Hiccups and cancer

People with cancer can get hiccups for lots of reasons. It is not a common problem but hiccups can be tiring and difficult to cope with.

Why have I got hiccups?

Hiccups can happen when you get a spasm in your diaphragm between normal breaths. You can’t control the spasm and hiccups usually go away on their own. 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.

Your diaphragm is the dome shaped muscle under your ribcage. It helps to pull air into your lungs by pulling downwards as you breathe in. 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 include:

• 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 also 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
• the 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)

Having hiccups

Hiccups normally go away on their own. But if your hiccups are troublesome and last more than a few days, it is important you talk to the team caring for you about them. They will want to find out if there is reason for them so that they can try to help you.  

Having hiccups for a few days or more can be difficult to cope with. They can make you feel anxious and depressed. They can affect your:

• ability to eat and drink
• concentration and sleep
• ability to talk

Healthcare professionals divide hiccups into groups depending on how long you have them. You might have:

• acute hiccups which can last from a few minutes to a few hours
• persistent hiccups which usually last more than 48 hours
• intractable hiccups which usually last more than one month

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:

• gargling or drinking ice 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
• taking a deep breath, holding it for as long as you can and repeating this several times
• sucking on a lemon
• drinking peppermint water
• 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 persistent hiccups

Some hiccups can last for more than a couple of days. If they last this long you may need medical treatment.

Your doctor will try to find out what is causing your hiccups. They will treat the cause if they find it. For example, the hiccups may go away if your doctor changes one of the drugs you take. 

Your doctor may treat the hiccups directly. Drugs they might use include:

• the anti sickness drug metoclopramide (Maxolon)
• a mild sedative, such as haloperidol or chlorpromazine
• a drug to relax your muscles such as baclofen
• a proton pump inhibitor such as omeprazole

Doctors will try one drug for a short time to see if it is helpful and stops the hiccups. If the hiccups start again they may use a different drug or a combination of drugs until they stop completely.