What is Hiccup, What Causes It, How Can It Be Treated?

The diaphragm is the muscle that separates the chest from the abdomen and plays an important role in breathing. A spasm in this muscle causes the vocal cords to close for a short time and produce a “hiccup” sound. Hiccups are uncontrollable recurring spasms or sudden movements of the diaphragm. Eating too much food, drinking alcoholic or carbonated drinks, or getting suddenly excited can cause hiccups. For most people, hiccups usually last only a few minutes and go away on their own.

What is Hiccup?

Hiccups are recurring spasms of the diaphragm caused by the closure of the vocal cords. The diaphragm is a muscle under the ribcage that separates the chest and abdomen, which is an important part of the respiratory process. The diaphragm moves downwards when inhaling and upwards when exhaling. The phrenic nerve, which connects the neck to the diaphragm, and the vagus nerve, which connects the brain to the stomach, are important parts of the breathing process. It is a reflex caused by sudden spasmodic contraction of the diaphragm, which causes the inspiratory muscles in the chest and abdomen to shake, and the sudden closure of the glottis, which creates a characteristic sound of air being violently expelled from the lungs. The hiccup reflex consists of the afferent limb, the central connection, and the efferent limb. Depending on their duration, hiccups are classified as transient (bouts lasting seconds or minutes), persistent (bouts lasting more than 48 hours), and recurrent hiccups. Persistent or recurrent hiccups are more likely to be linked to an underlying disease and may need medical tests.

What Causes Hiccup?

Although the cause of hiccup is not exactly known, there are various guesses. There are several possible causes of hiccups, including low levels of carbon dioxide in the blood and irritated nerves. Possible causes are:

• sudden excitement
• emotional stress
• overeating
• eating too fast
• Drinking fizzy drinks
• Temporary bloating caused by swallowing air
• sudden temperature change
• Alcohol
• Fear
• Various drugs
• chewing sake
• smoking
• metabolic problems
• nerve damage
• Drinks that are too hot or too cold

In some cases, especially persistent hiccups, may be caused by an underlying disease. Reflux is an example of these patients, and when such a disease is suspected, various checks must be performed by the doctor. Another cause of prolonged hiccups is damage or irritation of the vagus nerves or phrenic nerves that supply the diaphragm. A tumor, cyst or growth in the thyroid gland in the neck can cause damage to these nerves. Damage to the central nervous system, which may also occur due to a tumor or infection in the central nervous system, or an injury, are among the reasons why your body develops a hiccup reflex. At the same time, prolonged hiccups can occur when the body’s metabolism is not working properly.

Hiccup Diagnosis Methods

When applying to a health institution due to hiccups, the person’s medical history is first taken and a physical examination is performed. If no problems are found in the medical history and physical examination, no special evaluation is required for acute hiccup. Unless there are persistent hiccups lasting more than 48 hours or frequent brief bouts of hiccups, no tests are needed. Patients with longer-lasting hiccups without an obvious cause may need tests, possibly including serum electrolytes, blood values ​​such as blood urea nitrogen (BUN), creatinine, and chest X-ray and ECG. In more advanced cases, upper gastrointestinal endoscopy and esophageal pH monitoring may be requested. If the results of these tests are not normal, a brain MRI and chest CT may be performed. These are tests performed to detect the presence of changes in blood chemistry, such as chest problems or heart disease. Other tests may be recommended depending on your individual situation and whether any other medical conditions are suspected.

Hiccup Treatment Methods

Recommendations for treating temporary hiccup include nasopharyngeal stimulation (drinking a glass of water), vagal stimulation (carotid sinus massage, cold compress to the face, or induced vomiting), and respiratory maneuvers (holding the breath, coughing, breathing into a paper bag). The purpose of these maneuvers is to attempt to interrupt the reflex arc intended to maintain repetitive diaphragmatic contractions. These maneuvers are generally only effective in relieving an acute hiccup attack and are not effective in treating persistent recurrent hiccups. For persistent hiccups, a specialist should usually be seen to look for a cause or offer more treatment options. Treating chronic and persistent hiccups often requires more than just drinking a glass of water. Because chronic hiccups can be a sign of a larger health problem, most treatments require the help of a medical professional. If an underlying cause is found in the tests requested for chronic or recurrent hiccups, treatment of the underlying cause can cure the hiccups. Various medications can also be used for long-term chronic hiccups. The purposes of these drugs are:

• Relaxing the nerve supply to the muscles below the lungs that help with breathing
• Relieving hiccups with an anesthetic agent
• Relieve stress caused by hiccups with sedatives

If chronic hiccups subside as a result of treatment, then medications can usually be stopped within a day or so of seeing results. Most drug treatments are prescribed for use over a period of 7-10 days. At the same time, in addition to medication use, operations such as implanting a device that electrically stimulates the vagus nerve may also be necessary. There are some surgical approaches to treat persistent cases of hiccups that do not respond to other treatments. The phrenic nerve is the nerve that controls the diaphragm. Phrenic nerve surgery requires surgical crushing or blocking of this nerve through the use of local anesthetic. These treatment options are considered a last resort when trying to end chronic hiccups.

Natural Hiccup Treatment Methods

There are many natural treatments for hiccups. While there are many popular treatment options that are said to stop a brief bout of hiccups, these are options that are based on people’s individual experiences. However, it would not be correct to give definitive information about whether these methods are truly therapeutic or not. Breath holding is one of the most commonly preferred hiccup relief methods, as it is thought to relax the body and stop diaphragm spasms that cause hiccups. To perform breath holding, also known as the Valsalva maneuver, the patient is asked to try to exhale by keeping his nose and mouth closed. This continues for 10 to 15 seconds. This exercise can be repeated if hiccups continue. Since a hiccup attack usually passes quickly, most cases do not need treatment. Methods that can be applied naturally to treat hiccup are as follows:

• Holding breath
• Drinking a glass of water quickly
• pulling one’s tongue hard
• bite a lemon
• gargling with water
• swallow a teaspoon of sugar
• Sipping cold water

However, none of these methods are proven treatments. Therefore, before performing such practices, the person should consider his/her existing health condition and wait for the hiccup to disappear on its own after a while. If hiccup does not go away on its own after a while, you may be asked to apply to a health institution for the necessary examination.

If hiccups last more than 48 hours or are severe enough to cause problems with eating, sleeping, or breathing, it is necessary to seek medical attention.