan of the chest may be performed. These are tests conducted to detect the presence of changes such as blood chemistry, chest problems, or heart disease. Depending on the individual’s condition and any other suspected medical issues, additional tests may be recommended.

Hiccup Treatment Methods

Suggestions for treating temporary hiccups include nasopharyngeal stimulation (drinking a glass of water), vagal stimulation (carotid sinus massage, applying a cold compress to the face, or induced vomiting), and respiratory maneuvers (holding the breath, coughing, or breathing into a paper bag). The aim of these maneuvers is to interrupt the reflex arc thought to sustain the recurring diaphragm contractions. Generally, these maneuvers are effective only for acute hiccup attacks and are not effective in treating persistent recurring hiccups. For persistent hiccups, it is usually advisable to consult a specialist to search for a cause or to provide additional treatment options. Treating chronic and persistent hiccups typically requires more than just drinking a glass of water. Since chronic hiccups may indicate a larger health issue, most treatments require the assistance of a medical professional. If underlying causes are found in the desired tests for chronic or recurring hiccups, treating the underlying cause may alleviate the hiccups. Additionally, various medications may be used for prolonged chronic hiccups. The purposes of these medications include:

• Relaxing nerve supply to the muscles that assist breathing below the lungs
• Alleviating hiccups with anesthetic substances
• Reducing stress caused by hiccups with tranquilizers

If chronic hiccups decrease as a result of treatment, the medications can typically be stopped about a day after the results are obtained. Most medication treatments are prescribed for a duration of 7-10 days. Additionally, surgeries such as implanting a device that electrically stimulates the vagus nerve may be necessary apart from medication use. There are some surgical approaches to treating stubborn hiccups that do not respond to other treatments. The phrenic nerve controls the diaphragm. Phrenic nerve surgery requires surgical crushing or blocking of this nerve through the use of a local anesthetic. This treatment option is considered a last resort while attempting to stop chronic hiccups.

Natural Hiccup Treatment Methods

There are many natural remedies for hiccups. While many popular treatment options claim to stop a brief hiccup episode, these are based on individual experiences. However, it would not be accurate to definitively say whether these methods are truly therapeutic. One of the most commonly preferred hiccup relief methods is breath-holding, which is thought to allow the body to relax and stop the diaphragm spasms causing hiccups. To perform breath-holding, the patient is asked to keep their nose and mouth closed while trying to exhale, which lasts for about 10 to 15 seconds. If hiccups persist, this exercise can be repeated. Since a hiccup episode typically resolves quickly, most cases do not require treatment. Natural methods that can be applied for hiccup relief include:

• Holding the breath
• Drinking a glass of water quickly
• Pulling the tongue firmly
• Biting a lemon
• Gargling with water
• Swallowing a teaspoon of sugar
• Sipping cold water

However, none of these methods are proven treatments. Therefore, individuals should consider their existing health condition before trying such applications and may wait for hiccups to resolve on their own after a while. If hiccups do not resolve on their own after some time, it may be advisable to seek medical examination at a healthcare institution.

If hiccups last longer than 48 hours or are severe enough to cause issues with eating, sleeping, or breathing, one should consult a healthcare institution.