Yeah, you heard me right.

We all have various ways of attempting to get rid of the hiccups. Drinking a glass of water backward, eating a spoonfull of sugar, getting surprised or scared, holding your breath. The list goes on. But what if those DON’T WORK? What if even medications don’t work!? Wherever shall you go? Whatever shall you do?

Well, have you tried stimulating your rectum? (But please, please, NOT on the puppy!!!)

Odeh et al. “Termination of intractable hiccups with digital rectal massage” Journal of Internal Medicine, 1990.

So what IS a hiccup? A hiccup is a spasm of the diaphragm and the muscles surrounding it. The spasms create a fast contraction, which draws air in. The fast draw causes your vocal chords to close, causing that iconic “hic”.

Usually these go away on their own, though we often like to take the sugar cure anyway, but cases of intractable hiccups can require medical help. In such cases, doctors will often try sedatives or muscle relaxants to make them go away.

But what if even THAT does work?

Today’s case study involves a 60 year old man admitted to the hospital with acute pancreatitis. Pancreatitis is a horrifically painful condition that can be life threatening. In this case, it was a close call, and the doctors found several gallstones, which are often a cause. They inserted a nasogastric tube in preparation for what was going to be a long day, and ran into a problem.

Hiccups.

They took the tube out. The hiccups continued. They tried a spoonful of sugar (which has been reported to help). Nothing. They tried stimulating the back of pharynx. No dice. They tried Valsalva’s maneuver (I’ve heard of that to make your ears pop but never from hiccps), sinus massage, and got creative and massaged his eyeballs. Nothing. They broke out the sedatives and the muscle relaxers. NOTHING.

Finally, after TWO DAYS (I really hope they took care of the pancreatitis in the meantime) they went to perform a routine rectal examination. Stuck a finger in the rectum, and…silence. The first silence in two days. The silence continued for several hours, and then the hiccups came back. It was time to try again.

Digital rectal

massage was attempted again using a slow con-

tinuous circumferential motion and the hiccups were

terminated again immediately.

The patient stayed hiccup free for the next five days and was discharged from the hospital. I seriously hope he was ALSO pancreatitis free.

And now the question arises: how the HECK did this work!?! Was it just the total surprise of “digital rectal stimulation”? Apparently not. The authors hypothesize that what actually happened was that the hiccups were caused by continued firing from the vagus or phrenic nerves. These are both nerves that innervate the area around the diaphragm. The phrenic nerve controls the motor stimulation of the actual diaphragm, but the vagus nerve heads toward the esophageal plexus and the diaphragm as well, passing through the diaphragm and on down toward the thoracic cavity. If either one of these nerves started sending signals spasmodically, you might end up with the hiccups. BUT, both of these nerves ALSO send and receive signals from the thorax, including from the gut and GI tract. So if you have spasms going on in these nerves, stimulation via pressure in the rectum (which is very sensitive to pressure), might help. In this case it seems that the big deal was the vagus nerve, which has much more innervation in the rectum.

The authors conclude by saying that this technique is a good way to stimulate the vagus (it’s certainly better than waltzing in and stimulating your carotid sinus in your neck, which is a good bit more dangerous), and they recommend that you try it before trying medication for your hiccups. I don’t know about you, but I still prefer the spoonful of sugar.

Odeh M, Bassan H, & Oliven A (1990). Termination of intractable hiccups with digital rectal massage. Journal of internal medicine, 227 (2), 145-6 PMID: 2299306

Edit: Though I did know that this was not the only case study out there on rectal stimulation, I didn’t know which one was the other one. Ivan Oransky and Marc Abrahams helpfully pointed out that the two case studies (which are both listed here, the second doesn’t appear to have online access, but came out in 1993) shared the IgNobel prize (which I totally did not know) in 2006. Still, it’s only an n=2. Wider study needed, obviously, though I wonder how many people get hiccups THAT badly…

Thanks Ivan and Marc! And Marc, you KNOW you want someone fun to help cover the IgNobels this year…pleeeeeeeease!??! 🙂