HICCUPS

Everyone has their own personal remedy for hiccups. But what causes hiccups and can they ever be dangerous?

When you breathe in and out normally, air flows smoothly in and out of your lungs in time with the up and down movements of the diaphragm-a touch sheet of muscle at the base of the chest cavity which separates the contents of the chest from the abdomen-and with the help of contractions and relaxation’s of the muscles between ribs (intercostals muscles).

HOW A HICCUP HAPPENS ?

A hiccup happens when the normal sequence of events is disturbed. As you breathe in, the diaphragm begins to contract and to flatten out as the lungs start to expand and fill with air.

At the same time a flap of tissue valued the epiglottis, which prevents food from getting into the airway during swallowing, opens as it should and so does the glottis, the gap between the vocal cords.

But with a hiccup, as this is going one, the diaphragm (and usually the intercostals muscles too) make a sort of muscular spasm. This starts an unconscious gulping of air during which the epiglottis and the glottis both snap shut,.

The typical hiccup sound is produced as air is forced rapidly through the coal cords and then cut off. Lastly, the glottis and epiglottis open, the diaphragm relaxes and curves upwards, the intercostals muscles relax and air is breathed out.

Hot or cold food or drinks, spicy food, eating too quickly, eating too much, drinking alcohol, gulping cold air or taking vigorous exercise straight after a meal can bring on an attack of hiccups.

However, sometimes they seem to begin for no obvious reason and many babies seem to get hiccups after nearly every feed, even if they have no wind. But just what it is that triggers off the hiccup reaction is something of a mystery.

It is certain that in hiccups one of two nerve mechanisms are at fault. Either the nerve impulses sent out by the area of the brain which controls the rhythmical activities of breathing are disturbed, or imprecise impulses are sent out by one of the two phrenic nerve, originating in the neck region of the spinal cord and specifically regulate the diaphragm. It is not known why stomach problems trigger off these impulses.

Certainly the phrenic nerve sends many branches to the oesophagus (the tube which takes food from the back of the throat to the stomach) which explains why swallowing certain foods, or taking in air in an odd way can cause hiccups, but there are very few branches of the nerve to the stomach itself.

REMEDIES

Remedies for hiccups are legion. Babies’ hiccups are best ignored unless they go on for as an hour, in which case you can try giving a teaspoon of gripe water or just plain warm water.

Popular hiccup curs include holding your breath, sucking a lump of sugar, sipping very cold water and drinking out of the wrong side of a glass.

All these ideas are though to work because they distract the nervous system and so stop the hiccup rhythm. The other well-tried remedy is breathing in and out with your nose and mouth inside a paper bag. This is thought to be effective because carbon monoxide builds up in the air breathed in, which depresses the activity of the nerves in the brain which are responsible for causing hiccups.

Because the phrenic nerve is long and extends to many internal organs its activity can sometimes be disturbed by serious disease. So hiccups can sometimes be of the symptoms of peritonitis (an inflammation of the membrane lining the abdominal cavity), disease of the kidneys, heart trouble, or the growth of tumours in the neck which press on the nerve and make it send out impulses that cause hiccups.

MEDICAL TREATMENT

Hiccups are only a case for medical treatment if they are associated with some other symptoms which suggest that there is something seriously wrong - in which case the underlying cause needs treatment-or if they go on for so long that you feel tense and exhausted.

Some people have been known to suffer from hiccups that have defied treatment, but in cases of server hiccups the doctor will try giving sedative drugs, such as chlorpromazine, or possibly get the patient to inhale the drug amyl nitrite which is usually used to deal with angina but which also seems to be effective in getting rid of hiccups.