Chest physician and Head, Medical Unit, Emergency Medicine Department, University of Nigeria Teaching Hospital, Enugu, Dr Augustine Ikechukwu, speaks with AJIBADE OMAPE on the mechanisms of hiccups and how potentially deadly ailments hide underneath
Can you explain the physiological mechanism behind hiccups and how they occur in the human body?
Well, hiccup is a contraction of the diaphragm; the diaphragm is the muscle in the body that separates the chest from the abdomen so that they don’t get to mix up; the diaphragm helps you to breathe in. When you take a deep breath and breathe out, the diaphragm relaxes, but when this happens very quickly and in short intervals, that is what happens with hiccups. Hiccups are just a quick contraction of the diaphragm and a quick relaxation of the diaphragm, so it is as though you are breathing in and breathing out very fast. Once the diaphragm contracts quickly and then relaxes, usually a part of it should do that, what happens is that hiccups occur if there is anything that touches or irritates the diaphragm; remember I said it separates the chest from the abdomen, below you have the liver, the stomach basically the intestines, and you also have the kidney, and above it, you also have your lungs and then the heart, and of course, there is the nerve connecting down to the diaphragm, which stimulates the diaphragm to contract; so anything in the brain that is around the nerve that controls the contraction of the diaphragm can make a person have hiccups; so if there is a stroke around that area, any infection around that area of the brain that controls the diaphragm can make anybody have hiccups.
Normally, when someone is eating too fast or taking in water too quickly, because it is coming in too fast it can irritate the diaphragm and cause hiccups; any infection around the lungs as well can irritate the diaphragm because the lungs are sitting just around the diaphragm. There are other systemic things like kidney failure, which can also make the diaphragm irritated. So, largely anything around the diaphragm can cause hiccups. Normally once it happens physiologically, it will go away within minutes; one shouldn’t have hiccups lasting up to an hour, but once it continues for days, we know there is a problem and that is what we call protracted hiccups or intractable hiccups, so we usually begin to assess the problem. If you have hiccups that have lasted for days, we begin to worry but for the usual ones, the moment you take water, it should subside.
What are the common causes of hiccups, and how do they vary from babies to adults?
Hiccups in adults and babies have the same mechanisms; hiccups are more common in babies because of how they are, particularly when they feed on breast milk and breathe very fast they tend to have hiccups. Traditionally, we try to put something on the head for it to stop. Normal physiologic hiccups will run their course and will stop, but most hiccups in children are physiologic so they will stop but when you have hiccups lasting long, then there is a problem.
Are there any specific triggers or underlying medical conditions that can contribute to persistent or chronic hiccups?
Yes, once hiccups last longer than 24 hours, we know there is a problem and we begin to evaluate and assess the body for infections around the liver and lungs, check for stomach cancer and brain injuries and do other assessments around the diaphragm because that is where it is coming from; we check the stomach, the liver, the lungs, the brain and that’s how we evaluate hiccups; sometimes, someone who takes an overdose of drugs will have hiccups; even alcohol overdose can cause hiccups.
How long do hiccups typically last, and what factors can influence the duration and severity of hiccups?
Well, hiccups naturally should not last more than a few minutes, especially for the physiological ones, but the intractable or protracted hiccups could last more than 24 hours, which is a sign that there is a medical condition or organ in the body that needs attention.
What are the potential effects or discomfort associated with prolonged or severe hiccups?
For the physiologic hiccups, there are no effects; it is natural so there is no issue; once water is ingested, they should subside, but the intractable or protracted hiccups can be very disturbing and embarrassing; they can contribute to a lack of sleep, because there is more background problem; the patient will also be suffering from the background problem so it is quite disturbing having persistent or recurrent hiccups. So generally, hiccups in themselves may not be so disastrous in that sense, but if they’re protracted, it’s only a sign that there is a background problem.
Can hiccups be indicative of underlying health issues or complications, and if so, what are some examples?
Yes, it is a red flag that there is a very serious or heinous health issue; just like I said earlier, hiccups in themselves may not be so deadly but just a sign that there is an issue with someone medically; it can be a sign that someone has kidney problems, kidney disease, kidney failure, liver failure, liver cancer, stomach cancer, lung infection, and lung cancer, particularly if they are located at the lower parts of the lungs, these are the possible issues that the hiccups could be signalling if there is an infection in the oesophagus, or around the diaphragm; the hiccups can give you all of those signs.
Is there any evidence to suggest that hiccups can lead to serious medical complications or death?
Well, not in the sense of leading to serious medical conditions or complications or death, it is just an indicator that there is a need for an assessment; hiccups cannot lead to death, they can only signal one to assess and look for life-threatening ailments that could potentially cause harm to the individual.
A Nollywood actor popularly called Sisi Quadri, died recently, and there were rumours that he had hiccups before being taken to a hospital, can hiccups be a symptom of an illness or are they deadly on their own?
Well, there is never a never in medicine, but it is not common for one to die from protracted hiccups since they are just an indicator that there are underlying issues. For instance, if someone takes alcohol and gets intoxicated, such a person can have hiccups before he gets to the hospital and such a person can die of low blood sugar because alcohol will give you low blood sugar so, it may not necessarily be the hiccups because the person could be having severe kidney problems or other underlying issues so the hiccups are what the main ailment comes with. Once someone has protracted hiccups, it is an indicator of an underlying issue, so it is not a usual thing for someone to have hiccups and die from it; the person will only be dying from the underlying issues.
How do medical professionals assess and treat severe or persistent cases of hiccups, and what options are available for management?
I mentioned before that hiccups are a red flag, so what we do is not go chasing the hiccups; we go chasing the things that could most likely trigger the hiccups. We do things like urinary function tests, liver function tests, chest X-rays, etc. We may even need to assess some basic things to be sure what problem the patient could be having, and what we find preliminary will determine how far we go with the investigations; you may just do a renal function test and find out that the person’s kidneys are bad and then you may not go too far, all you have to do is just treat the kidney problem and the hiccups will stop, so in itself we don’t start to evaluate hiccups, we chase what could cause the hiccups and what we find in the preliminary investigations will determine how far we go with the other evaluations.
Can you discuss any potential complications or risks associated with treating hiccups, especially in cases of underlying medical conditions?
If a patient comes with prolonged hiccups, it is disturbing so we may want to give the patient a few drugs to try to reduce the number of contractions, because if the contraction becomes too much it could wear the patient out, resulting in fatigue and exhaustion. We will want to calm the patient down with a few drugs that can reduce the frequency of the contraction, while you treat the underlying issue; overzealous chasing of the hiccups can make one use too many drugs that may not be too good for the patient’s health because there may be something underlying happening but at the same time you do not want to overload the patient with drugs that may also weigh them down, so we are very careful with the management and assessment.
What lifestyle factors or habits can contribute to the development or exacerbation of hiccups, and are there any preventive measures individuals can take?
Well for the physiologic hiccups, as much as possible, no matter how hungry you are, try to eat slowly, because if one eats too fast or drinks too fast, hiccups are bound to occur; another thing is alcoholism and heavy drinking can cause hiccups, so people should engage in controlled drinking. I advise that drinking should be cut down to safe limits, eat healthy food and drink enough water, exercise, avoid refined sugar, and quit smoking, these are some of the general principles that can prevent hiccups.
How do hiccups differ in their management between adults and infants or children?
It is the same mechanism for infants and adults; hiccups are largely physiologic because once the infant feeds, the stomach is already hinging on the diaphragm. They begin to have hiccups that happen as often as they feed. Also, the positioning of the infant immediately after feeding can cause them to have hiccups. If they have gone on for days, that is the only thing that can raise concerns to check if there are congenital problems, but physiological hiccups generally will stop.
Are there any misconceptions or myths surrounding hiccups that you would like to address or clarify?
Well, traditionally we have women putting threads on the head of a child who has hiccups, but I think these things work because people believe in them; however, there is no medical backing to putting a thread on the head of a child as a solution to hiccups. You can find out that because the hiccups are self-limiting, they will die or go naturally. So imagine that if at the time one is putting the thread on the head of a child at the same time the hiccups are now dying off naturally, over time it will be believed that putting a thread on the child’s head is what cured the hiccups, meanwhile, the hiccups just went naturally. What you believe is what works for you; we cannot throw away everything traditional, so if that worked in the past, why not now? But we know that it is just a coincidence, and so far it is not a harmful practice there is nothing wrong with it.
What advice do you have for individuals experiencing persistent or severe hiccups, and when should they seek medical attention?
Once the hiccups have gone beyond days, one needs to see the doctor, and particularly if one is feeling unwell and has hiccups, such a person should also see the doctor, also one should cut down on drinking, eat healthy foods, drink, and eat slowly to avoid contraction of the diaphragm, but particularly if one feels unwell with hiccups, one needs to see the doctor. Nobody visits the doctor because they had hiccups for a few days, however, if it becomes recurrent and persistent, such a person should see the doctor.
