Hiccups are caused by an uncontrollable contraction of your diaphragm. This page focuses on hiccups in palliative care.
Key points
- Your diaphragm is the muscle that separates your abdomen from your chest. The contraction causes your vocal cords to close briefly, resulting in the hiccup sound – hic!
- Hiccups can be very distressing.
- There are many causes that can contribute to hiccups if you have a terminal illness.
- Treatment of hiccups comprises non-medicine and medicine treatment.
What causes hiccups?
There are many causes that can contribute to hiccups if you have a terminal illness.
It can be caused by the terminal illness you are living with, eg, liver cancer, or other medical conditions that happen at the same time.
Common causes of hiccups in people living with a terminal illness include:
- gut problems such as stomach distension, gastric stasis, constipation, bowel obstruction or gastroesophageal reflux
- metabolic conditions such as uraemia, high blood calcium, low blood potassium or low blood sodium
- infections
- liver disease
- brain conditions such as stroke, brain tumour, head injury or brain infection
- irritation of the nerves that supply your diaphragm, such as the phrenic nerve and the vagus nerve, due to surgery, tumours or infections
- medicines with anticholinergic activity, such as cyclizine or tricyclic antidepressants.
How are the causes of hiccups diagnosed?
Your doctor may ask you some questions to find out the possible causes of your hiccups. They may also examine you.
Some tests may also be done, depending on what your doctor thinks is causing your hiccups. These include:
- blood tests such as full blood count, kidney function tests or liver function tests
- imaging tests such as ECG, chest x-ray or CT scan.
How are hiccups treated?
If you have a medical condition, or any obvious causes of your hiccups are found, treatment will focus on the condition or cause.
You may have many health professionals such as doctors, nurses, a palliative care specialist or a cancer specialist involved in your care, as it requires treatment from a multidisciplinary team.
Treatment of hiccups comprises non-medicine and medicine treatment.
Non-medicine treatment
These simple measures can be effective, especially if they have worked for you previously:
- Sip iced water or swallow crushed ice.
- Breathe into a paper bag or hold your breath for a short time.
- Use a swab to rub your soft palate.
- Pull your knee up to your chest and lean forward.
Medicines
Common medicines that may be used to treat hiccups include:
- chlorpromazine
- baclofen
- dexamethasone
- gabapentin
- haloperidol
- metoclopramide
- midazolam
- nifedipine
- simeticone.
Sometimes, hiccups can be difficult to manage despite having treatment.
What support is available with hiccups?
Living with hiccups and other symptoms of terminal illness can be frustrating. It can also be challenging to do things physically. Talk through your feelings with your family/whānau and friends to get the support you need.
If you need extra help in daily activities such as washing, dressing or cooking, your doctor may be able to arrange this for you.
Below are some support services and information for people affected by cancer and their family/whānau:
Emotions & cancer Cancer Society, NZ
How we can help Cancer Society, NZ
NZ cancer services - find a hospital/service near you Healthpoint, NZ
More cancer support groups
Learn more
The following links provide further information about hiccups. Be aware that websites from other countries may have information that differs from New Zealand recommendations.
Managing the symptoms of cancer Macmillan Cancer Support, UK
Hiccups NHS, UK
Hiccups Patient Info, UK
References
- Hiccups in palliative care Auckland Regional HealthPathways, NZ
- Hiccups Scottish Palliative Care Guidelines, UK