Maybe once or twice is funny, but more of it is annoying, yeah they’re HICCUPS. All of us have experienced them but do we know why they occur? Further, where do they come from? The fact that it’s complicated if experienced for a long time? Let’s find the answers to it. Hiccups are little strange sounds that come from the mouth without warning, they happen when a person’s intake of air is momentarily blocked.
These are formed because of sudden, involuntary contraction of the diaphragm which repeats several times per minute. Further, it is an involuntary action involving a reflex arc. When triggered it causes the contraction of the larynx (voice box) and closure of the glottis (middle part of the larynx). So it results in a sudden rush of air in the lungs which produce the sound “HIC”. It can also happen for no reason. Also, we can develop them in situations like eating quickly, taking a cold drink along with a hot meal, consuming spicy food, drinking alcoholic beverages, crying loud or any electrolyte imbalance.
But prolonged hiccups can indicate a serious medical problem in the body, they can occur due to pressure on the phrenic nerve by other anatomical structures, in case of kidney disease or tumours. Moreover, it is reported that 30 % of chemotherapy patients suffer singultus – diaphragmatic irritation, as a side effect of chemotherapy treatment which leads to hiccups.
WHAT CAUSES HICCUPS?
There are several reasons why hiccups happen. It can be due to the low level of carbon dioxide in the blood and due to irritation of nerves- the phrenic nerve and vagus nerve which are important parts of the breathing process.
The most common factors which trigger hiccups are,
- Eating too much
- Rapid eating or drinking where we swallow air along with food
- Drinking carbonated beverages
- Intake of medications like benzodiazepines, corticosteroids, opiates, barbiturates
- Drinking very hot or very cold drink
- Due to stress
- Experiencing strong emotions
- Chewing a gum , there are possibilities to swallow air while chewing
- Eating hot or spicy food which irritates phrenic nerve
Subsequently, hiccups caused by these factors settle within 24 hours to a maximum of 48 hours. Hiccups that last more than 48 hours can be due to any pathophysiological causes or in rare cases they can be a sign of medical problems.
Pathophysiological causes are,
- Rapid eating
- Swallowing excessive air
- Hiatal hernia
- Intake of spicy foods
- Gastroesophageal reflux
- Laughing vigorously for long time
Medical problems which are related to prolonged hiccups:
- Phrenic nucleus irritation of medulla – kidney failure , hypoglycaemia, hyperglycaemia, diabetes
- Also, gastrointestinal conditions – bowel obstruction, inflammatory bowel disease, gastroesophageal reflux disease (GERD)
|SYSTEM INVOLVED IN THE DAMAGE||FACTORS CAUSING DISTURBANCE|
|Nerve damage or irritation to the vagus and phrenic nerve||Tumour or goitre in the neck|
Irritation in eardrum
Laryngitis (sore throat)
|Central nervous system disorders||Tumours|
Traumatic brain injury
Respiratory problems – pleurisy of diaphragm, asthma, pneumonia
|Autonomic nervous system||Affects heartbeats |
|Rarely in cancer||As a side effect of chemotherapy|
TYPES OF HICCUPS:
|TYPE OF HICCUP||DURATION OF THE HICCUP|
|Hiccup bout||Lasts up to 48 hours.|
|Persistent hiccups||More than 48 hours to one month.|
|Intractable hiccups||Lasts more than a month.|
Episodes last a few minutes. Simple home remedies can cure hiccups.
PERSISTENT HICCUPS (CHRONIC HICCUPS):
They last for two days or more. It can be due to irritation of breathing muscles and nerves, surgeries involving the chest, abdomen, central nervous system and any metabolic conditions.
Episodes that last more than a month. It can be triggered by spicy foods, hot drinks and surgery, other conditions like brain tumours or strokes, diseases affecting the diaphragm, medications given during chemotherapy and psychological problems.
HICCUPS IN INFANTS:
Babies can get hiccups during the pregnancy period by the 6th month of pregnancy when baby lungs start developing. Infants and babies up to one year old get hiccups due to swallowing of air during feeding. When babies get hiccups during breastfeeding or bottle-feeding, water should not be given to babies under 6 months old as it can obstruct breathing.
Firstly, a change of feeding positions or relaxation can calm them. Further, if baby hiccups frequently feed small amounts at frequent intervals which can keep them from swallowing air. Most importantly, during bottle feeding, burping the baby frequently after feeding to avoid air obstruction can be done by giggling babies.
HOW DOES IT OCCUR?
THE ACTUAL MECHANISM BEHIND HICCUPS:
Firstly, singultus or synchronous diaphragmatic flutter are the other names of hiccups. This can happen due to two causes – air blockage and food lodgement.
It happens when the air intake is momentarily blocked, it can happen due to several reasons or no reason. They tend to form because of sudden, involuntary contraction of the diaphragm while at the same time contraction of the larynx (voice box) and complete closure of the glottis (middle part of the larynx). Further, this causes a sudden rush of air into the lungs and produces a HIC sound.
Hiccups that are produced by food lodgement occur when food is stuck in the oesophagus. When the food particle swallowed is large it’s natural for peristalsis of the oesophagus to move food into the stomach. Moreover, it applies pressure on the phrenic nerve causing the hiccup reflex. Further, it causes the diaphragm to contract and create a vacuum in the thoracic cavity, it creates low pressure near the stomach and high pressure near the mouth.
WHICH TYPE OF DOCTOR SHOULD WE CONSULT?
- Also, a neurologist
A hiccup that lasts less than 48 hours doesn’t need any medical attention as it can resolve by itself. Subsequently, a doctor should be consulted in case of chronic hiccups.
- Most importantly, physical examination and neurological examination is performed
- Muscle tone
- Eyesight coordination
- Muscle strength
- If hiccups are due to these conditions, tests are performed,
- CT or MRI scan is done to access abnormalities which affect phrenic, vagus nerve or diaphragm.
- Endoscopic tests to check the esophagus.
- Blood test to check infection or any disease.
- Also, ECG (electrocardiogram) to check heart related condition.
Techniques that stimulate nasopharynx and vagus nerve can decrease hiccups,
Gargle with water
Holding your breath
Drink a glass of water
A sudden fright or shock can stop hiccups
Use smelling salts
Bite a lemon
Swallowing sugar or crushed ice
Also, breathing in a bag and gagging
They are psychosomatic cures that are around relaxation and distraction involving swallowing and eating which would remove irritants or reset mechanisms. Further, some cures involving controlled breathing. Further, the common home remedy which is followed is applying pressure on one’s ear and drinking water by holding the nose. Moreover, these are effective for short time hiccups.
While breathing in a bag or enclosed container respiratory acidosis takes place. Also, it increases the inspired carbon dioxide, which further increases the level of carbon dioxide in serum. These increased carbon dioxide levels lower the pH in blood and create acidosis. Moreover, this state of acidosis produces vasodilation and depression of central nervous system which allows increase blood flow to affected muscles and suppress nervous impulse. Hypoventilation cures hiccups as the diaphragm rests against pulmonary vasculature flowing with low ph blood. As cabin dioxide level rises the person pass out within few minutes so it should be done with another person.
By holding breath, when that person holds breath for a long time the lungs take more space in the chest and apply pressure on the diaphragm.
Most importantly, hiccups are treated medically only in persistent and severe cases with anti sedatives, anti-psychotic and gastrointestinal stimulants.
Firstly, chlorpromazine is the first-line medication prescribed for hiccups. Persistent hiccups which occur due to electrolyte imbalance can be treated by drinking a carbonated drink with salt to balance potassium-sodium in the nervous system, it promotes quick absorption.
Antispasmodics are given to suppress hiccups. Hiccups that last for a long time can be controlled by performing phrenic nerve surgery. Moreover, the surgery blocks the phrenic nerve temporarily with an injection of 0.5% procaine. On the other hand, bilateral phrenectomy offers a permanent solution. Further, this treatment is rarely performed when patients do not respond to other medications.
COMPLICATIONS OF HICCUPS:
|Fatigue||It is difficult to eat or sleep and causes exhaustion.|
|Weight loss||Due to persistent hiccups within short intervals, it is difficult to eat.|
|Insomnia||When hiccups persist during sleep hours it makes it hard to stay asleep.|
|Depression||Decreases self-confidence and causes depression.|
|Delayed wound healing||Post-surgical wounds delay healing and increase the risk of infections and bleeding.|
|Other rare complications are irregular heartbeat and GERD||Gastroesophageal reflux.|
To sum up, hiccups happen to people of all ages including infants. Further, when it occurs for a short time period it resolves on its own or by any remedies but we need to be careful when it prolongs for a long time.