Causes of hiccups persistent

Overview

Persistent hiccups are hiccups that last longer than 48 hours. Hiccups happen when your diaphragm (the muscle that helps you breathe) suddenly tightens and then your vocal cords snap shut, making a 'hic' sound. When they don't go away on their own, they may be a sign of an underlying health condition.

No, persistent hiccups are not common. Most people only have short bouts of hiccups that last a few minutes. Persistent hiccups affect only a small number of people, mostly adults.

Persistent hiccups can happen to anyone, but they are more common in adults, especially men over 50. People with certain medical conditions (like stroke, multiple sclerosis, or kidney problems) or those who take certain medications may be at higher risk.

Symptoms

Common symptoms

• Repeated, uncontrollable 'hic' sounds.
• A feeling of tightening in the chest, throat, or belly.
• Short, sudden breaths followed by a hiccup noise.

Symptoms in children

• Similar hiccup sounds and chest tightening.
• Children may cry or seem uncomfortable, but hiccups usually stop on their own.

Symptoms in older adults

• Hiccups can last longer and may be harder to ignore.
• They might be linked to other health problems or medications, so they need more attention.

Causes

Main causes

• Irritation of the nerves that control the diaphragm (phrenic or vagus nerves) – often from eating too quickly, drinking carbonated drinks, or sudden excitement.
• Gastrointestinal issues such as acid reflux (GERD) or a stomach ulcer.
• Conditions that affect the brain or nervous system, like a stroke, multiple sclerosis, or a brain tumor.
• Metabolic disorders such as kidney failure or electrolyte imbalances.
• Certain medications, including steroids, chemotherapy drugs, or tranquilizers.
• Alcohol use, especially heavy drinking.
• Surgery, especially abdominal or chest surgery, which can irritate the diaphragm or its nerves.

Risk factors

• Being male (especially over 50).
• Having a medical condition like diabetes, multiple sclerosis, or gastroesophageal reflux disease (GERD).
• Taking certain long-term medications.
• Drinking alcohol regularly or in large amounts.
• Having surgery involving the abdomen or chest.

When to see a doctor

See a doctor urgently if:

• If hiccups are accompanied by any emergency symptoms listed above.
• If you have hiccups and a history of stroke or head injury.

Book a routine appointment if:

• If your hiccups last longer than 48 hours and you don't have emergency symptoms.
• If hiccups come back often and interfere with your daily life.
• If you have other symptoms like heartburn, weight loss, or trouble swallowing.

Diagnosis

Your doctor will ask about your hiccups – when they started, what makes them better or worse, and any other symptoms you have. They will also do a physical exam, listening to your heart and lungs and checking your abdomen.

Tests that may be done

• Blood tests: to check for infection, kidney function, or electrolyte imbalances.
• Imaging tests: such as a CT scan or MRI of the head and chest to look for nerve irritation or other problems.
• Upper endoscopy: a thin tube with a camera to look inside your stomach and esophagus for reflux or other issues.

What to expect at your appointment

The doctor will take a detailed history and may order tests based on your symptoms. The process is usually straightforward and can often find the cause. Even if no cause is found, treatments can still help manage the hiccups.

Treatment

Treatment for persistent hiccups focuses on stopping the hiccups and treating the underlying cause if one is found. Many people find relief with simple home remedies, while others may need medical treatments.

Self-care at home

• Hold your breath for a few seconds (but not if you have a heart condition).
• Drink a glass of cold water slowly.
• Swallow a teaspoon of sugar (without water) – this can stimulate the vagus nerve.
• Gargle with ice water.
• Gently pull your knees up to your chest while leaning forward.
• Breathe into a paper bag (not a plastic bag) to raise carbon dioxide levels.

Medical treatments

If self-care does not help, your doctor may prescribe medications that relax the diaphragm or calm the nerves involved in hiccups. These are generally taken for a short time. Some people respond to medicines used for muscle spasms or nerve pain. Always follow your doctor’s advice; never take someone else’s medicine.

When is surgery considered?

Surgery is rarely needed. In very severe cases that do not respond to any other treatment, a procedure called phrenic nerve block or a vagus nerve stimulator may be considered. This is only done by specialists in a hospital.

Living with this condition

Living with persistent hiccups can be tiring and frustrating. They can interrupt talking, eating, and sleeping. Try to stay calm and use the self-care tips to break the cycle. If they continue, follow up with your doctor.

Lifestyle tips

• Eat slowly and avoid eating large meals that fill your stomach too quickly.
• Avoid carbonated drinks (soda, beer) and very hot or spicy foods.
• Limit alcohol consumption.
• Avoid sudden changes in temperature, like a cold shower after hot food.
• Manage stress with relaxation techniques like deep breathing or meditation.

Diet and exercise

Eat smaller, more frequent meals. Chew food thoroughly and avoid talking while eating. Gentle exercise like walking may help, but avoid strenuous activity immediately after meals. If hiccups start during exercise, stop and rest.

Mental health and emotional wellbeing

Constant hiccups can cause anxiety, embarrassment, and trouble sleeping. You may feel isolated or frustrated. It is important to talk to your doctor about these feelings. Professional support, such as counseling, can also help you cope.

Prevention

You cannot always prevent persistent hiccups, but you may reduce your risk by avoiding known triggers: eat slowly, limit carbonated drinks and alcohol, avoid very spicy or hot foods, and manage stress.

Complications

If left untreated

• Extreme tiredness from interrupted sleep.
• Weight loss and dehydration if hiccups make it hard to eat or drink.
• Aspiration (inhaling food or liquid into the lungs) if hiccups cause choking.
• Worsening of the underlying condition causing the hiccups.

Long-term outlook

The outlook for most people with persistent hiccups is good. With treatment, hiccups usually stop within days or weeks. Even when a cause is found, addressing it often resolves the hiccups. While it can be frustrating, help is available, and most people recover fully.

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