Hiccups

Your diaphragm helps control your breathing. When you breathe in, it contracts and moves downwards. Your vocal cords (glottis) at the top of your throat then close to control the intake of air. When you breathe out, your diaphragm relaxes and air passes out of your lungs via your nose and mouth.  

If your diaphragm suddenly contracts, when your glottis then closes, a 'hic' sound is produced. Anyone can get hiccups, even a foetus growing in the womb. However, men are much more likely than women to get long-term hiccups, ie hiccups that last longer than two days. 

In most cases, hiccups last only a few minutes, go away on their own and do not need treatment. Hiccups that last more than two days or keep coming back could be a sign of an underlying medical condition.

The medical term for hiccups is singultus, which is Latin for gasp or sob. 

Short-term hiccups

A short (transient) bout of hiccups often starts or stops without an obvious cause. Things that can irritate your diaphragm and trigger transient hiccups include:

• Drinking fizzy drinks or alcohol — this can stretch your stomach, which may irritate your diaphragm, causing hiccups
• Eating big meals, especially if they are fatty or spicy 
• Feeling afraid, anxious, excited or stressed
• Noxious fumes
• A sudden change in temperature
• Swallowing air — this may happen if you eat too quickly, chew chewing gum or suck on a sweet or lolly

Avoiding these triggers may help reduce how often you have short-term hiccups.

Long-term hiccups

Hiccups that last more than two days (persistent hiccups) or that keep coming back (recurrent hiccups) may have an underlying medical cause.

This could be a condition that’s affecting your diaphragm or the nerves in your head and neck which control the movement of your diaphragm. These include:

• Acid reflux (gastro-oesophageal reflux) — when some of your stomach contents come back up into your gullet (oesophagus)
• Certain chronic (long-term) health conditions eg renal failure
• Conditions affecting your neck — this includes:
• A cyst or tumour in your neck 
• Goitre — a lump in the front of your neck caused by a swollen thyroid gland
• Sore throat (laryngitis)
• Swelling inside your neck that’s pressing on a nerve
• Damage to your eardrum or a hair touching your eardrum
• Diseases that affect the nerves supplying your diaphragm — this includes: 
• Liver disease
• Pneumonia and other lung diseases

Long-term hiccups can also be a side effect of medication you’re taking, such as:

• Acid reflux medication
• Benzodiazepines — this includes alprazolam, diazepam and lorazepam
• Levodopa — a Parkinson's disease medication
• Nicotine — this is used to help quit smoking
• Ondansetron — an anti-nausea medication
• Steroids 

Certain tranquilizers can also cause long-term hiccups, as can stomach surgery and general anaesthesia.

You are more likely to get long-term hiccups if you have a condition that affects your metabolism, the process that converts food to energy. These include:

• Alcoholism
• Diabetes
• Electrolyte imbalance — a disorder of salts and minerals that regulate the body’s systems
• Kidney disease

In rare cases, long-term hiccups may also be a symptom of conditions that affect your central nervous system, such as:

• Brain inflammation or injury
• Brain tumours that affect your brain stem
• Encephalitis
• Meningitis
• Multiple sclerosis
• Stroke

See your GP if your hiccups last for more than 48 hours, keep coming back or are making it harder to eat, drink or sleep normally.

Your GP will diagnose hiccups from your symptoms. They may refer you for other tests and scans to find out what is causing them, such as:

• An X-ray
• Blood tests
• CT scan
• Endoscopy — an examination using a tiny camera on the end of a flexible tube to see inside your throat
• MRI scan

You should seek urgent medical attention if your hiccups occur alongside: 

• Coughing up blood
• Feeling as if your throat is closing up
• Fever
• Pain in your abdomen
• Shortness of breath
• Vomiting

n most cases, you won’t need treatment for hiccups. Some people find that these self-help hiccup cures get rid of hiccups, although there is no proof to support whether or not they are effective:

• Breathing into a paper bag
• Gargling with iced water
• Holding your breath for a short time
• Pulling your knees up to your chest and leaning slightly forward
• Sipping cold water
• Tasting vinegar

If your hiccups are affecting your everyday life, your GP might recommend:

• Changing a medication that is causing your hiccups as a side effect
• Medication to control your hiccups — this is rare but if you have severe, persistent hiccups, your doctor may prescribe chlorpromazine, haloperidol or metoclopramide 
• Treatment for the underlying problem causing your hiccups

Depending on the cause of your hiccups, your GP may refer you to a specialist, such as a: 

• Gastroenterologist (a doctor who specialises in treating the digestive system) eg if your hiccups are caused by acid reflux
• Neurologist (a doctor who specialises in treating the brain and nervous system) eg if your hiccups are caused by a stroke or other disorder affecting your brain or nervous system
• Respiratory consultant (a doctor who specialises in treating the lungs and respiratory tract) eg if your hiccups are caused by lung disease or pneumonia

Specialist treatments include:

• An operation to stimulate the main nerve that affects hiccups (phrenic nerve) using a battery-operated implant
• Injecting anaesthetic into the phrenic nerve
• Phrenic nerve surgery — this treatment is very rare and only given as a last resort if your long-term hiccups are affecting your quality of life and all other treatments have been ineffective

To reduce your risk of getting hiccups, try to avoid eating or drinking too much or too quickly.

Hiccups in newborns, babies and infants are usually not something to worry about and will go away on their own. 

If hiccups occur while feeding, try stopping feeding and waiting until the hiccups go away. If the hiccups don't go away after a few minutes, resuming feeding may help them stop. 

If feeding a baby, you can try changing their position to help them burp or calm them down until the hiccups stop. If your baby often hiccups when feeding, try to feed them before they get too hungry and while they are relaxed. 

If your baby or infant has hiccups that are upsetting them or are getting worse, see your GP. 

Hiccups rarely cause complications as they usually go away on their own. However, if you have severe or persistent hiccups that disturb your ability to eat, drink or sleep normally, you may unintentionally lose weight or develop sleep problems. 

In rare but severe cases of hiccups, heart arrhythmias or gastro-oesophageal reflux disease (GORD) may occur.