Brief overview
- Description: Hiccup (Singultus) is a Hicksen, which can occur four to 60 times per minute.
- Cause: jerky contraction of the diaphragm, resulting in a sudden, deep inhalation with the glottis closed – the respiratory air bounces off, the hiccupping sound is produced.
- Triggers: e.g. alcohol, hot or cold food and drinks, hasty eating, diseases such as inflammation (in the stomach, esophagus, larynx, etc.), reflux disease, ulcers, and tumors.
- When to see a doctor? If hiccups persist for a long time or recur frequently, you should see your family doctor or general practitioner to rule out a disease as the cause.
- Diagnosis: Patient interview, physical examination, if necessary further examinations such as X-ray, bronchoscopy, blood test, etc.
- Therapy: In most cases, hiccups do not require treatment because they disappear on their own. Otherwise, tips such as holding your breath for a short time or drinking water in small sips can help. For chronic hiccups, the doctor sometimes prescribes medication. Breathing training, behavioral therapy and relaxation techniques may also be useful.
Hiccups: Causes and possible diseases
The main responsible for this reflex of the diaphragm are the phrenic nerve and the cranial nerve vagus, which react sensitively to certain external stimuli. This can be, for example, too hot or too cold food, too hasty swallowing, alcohol or nicotine. However, various diseases can also trigger hiccups via the aforementioned nerves or directly via the diaphragm.
If the hiccups last longer than two days, they are called chronic hiccups. Often, no cause can be identified.
General triggers of hiccups
- hasty eating and swallowing
- very full stomach
- hot or cold food or drinks
- carbonated drinks
- alcohol
- nicotine
- stress, excitement, tension, or anxiety
- depression
- Pregnancy, when the embryo presses against the diaphragm
- Abdominal surgeries that irritate or affect nerves
- gastroscopy, which irritates the larynx and the nerves there
- some medications, for example, anesthetics, sedatives, cortisone preparations or antiepileptic drugs
diseases as cause of hiccups
- Inflammation of the gastrointestinal tract (gastroenteritis)
- Gastritis (inflammation of the mucous membrane of the stomach)
- Esophagitis (inflammation of the esophagus)
- Laryngitis (inflammation of the larynx)
- Pharyngitis (inflammation of the throat)
- pleurisy (inflammation of the pleura)
- Pericarditis (inflammation of the heart sac)
- Brain inflammation (encephalitis)
- Meningitis (inflammation of the brain)
- Reflux disease (chronic heartburn)
- Damage to the diaphragm (e.g. hiatal hernia)
- Gastric ulcer
- Craniocerebral trauma or cerebral hemorrhage, increased intracranial pressure
- Hyperthyroidism (overactive thyroid gland)
- Liver disease
- Diabetes or other metabolic disorders
- Heart attack
- Stroke
- Kidney failure or kidney disorders
- multiple sclerosis
- Tumor of the esophagus, stomach, lung, prostate, brain, or in the ear or throat
- enlarged lymph nodes (abdomen/breast)
Hiccups in children
Hiccups don’t just affect adults: babies and toddlers can also hiccup. In fact, they often do it more often than teenagers and adults. Even in the womb, unborn babies can have hiccups, which mothers sometimes feel.
What helps against hiccups?
Hiccups usually go away all by themselves. There is a lot of advice on what you can do yourself when you have hiccups: drink a glass of water, put a spoonful of vinegar with sugar in your mouth and swallow slowly, or let yourself be frightened – the tips and home remedies for hiccups are as varied as they are adventurous. And almost all of them lack a scientific basis. Nevertheless, they can help to calm breathing and loosen the tense diaphragm.
For example, when you drink a glass of water in small sips, you automatically hold your breath. The same applies to vinegar with sugar, which melts on the tongue and is swallowed slowly. Other tips against hiccups include sticking your tongue out or rolling it back for a few breaths. This ensures that breathing takes place more through the abdomen and becomes calmer. The spasm in the diaphragm can be released.
Against hiccups sometimes helps the so-called Vasalva method, which also gets rid of pressure on the ears: Hold your nose, close your mouth, and then tense your breathing muscles as if you were exhaling. The pressure will bulge the eardrum outward and compress the chest cavity. Maintain this pressure for around ten to 15 seconds. Again, don’t overdo it with the pressure and duration of the exercise.
If you frequently react to cold, hot or spicy foods and drinks with hiccups, you do not necessarily have to give them up completely. Instead, you should pay special attention to breathing calmly and evenly while eating and drinking. You should also sit relaxed and upright while doing so.
What helps against chronic hiccups?
Some patients may also be helped by certain drugs against epileptic seizures (antiepileptic drugs), for example gabapentin or carbamazepine. Depending on the cause of the hiccups, the doctor may also recommend sedatives, neuroleptics or cannabis products, for example.
Chronic hiccups without an identifiable cause (idiopathic hiccups) can also be treated to some extent with medication.
As an alternative or complement to medication, breathing training or behavioral therapy may help. In these courses, sufferers learn both to prevent hiccups and to dispel any hiccups that occur. Various relaxation techniques also serve the same purpose, helping to calm the out-of-control diaphragm.
Hiccups: When do you need to see a doctor?
Call an emergency physician immediately if, in addition to the hiccups, other symptoms such as headaches, visual disturbances, speech disorders, paralysis, nausea or dizziness occur. It could then be a stroke, which must be treated immediately!
Hiccups: What does the doctor do?
The first port of call for chronic or frequent hiccups is the family doctor or general practitioner. He will first get a more detailed picture of the symptoms and the possible causes through the patient interview (anamnesis). Possible questions to ask are:
- When did the hiccups occur?
- How long did it last or how quickly did it return?
- How did you experience the hiccups, how violent were the hiccups?
- Did you also have to burp?
- Do any common triggers of singultus come to mind for you, such as cold foods, hasty eating, alcohol, or cigarettes?
- Are you currently suffering from stress or other psychological distress?
- Are you taking any medications? If yes, which ones and how often?
This sometimes already gives rise to a suspicion as to what triggers the hiccups. To confirm the diagnosis, the doctor can perform further examinations or refer the patient to a specialist, such as an internist, gastroenterologist, neurologist or endocrinologist. The further examinations depend on the concrete suspicion of the disease. Among others, the following come into question:
- pH measurement or trial therapy with acid inhibitors if reflux is suspected
- Esophagoscopy and gastroscopy to rule out reflux disease or a stomach ulcer, among other things.
- Ultrasound examination of the neck and abdomen
- X-ray of the chest and abdomen
- Breathing function test to detect irregularities in the respiratory muscles and especially in the diaphragm, as well as to check lung activity
- Bronchoscopy (examination of the bronchial tubes)
- Blood test for inflammatory markers and possible deficiencies
- Electrocardiography (ECG) and cardiac ultrasound (echocardiography), if the heart may be involved
- Computed tomography (CT) of the neck and chest area
- Sampling of cerebrospinal fluid (lumbar puncture) if inflammation of the nerves or meninges is suspected
- Magnetic resonance imaging (MRI) or computed tomography (CT) if nerve damage is suspected
- Ultrasound (Doppler sonography) of the blood vessels in case of a possible heart attack or stroke
If no cause for the hiccups can be found, the doctor speaks of idiopathic chronic hiccups. However, it is quite rare.
