The hiccup is the result of a sudden and involuntary contraction of the diaphragm muscle, which is located between the thorax and the abdomen.
In the vast majority of cases, it is a self-limiting, short-term problem with no clinical relevance. In some people, however, the hiccup can be persistent, becoming a chronic problem and difficult to control.
The diaphragm is a muscle that is located between the thorax and the abdomen, being the main muscle of breathing. Thanks to the movement of the diaphragm, we were able to fill and empty our lungs with air.
The hiccup occurs when our diaphragm undergoes a quick and involuntary contraction, making us breathe in air. As this respiratory movement is unwanted, also involuntarily, our vocal cords suddenly close, preventing the entrance of the air, causing the known sound of the sob, similar to a crack.
The closing of the vocal cords prevents the air from reaching the lungs, sometimes causing it to go to the stomach. This is why some people swallow air during the hiccup.
How are hiccups classified?
Most hiccups last a few minutes, disappearing spontaneously or after some maneuvers, such as drinking cold water or holding your breath. In some people, the hiccups may take several minutes to disappear.
Common hiccups rarely have any clinical significance, and the average assessment for them is not required.
More rarely, a hiccup episode can last for several hours. When the hiccup takes more than 48 hours it is called a persistent hiccup. When it lasts for more than a month, it is called an intractable hiccup. Both persistent and intractable solutions are usually caused by some illness and should always be evaluated by a physician.
We do not know exactly why simple sobs occur, which last a few minutes and disappear spontaneously. Hiccups are thought to be caused by situations that somehow irritate the diaphragm. In 80% of cases, the hiccups occur only by spasms in the left portion of the diaphragm. Why this occurs, we do not know.
The situations that most often trigger hiccups are:
Why the above situations act as a trigger for some people's hiccups, and only at certain times, is still unknown. If you often have hiccups, try to figure out which trigger is most common to avoid it. Sometimes small changes in habits, such as eating more calmly, are enough to lessen the frequency with which attacks of hiccups arise.
2. Persistent or intractable sobs
Hiccups that last more than 48 hours can be caused by a variety of factors, which are usually grouped into the following categories:
2.1. Irritation of the nerves of the diaphragm
Like any muscle in our body, the diaphragm is controlled by our brain, which sends its orders through the phrenic nerve and the vagus nerve. Irritations of these nerves can cause undesired movements of the diaphragm, causing a prolonged hiccup. The main situations that can cause irritations of the nerves that serve the diaphragm are:
Changes in our metabolism, levels of hormones or other substances in the blood, such as electrolytes (minerals) and glucose, can also lead to prolonged hiccups. The most common causes are:
Common hiccups are not considered medical problems and do not need specific treatment, since they last, usually, a few minutes, disappearing even if nothing is done.
However, no one likes to have hiccups and most people end up looking for a way to abbreviate crises. Because hiccups usually occur from irritation of the diaphragm or nerves, some simple maneuvers that stimulate at least one of these structures serve to abort the seizures.
Many of the home remedies for hiccups actually work and have a scientific basis for doing so. For example:
When we take a fright, we suddenly increase the release of a hormone called adrenaline, which among hundreds of other actions, acts directly on the contraction of the diaphragm.
When we hold the air for a few seconds without breathing, the level of carbon dioxide (CO2) in the blood rises, which is a strong stimulus for the brain to activate the nerves of the diaphragm, forcing it to contract.
When we drink cold water, the vagus nerve, which acts on the diagram but also innervates from the throat to the stomach, is stimulated by the abrupt change in temperature.
Other home remedies to stop hiccup include:
Gargle with cold water
Sucking ice
Drink hot water (be careful not to be too hot to burn your mouth)
Breathe into a paper bag
Suck lemon
Eat ginger
Traction the tongue
Touch the uvula (throat sinus) with an object, like a straw
Eat a spoon full of sugar or honey
Bend your knees and hug your legs, squeezing your chest
Hiccups that last more than 48 hours should be investigated as they are fatally caused by a medical problem. In these cases, the treatment of the hiccups goes through the treatment of the underlying cause. If the patient has an ear infection, the treatment is with antibiotics; if you have very low blood sodium levels, sodium replacement makes the sob stop; if the cause is a drug, the drug is discontinued, etc.
Not always, however, the problem behind persistent hiccups is easily identifiable. In other cases, the disease causing the hiccup does not have a specific treatment, such as in patients who have had a stroke or a head injury. Therefore, the doctor often needs to use some drugs that inhibit hiccups without necessarily acting directly on their cause. Some medications used to stop persistent hiccups are:
Chlorpromazine (most commonly used and most studied drug to treat hiccups)
Haloperidol
Baclofen
Metoclopramide
Gabapentin
Other options for controlling persistent hiccups are acupuncture and hypnosis
In extreme cases - very rare, by the way - surgery may be necessary with the implantation of an electrical stimulator on the diaphragm, similar to the pacemakers used in the heart.
More than 80% of babies have frequent episodes of hiccups. In fact, babies begin to sob even when fetuses are inside the uterus. Hiccups are believed to be important for the development of the fetal respiratory system, serving as exercises for the diaphragm and other respiratory muscles.
The more immature the nervous system, the more common the bouts of sobbing. Premature babies have more sobs than full-term babies, who in turn have more sobs than babies older than 6 months.
Babies' sobs cause a lot more discomfort in parents than in our own. The baby with a sob does not feel pain or become irritated. Babies do not bother with sobs like we adults do.
It is impossible to prevent babies from having hiccups, especially in newborns. However, some tips help minimize crises.
Hiccups in babies are usually triggered by feeding or by decreasing body temperature. Babies who suckle very fast and swallow a lot of air tend to have more sobs. Try to keep your baby warm and well-groomed to minimize hiccups. After the feeding, leave it upright so that it clears and decreases the amount of air in the stomach.
Do not use the tips to stop adult hiccups in babies; they do not work and can still do harm. Do not give scares, do not press your eyeballs, do not pull your tongue and do not squeeze your fontanelle. Remember that babies do not bother with hiccups, have patience that after a few minutes it will disappear. As the baby grows, crises become less and less common.
Hiccups in babies only cause concern if they are disturbing their usual activities like sleeping or eating, or if they are persistent, not after a few minutes. Frequent hiccups in babies over one year of age are also not common. In these cases, mention the fact to the pediatrician that he will know what to do to find out if there is any problem behind the hiccups, such as gastroesophageal reflux, for example.
