Hiccups: Causes, Treatment and Old Wives' Tales
We've all had them. We've all heard 1,000 different ways to get rid of them; some remedies work, some don't. More often than not, they go away on their own. Rather than waste time (and energy) hic-ing throughout a day, find out what really works to treat the hiccups.
Hiccups are involuntary spasms of the diaphragm, the muscle at the base of the lungs that is involved in breathing. That distinctive hic sound is caused by a fast contraction of the vocal chords that follows the spasm.
According to the A.D.A.M. Medical Encyclopedia, hiccups most often start for no apparent reason and disappear after a few minutes. However, there are cases where hiccups can get out of control, lasting for days, weeks or even months. In other cases, some patients can hiccup up to 60 times a minute, which could severely limit breathing.
Hiccups can be caused by a variety of "triggers" (or sometimes nothing at all), including abdominal surgery, pneumonia, spicy foods or drinks, acid reflux, harmful fume inhalation or stroke. Newborns and infants also have been known to spontaneously start hiccupping.
Now let’s evaluate some of the treatments, ranging from the common (holding your breath, breathing into a paper bag) to the not-so-common (digital rectal exam, anyone?).
1) Holding your breath is one of the most common ways to get rid of hiccups, as this helps "reset" the natural rhythm of the diaphragm and breathing. Studies have shown that hitting the "gag reflex," diaphragm immobilization (flexing the gut and holding your breath), and using a modified Heimlich maneuver (consisting of three thrusts at 10-second intervals) have shown success in terminating hiccups.
2) Consuming peppermint is generally regarded as a good way to relieve hiccups, as peppermint facilitates belching by relaxing the lower esophageal sphincter, according to a study in Canadian Family Physician.
3) The Canadian Family Physician also evaluated options that involve "glottic stimulation" – including holding your breath, drinking multiple gulps of water, drinking water upside down, eating a spoonful of peanut butter, chewing on a lemon or inhaling pepper to induce a sneeze. These work some of the time for some people, according to the article, by stimulating or blocking the nerves that induce the hiccups.
4) There are also theories that involve increasing the pressure of carbon dioxide in the body, as this will confuse breathing and – hopefully – restore natural diaphragm function. Holding your breath and breathing into a paper bag would fall into this category.
5) In extreme cases, medication can be given to a patient who has persistent hiccups. Patients can be prescribed antipsychotic medications, including haloperidol and chlorpromazine, which is the only drug approved by the FDA to treat hiccups. Anticonvulsants valproic acid, phenytoin, carbamazepine and gabapentin can be used for hiccups, but patients should be weary of side effects and potential interactions with other medications.
6) Defoaming agents, prokinetic agents and proton pump inhibitors can be used for hiccups when specific gastric conditions are present. Baclofen, lidocaine and methylphenidate (Ritalin) can also be used to treat hiccups.
7) And perhaps the strangest treatment evaluated, a digital rectal massage was found to be very effective in treating the hiccups. Published in the Journal of Internal Medicine, scientists used the digital rectal massage on a patient with persistent hiccups, even after being treated with medication. The man's hiccups disappeared, then returned several hours later, only to be stopped again with the rectal massage.
By all accounts, science does not have a firm understanding on what really initiates or stops the hiccups. Studies have found success with some methods while other treatments may be more effective for some people. Different solutions can even exist for different cases of hiccups within the same person. My advice: run through some of the above options, going from the least extreme to those that require medical assistance. If hiccups persist beyond a several hours or days, see a doctor.
A.D.A.M. Medical Encyclopedia. (January 31, 2011). "Hiccups." MedlinePLUS. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/003068.htm.
Chang, FY., Lu, CL. (April 9, 2012). "Hiccup: mystery, nature and treatment." Journal of Neurogastroenterology and Motility. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3325297/.
Odeh, M., Bassan, H., Oliven, A. (February 1990). "Termination of intractable hiccups with digital rectal massage." Journal of Internal Medicine. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/2299306.
Woelk, C. (June 2011). "Managing hiccups." Canadian Family Physician. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3114667/.