Hiccups are short repeated sounds like, "hic”, produced from the throat of an individual per minute. At times the sound may be loud like gasps or sighing. Occurring for a short duration, they are usually harmless, but they cause much discomfort and embarrassment to the affected person.

The abrupt rush of air in the lungs causing the vocal cords to close suddenly produces this sound like, "hic”. Irritation of the nerve to diaphragm or sudden closure of the diaphragm also produces hiccups.

Drinking a binge of alcohol or carbonated drinks can produce hiccups of short duration. Consuming dry bread or very dry food is also known to cause hiccups. Hiccups can also be produced by very spicy, hot food.

Chronic constipation, flatulence, gastro esophageal reflux, e.t.c., are yet another reasons for hiccups to occur. They can also be produced by conditions like sore throat, laryngitis, electrolyte imbalance due to diarrhea, vomiting, e.t.c.

Some diseases like renal failure, diabetes, pneumonia, chronic lung diseases, e.t.c. are associated with hiccups as one of the manifestations. A cyst, tumor or goiter in the neck can also induce hiccups. Tumors of the brain, encephalopathy, stroke, head injury are some of the neurological conditions known to cause hiccups.

Hiccups are a very commonly used complaint for malingering for some personal vested interest. But this can be easily differentiated from true hiccups by simply talking to the person. Real hiccups continue till resolved, whereas in most of the cases of malingering, a person remains normal while speaking and then the hiccups resume again after he stops talking.

Once somebody has hiccups it is very embarrassing, particularly when in company of others. The repetitive sounds produced cause discomfort in the chest and abdomen. It can also induce throat and chest pain. Continuous hiccups can physically exhaust a person.

If one has hiccups repeatedly or they are persistent for more than a day or so, he or she needs to be investigated to determine the underlying cause.

There are many traditional treatments of treating hiccups. The results of these are variable depending on one’s previous experience with the treatment regarding its efficacy and underlying cause for the hiccups. One of them is a shock therapy. It is said that if the affected individual is exposed to some news or action which induces shock, the hiccups will stop. Another traditional treatment is to force a small bolus of sugar suddenly in the throat. Taking sips of iced water or milk, sucking on a lemon or vinegar is also useful in stopping hiccups. Breathing fast or holding the breath, pulling the knees up to the chest or leaning forwards to compress the chest are other maneuvers found to be useful by people for stopping hiccups.

If the hiccups persist after such treatments or are severe they have to be controlled by medical therapy. Drugs like metoclopramide, chlorpromazine, promethazine, are used as tablets or injections, to treat hiccups depending on the severity. Laxatives are useful if constipation and flatulence are the cause for hiccups. Chewing antacid tablets is also useful for curing hiccups, particularly if they are due to acid reflux or flatulence.

Hiccups due to minor digestive disturbances or sore throat usually resolve spontaneously. But those due to underlying organic disease or conditions like electrolyte imbalance need to be investigated. They get cured only after cure of the underlying disease.

Avoiding constipation, acid reflux and or flatulence by a suitable diet and life style changes help to prevent occurrence of hiccups. One should avoid alcohol as it causes hiccups due to multiple reasons and is also bad for overall health of an individual. Similarly used of carbonated soft beverages can also be reduced.

If in spite of such measures one gets hiccups, underlying disease should be searched and treated.

Dr Rachna Pande, Specialist, internal medicine rachna212002@yahoo.co.uk