Persistent Hiccups

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By peace | June 2, 2006

A hiccup happens when the normal sequence of events is disturbed. As you breathe in, the diaphragm begins to contract and to flatten out as the lungs start to expand and fill with air.

At the same time a flap of tissue valued the epiglottis, which prevents food from getting into the airway during swallowing, opens as it should and so does the glottis, the gap between the vocal cords.

But with a hiccup, as this is going one, the diaphragm (and usually the intercostals muscles too) make a sort of muscular spasm. This starts an unconscious gulping of air during which the epiglottis and the glottis both snap shut,.

The typical hiccup sound is produced as air is forced rapidly through the coal cords and then cut off. Lastly, the glottis and epiglottis open, the diaphragm relaxes and curves upwards, the intercostals muscles relax and air is breathed out.

Hot or cold food or drinks, spicy food, eating too quickly, eating too much, drinking alcohol, gulping cold air or taking vigorous exercise straight after a meal can bring on an attack of hiccups.

However, sometimes they seem to begin for no obvious reason and many babies seem to get hiccups after nearly every feed, even if they have no wind. But just what it is that triggers off the hiccup reaction is something of a mystery.

It is certain that in hiccups one of two nerve mechanisms are at fault. Either the nerve impulses sent out by the area of the brain which controls the rhythmical activities of breathing are disturbed, or imprecise impulses are sent out by one of the two phrenic nerve, originating in the neck region of the spinal cord and specifically regulate the diaphragm. It is not known why stomach problems trigger off these impulses.

Certainly the phrenic nerve sends many branches to the oesophagus (the tube which takes food from the back of the throat to the stomach) which explains why swallowing certain foods, or taking in air in an odd way can cause hiccups, but there are very few branches of the nerve to the stomach itself.

Hiccups are only a case for medical treatment if they are associated with some other symptoms which suggest that there is something seriously wrong - in which case the underlying cause needs treatment-or if they go on for so long that you feel tense and exhausted.

Some people have been known to suffer from hiccups that have defied treatment, but in cases of servere hiccups the doctor will try giving sedative drugs, such as chlorpromazine, or possibly get the patient to inhale the drug amyl nitrite which is usually used to deal with angina but which also seems to be effective in getting rid of hiccups.

When To See A Doctor
You should see a doctor if the hiccups become chronic and persistent (if they last more than 3 hours), or if they affect your sleeping patterns or interfere with eating.

A case of the hiccups is rarely a medical emergency. If your hiccups last for more than 3 hours, occur with severe abdominal pain, or you spit up blood, however, you should seek medical attention.

Exams And Tests
Diagnosis is based on physical evaluation. Laboratory testing is rarely necessary unless your hiccups are a symptom of an associated condition.

Medical Treatment

Treatment for hiccups depends on how severe they are.

For the common hiccups that will usually stop on their own, home remedies are generally recommended.

For more severe, persistent hiccups, your doctor may try medications to manage your hiccups. Chlorpromazine (Thorazine) is usually the first prescription medication tried for hiccups, although drugs such as baclofen (Lioresal) and medications for convulsions such as phenytoin (Dilantin) have also been successful.