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Hiccups and cancer

My mum has cancer and has terrible hiccups. What can we do to help her?

 

What hiccups are

Hiccups are a common problem that we all have from time to time. For most people, hiccups are usually mild and go away without any medical treatment. But when hiccups are a symptom of cancer, or a side effect of cancer treatment, they can go on for longer. This makes them tiring and difficult to cope with.

Hiccups are uncontrolled spasms of your diaphragm between normal breaths. The diaphragm is the dome shaped muscle under your ribcage. Normally, your diaphragm helps to pull air into your lungs by pulling downwards as you breathe in. And when you breathe out, your diaphragm pushes upwards.

But when you hiccup, two things happen

  • Firstly, your diaphragm contracts and pulls down between your normal breaths, sucking air in
  • Immediately after this, the top of the windpipe (trachea) closes briefly, to stop more air getting in. This makes the hic sound.
 

Causes of hiccups

We don’t know the exact cause of hiccups. It might happen if the nerve that controls the diaphragm (the phrenic nerve) is irritated.

Thing that might trigger hiccups are

  • Eating and drinking too quickly, particularly gulping fizzy drinks
  • Over eating
  • Heartburn
  • Stress
  • Sudden changes in air temperature
  • Over stretching your neck
  • Certain drugs, such as medicines to treat anxiety (benzodiazepines)
  • Alcohol

But if you have cancer you might get hiccups if

  • Your stomach stops working and becomes extended and bloated
  • You have an infection affecting your chest, or food pipe
  • You are having chemotherapy, steroids or an opiod painkiller such as morphine
  • Your cancer is pressing on your diaphragm
  • You have symptoms because of a brain tumour
  • Your kidneys are not working normally and your blood chemistry changes
  • You have high blood calcium levels (hypercalcaemia)
 

Things to try for mild hiccups

Most people find that their hiccups go away either on their own or by trying one of the following suggestions

  • Gulping a glass of water
  • Eating a piece of dry bread slowly
  • Drinking water from the far side of a glass – you will need to be able to bend over to do this
  • Breathing in and out of a paper bag (not a plastic one and don’t do this for any longer than 1 minute)
  • Gargling with water
  • Taking a deep breath, holding it for as long as you can and repeating this several times
  • Sucking on a lemon
  • Drinking peppermint water
  • Eating a teaspoon of dry sugar
  • Pulling your knees up to your chest

If your mother has had hiccups for more than a day she should tell her doctor or nurse so that she can have treatment.

 

Treatment for more severe hiccups

Some hiccups can last for more than a couple of days. Doctors call these persistent hiccups. If they last longer than a month, doctors call them intractable. If they last this long they can cause other problems, including

  • Weight loss
  • Difficulty in sleeping
  • Feeling sick
  • Embarrassment
  • Feeling sad or depressed

People with persistent or intractable hiccups need medical treatment. First, your doctor will try to find out what is causing your hiccups. They may disappear by treating the cause, for example, changing the drugs that may be responsible for the hiccups.

But your doctor may treat the hiccups directly. Drugs used include

  • The anti sickness drug metoclopramide (Maxolon)
  • A sedative, such as haloperidol or chlorpromazine
  • A drug to relax your muscles such as baclofen

You can find out more about managing other cancer symptoms in CancerHelp UK.

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Updated: 27 September 2011