By Martha A. Simpson, D.O., M.B.A.
Assistant Professor of Family Medicine
Ohio University College of Osteopathic Medicine

READER'S HICCUP PROBLEM ANNOYING, BUT NOWHERE NEAR RECORD

Question: My husband thinks I get hiccups a lot. I do have them two to three times a week. He never seems to have them. What causes hiccups, and what can I do to make them go away? Sometimes they last for quite a long time –- as long as an hour or more. Ideally, I would like to prevent hiccups. Do you have any suggestions?

Answer: Hiccups are caused by a sudden involuntary contraction of the diaphragm, the large muscle that separates your chest and abdomen and controls your breathing. This causes an inrush of air and a sudden, but brief, closure of the glottis. This structure shuts off your windpipe when you swallow. It is the sudden “slamming shut” of the glottis during a hiccup that produces the characteristic “hic” sound.

While we know that this is what a hiccup is, no one is quite sure why people have hiccups. They do not seem to serve any physiological purpose. Most everyone has hiccuped at some time during his or her life. Air swallowing, smoking, excessive food or alcohol intake, laughter, or ingestion of spicy or very cold foods can trigger episodes of hiccups, called singultus in medical terms. While to the person affected a hiccup episode can seem to last for a long time, it's usually self-limiting of relatively brief duration.

Although the vast majority of hiccups are merely a nuisance, there are some rare instances where a serious medical condition can be an underlying cause. In these cases, hiccups can be unusually difficult to stop. Diseases that are sometimes associated with hiccups that go on and on –- doctors call these “intractable hiccups” -- include brain tumors, heart attacks, dementia and neurological problems, such as meningitis. Various abdominal disorders can also cause irritation of the diaphragm, leading to hiccups. Finally, some very uncommon disorders in the lung, such as sarcoidosis or pulmonary fibrosis, can result in persistent hiccups.

The transient hiccups that you are experiencing are annoying but, as you indicate, go away after you wait for a period of time. If you are impatient and want to try to get over them more quickly, there are many home remedies that may help. Here are a few: holding your breath, pulling on your tongue, gargling with water, drinking pickle juice, rubbing your stomach, having someone scare you and breathing 10 times into a paper bag that is sealed around your mouth.

With intractable hiccups, however, finding the cause and treating it is first order of business. If a known cause is found and the hiccups persist, prescription medications may be indicated. Rarely, intractable hiccups are not the result of a serious underlying disease. How long can such an episode of hiccups last? Well, the Guinness Book of Records says that one poor fellow had them for more than 69 straight years. I guess an hour or two a few times a week isn't so bad by comparison. Is it?

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnosis and recommend treatment for any medical conditions. Past columns are available online at http://www.FamilyMedicineNews.org.