Find out about hiccups and cancer and what to do if you have them.
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, 2 things happen:
- 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.
Things that might trigger hiccups are:
- eating and drinking too quickly, particularly gulping fizzy drinks
- over eating
- sudden changes in air temperature
- over stretching your neck
- certain drugs, such as medicines to treat anxiety (benzodiazepines)
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 (oesophagus)
- you are having chemotherapy, steroids or an opioid 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
- 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
- breathing in and out of a paper bag (not a plastic one and don’t do this for any longer than 1 minute)
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
- 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 they may use include:
- the anti sickness drug metoclopramide (Maxolon)
- a sedative, such as haloperidol or chlorpromazine
- a drug to relax your muscles such as baclofen