Causes of hiccups

What causes hiccups?

“Hiccups occur when the larynx area, where the vocal cords are located, suddenly closes after the involuntary contraction of the muscle called the diaphragm, which separates the chest cavity from the abdominal cavity, and a sound is heard during this time. These contractions, which can repeat once in 2-6 seconds, can also be detected in the muscles between the ribs other than the diaphragm. Hiccups are caused by the stimulation of the nerve that affects the diaphragm, which we call the phrenic nerve. Hiccups can occur at any age and gender, including infants.

Hiccups are usually short-lived and such short-term hiccups do not indicate a disease. For example, hiccups seen in infants or those who eat too quickly and swallow air are short-term, temporary hiccups that are not due to an organic disease such as excessive laughing, excessive smoking and alcohol use, excessive stress-induced air swallowing. Hiccups can sometimes recur frequently and last for a long time. If the hiccups last 2 days to 1 month, it is defined as persistent hiccups, and if it lasts longer than 1 month, it is defined as resistant hiccups.

Coughs that exceed 3 weeks are generally called chronic hiccups. Chronic hiccups are more common in men, because the diaphragm muscle is thicker in men.

Overeating, Consuming spicy and spicy foods, Gastroesophageal reflux.

Some medications- Cortisone, some blood pressure medications, rheumatism medications, benzodiazepines

Chronic kidney failure – As the urea level increases, the frequency of hiccups also increases, Diabetes

It can be a sign of diseases related to the central nervous system such as neurological diseases, meningitis, intracerebral hemorrhage, brain tumors.

Heart diseases- Excessive heart enlargement due to heart failure can cause hiccups. Sometimes hiccups can occur in patients who have had a heart attack, and hiccups can be seen in patients with pericarditis (inflammation of the heart membrane).

Lung diseases – Pneumonia and fluid collection between the lung membranes can also cause hiccups. Hiccups can be seen in some lung cancers depending on the location. Hiccups may develop in diseases of the region called “mediastinum”, which is located between both lungs and contains the heart. Hiccups can be seen in the enlargement of the lymph nodes here for tuberculosis, sarcoidosis, cancer or other reasons,

Trauma of the phrenic nerve, esophageal obstruction are the main ones of these diseases.

Hernia of the diaphragm muscle, liver tumors and abscesses, stomach cancer, spleen infarction,

Hiccups can be detected in diseases such as intestinal obstruction, acute pancreatitis.

Hiccups can also occur after surgery on organs in the upper abdomen. Eating too much food and a full stomach can cause hiccups. Consuming too much alcohol, Swallowing too much air, Smoking, Stress and emotional changes. Sudden temperature change in the stomach, such as consuming very hot or cold liquids, Glaucoma (eye pressure), Goiter, Foreign body in the ear, many factors such as vagal nerve may cause hiccups.

What are the psychological causes of hiccups?

Breathing deeply during stress lowers the carbon dioxide rate in the blood and causes a deterioration in the body’s metabolic balances. After very fast and deep breathing, there may be contractions in the body, even an involuntary contraction of the hands, which we call the midwife’s hand, may occur, in the same way, the diaphragm may be stretched and hiccups may occur. In addition, swallowing a lot of air during deep breathing will cause bloating in the stomach, gas and stretching of the diaphragm, which causes hiccups. Psychic hiccups are most common in women. While 93 percent of the cause of hiccups in women is psychological, this rate is about 7 percent in men. In this way, what should be done in psychic hiccups caused by deep breathing due to stress is to breathe the person into a paper bag. This will increase the carbon dioxide in the blood and the contractions and therefore the hiccups will stop.

What are the causes of hiccups in newborn babies?

Hiccups are the sudden closure of the larynx as a result of the sudden contraction of the diaphragm muscle that separates the thoracic cavity and the abdominal cavity, and then the sound of a sudden inhalation. Hiccups are caused by the stimulation of the nerve that affects the diaphragm, which we call the phrenic nerve. Hiccups in infants up to 1 year of age are mostly a normal reflex. The causes of hiccups in babies can be summarized as swelling of the stomach after breastfeeding, swallowing air during feeding, sudden excitement of the baby and sudden decrease in ambient temperature, especially in fast-fed babies. In addition, the consumption of foods that will cause gas in the nursing mother may increase hiccups in the baby, while the consumption of milk and milk products by the mother in allergic babies, for example, in the baby with cow’s milk allergy, may cause gas formation in the baby, thus increasing hiccups. What can be done in the presence of hiccups in babies are as follows. First of all, attention should be paid to nutrition. The baby swallows some air along with it during breastfeeding. It is necessary to remove the air trapped in the stomach by burping the baby every 5-6 minutes, that is, it will not be enough to wait for the end of breastfeeding for the gas to come out. Thus, the tension in the stomach is reduced and the onset of the hiccup reflex is prevented. It is necessary to pay attention to this, especially in babies with a lot of hiccups. When there is hiccups, there may be a change in the environment, except for holding upright after breastfeeding. Since the sudden cooling of the environment increases hiccups, it may be beneficial not to keep it in a cold environment. Breastfeeding again usually helps the hiccups to stop. If the hiccups do not go away with simple methods, giving the baby a few teaspoons of water is a good help in relieving the hiccups. 1-2 drops of lemon juice dripped into the mouth is another method used to relieve hiccups. When a drop of lemon is given, the baby suddenly catches his breath and diaphragm irritation is prevented and hiccups. It cuts hiccups very quickly, but since its pH is not very suitable for children, it is not recommended very much in practice, although it is applied a lot, it can cause the baby to vomit. In cases of hiccups that will prevent the baby from feeding for a very long time, it may be necessary to use the medications recommended by the physician in rare cases. If the baby’s hiccups have exceeded an hour, it would be appropriate to call the doctor and consult if there is a very intense hiccup that prevents the baby from sucking.

How is the hiccup?

Most episodes of simple hiccups go away on their own. There are many methods applied in public for hiccups that last longer. 1- Various maneuvers: The most well-known of these is holding the breath, a practice that makes sense and can often work. When breathing is taken and held, the diaphragm’s contraction and movement during breathing will be prevented, so its load will decrease, only contraction due to hiccups will remain, and after a while, it will also stop. In addition, the accumulation of carbon dioxide in the blood will cause the hiccups to stop metabolically. A similar mechanism is also used in the work of breathing into the paper bag. In this method, the increase in carbon dioxide in the blood will cause the hiccups to stop. By holding the breath as much as possible, the diaphragm is misled and it is returned to the normal breathing rhythm.

By drinking ice water, lemon juice or vinegar, spasm in the larynx can be resolved.
Eating 2-3 cubes of sugar or 1 coffee spoon of salt can also give positive results.
Chewing a few cloves on an empty stomach works especially well for the elderly. If it does not pass, a doctor should be consulted. 2-Drug treatment: Various medications such as tranquilizers and muscle relaxants can be effective for hiccups that cannot be relieved by these methods. It is appropriate to arrange it by the relevant physician. 3-Other methods: Massage of the carotid vein in the neck by the physician can also be called. The last resort for unstoppable hiccups is blockage of the phrenic nerve with an anesthetic drug or surgically.

Some known methods are inconvenient to apply. For example, pushing, frightening, blocking the external ear canal, pressing the eye and drinking lemon juice. Each of these methods are applications with a high potential to harm the patient.

What can be done for hiccups that do not go away for a long time?

Although hiccups are a simple hiccup that is experienced by everyone in daily life and does not indicate any pathology, there may also be hiccups that are rarely prolonged and frequently recurring, impairing the quality of life of the person.

Gastrointestinal system diseases, especially gastroesophageal reflux often lead to hiccups, in addition, diaphragmatic hernia, esophageal tumors, liver diseases, acute pancreatitis are common causes of chronic hiccups.

Diseases that disrupt the body’s metabolic values, such as chronic kidney failure and diabetes, can lead to long-term hiccups.

Heart diseases, heart failure, pericardial inflammation

Lung diseases, fluid collection or tumor between the lung membranes, lung cancers (according to the location)

Diseases of organs located in the space between both lungs, which we call the mediastinum (lymph node enlargement, tuberculosis, sarcoidosis, lymphoma, goiter)

After operations on intra-abdominal organs

Peritoneal peritoneum due to inflammation

Long-term hiccups may be seen due to phrenic nerve irritation in cases such as meningitis and brain tumors in central nervous system diseases.

If the patient with chronic hiccups is not a known diabetes or kidney disease, he should be examined in terms of all these diseases, and the cause of chronic hiccups should be investigated. If an organic cause is detected, treatment should be applied for the cause.

What kind of problems may occur in people who have frequent hiccups?

Hiccups that last more than 3 weeks are called chronic hiccups. For persistent hiccups exceeding 24-48 hours, an absolute physician should be consulted. Again, frequent recurrent hiccups exceeding 3 weeks are also hiccups that should be investigated. If the patient with hiccups frequently has complaints of gas or burning and heartburn, seeing an internist or gastroenterology specialist will be beneficial for the diagnosis and treatment of digestive system pathologies such as reflux and ulcers. Similarly, if the patient who is constantly hiccuping is coughing at the same time, if there are complaints of sweating, weight loss, it would be correct to consult a chest diseases specialist, as possible diagnoses, fluid collection between the lung membranes, tuberculosis, lung cancer. In the presence of long-term hiccups together with neurological complaints such as headache, drowsiness, numbness in the arms and legs, it is appropriate to consult a neurologist to investigate nervous system diseases. Although hiccups are normal in babies up to 1 year old, it would be appropriate to consult with the pediatrician in order to apply certain precautions in the presence of hiccups that are frequent and long-lasting enough to prevent feeding, and to take medication recommendations when rarely necessary.

Should we see a doctor in case of persistent hiccups?

In the presence of unstoppable hiccups, a physician should be consulted. Hiccups are usually expected to disappear in less than 48 hours. If this period is between 48 hours and 30 days, it is defined as persistent hiccups, and if it lasts longer than 1 month, it is defined as resistant hiccups. If hiccups continue for 24-48 hours continuously or recur at frequent intervals for more than 3 weeks, a physician should be consulted. Treatment of persistent hiccups is primarily based on the cause, and if any system pathology is detected, for example, if there is heart failure, heart failure treatment is arranged. Thus, the contraction of the diaphragm muscle due to the enlargement of the heart improves with the treatment due to the shrinkage of the heart, and the hiccups also stop. Similarly, if the patient’s urea is very high due to chronic kidney failure, acidosis has developed in the blood, and there is hiccup due to this, the hiccups will improve when the treatment is applied and the urea is reduced. There are also some medications that stop hiccups. With the direct application of these drugs under the control of a doctor, the hiccups can be stopped in a short time. In very rare cases of persistent, prolonged hiccups, the phrenic nerve may be blocked, blocked, or even surgically cut.

Could hiccups be a symptom of heart disease? Excessive heart enlargement due to heart failure can cause hiccups. Sometimes hiccups can occur in patients who have had a heart attack. In a patient who has had a heart attack, there is a blood supply disorder in the heart muscle in accordance with the region where the clogged heart vessel is, and some chemicals are secreted from the heart muscle in the area with the infarction. Especially if that area is the left ventricle of the heart that sits on the diaphragm, which we call the ventricle, the patient may have chest pain, burning in the chest, and a feeling of pressure along with hiccups. The attacks of the lower end of the heart, which we call inferior infarction, are usually manifested by burning, souring, and nausea, like stomach discomfort. In this group of patients, especially if there is a sudden onset of persistent hiccups, they should be evaluated in terms of heart attack, and if necessary, they should be referred to a cardiologist for the removal of their echoes. Hiccups can be a warning sign in this case, it should not be ignored. Hiccups can also be seen in patients with pericarditis (inflammation of the heart membrane). Pericardial fluid, that is, the collection of fluid between the heart membranes, can lead to hiccups in patients with pericarditis by causing the contraction of the diaphragm on which the heart sits behind the pericardium first. Lung diseases- Pneumonia and fluid collection between the lung membranes can also cause hiccups. Hiccups can be seen in some lung cancers depending on the location. Hiccups may develop in diseases of the region called “mediastinum”, which is located between both lungs and contains the heart. Hiccups can be seen in the enlargement of the lymph nodes here for tuberculosis, sarcoidosis, cancer or other reasons.

How to understand the cause of hiccups?

In prolonged hiccups, in chronic hiccups lasting more than 3 weeks, investigations should be performed to investigate the cause of the hiccups. These are routine blood tests, chest X-ray for heart and lung diseases, ECG, Echocardiography, Whole abdominal ultrasonography for intra-abdominal evaluation, gastroscopy if there is a specialist physician’s evaluation for reflux according to the patient’s history. After these examinations, it would be appropriate to proceed according to the results to be obtained. Of course, if a neurological pathology is considered, the priority should be on the neurology examination and the examinations for it. According to the results of these examinations, appropriate treatment should be started for the cause of the patient.

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