Friday Weird Science: The new cure for the hiccups? Rectal stimulation

Jan 28 2011 Published by under Friday Weird Science

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!!!)

ResearchBlogging.org 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".


(Source)

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!??! :)

18 responses so far

  • Naon Tiotami says:

    Lucky I wasn't taking a sip of my drink as I read that title, or my computer would possibly be in need of replacing right now.

    Studies like this are amusing, but should be taken with a grain of salt (or spoonful of sugar, as the case may be) - it's very possible this result was only possible because of freaky, non-standard rectum-innervation in this 60 year-old man.

    What I'm trying to say is: more research needs to be done. Grant, anyone?

  • Girlpostdoc says:

    Oh my gosh you have outdone yourself.

  • Alan says:

    I'll let you all know next time I get hiccups.

    I must try to avoid post hoc ergo pooper hoc reasoning, though.

  • I have nothing clever to say, except that I'm passing this post along to my boyfriend.

  • I'm off to look up ways to CAUSE hiccups...

  • Nathan says:

    Haha finally a technique that won't elicit fakers, and scam artists trying to get drugs from clinic docs.
    'Hey doc I can't get rid of these hiccups, I guess it's time to give me some drugs right!'
    'WRONG! MUAHAUHAUHAHUUAHUA!'

  • You used the dachshund vid!

  • chris says:

    Must comment on the sugar thing and wish I knew how (and had the time) to get in touch with those researchers. For my entire life, I've gotten horrible hiccups that carry on so long that I get migraines which is just plain lovely.

    So, one day I was in search of something I could keep down during one of my cycles of hiccup -> migraine -> vomiting. Instant oatmeal was quick and easy. Hiccups were instantly gone. Migraine still there, darn it! I'd hypothesized it was the stomach full of hot oatmeal soothing my diaphragm. I tried soup one time, didn't work. I tried a heating pad on my belly, didn't work. Oatmeal, worked every time!

    After reading the sugar study, I experimented on myself with different foods, both hot and cold. I realized that anything thick and a little hard to swallow gave me an instant cure in one bite. My go-to cure is now peanut butter. Literally, get a heaping spoonful of it and swallow most of it in one bite. There's been a few times that it took a second bite (the rest of the spoon) to make them stop. I found that it worked much better than the sugar and it works without fail. I can jump up on teh first hiccup and it's gone before I even get close to feeling stressed out.

    So, my thought is that the muscles and/or nerves that deal with hiccuping are the same as those that deal with swallowing. By swallowing something a little difficult those nerves/muscles "reset" themselves and the hiccup quits.

    And I expect full credit for this discovery when another researcher has nothing better to do than figure out hiccup cures without anal probing :)

  • [...] Friday Weird Science: The new cure for the hiccups? Rectal stimulation [...]

  • Kent says:

    Ahhhh - nice. Here are some cures for hiccups that we came up with at The Top 7 - http://thetop7.net/2011/08/12/the-hiccups-cure/

  • Taylor says:

    I haven't seen this one anywhere yet and the Holy Spirit showed it to me so give God credit if it works for you. Take your hand and push back under your rib cage at the bottom of your breast bone or sternum. That's at the location of the diaphragm. I pushed as far as I comfortably could and the hiccups immediately stopped. I held the pressure just a little bit longer to make sure they were gone, and they were!

  • Selma says:

    My family have all been using a method I found here for as long as I can remember. My sister found it after she had hiccups for almost two days!!! I've always been distrustful of hiccup cures but amazingly this one seems to work. Luckily, I've never had it as bad as my sister!! ^_^

  • Helen says:

    Well I can confirm that after a pretty uncomfortable night of hiccups, I resorted to this method. I did it for around five minutes. It did NOT work. I should state that I am used to using rectal suppositories for medication and perhaps, as someone said here, it was merely the out right shock for this older guy to have something in his anus. Or perhaps it works only for men, in a similar way that ejaculation can be induced for men through rectal stimulation. I'm female.
    Before trying this rectal method, I'd used the spoonful of sugar under the tongue method. Not just sugar, but you keep the whole spoon under the tongue until the sugar dissolves. This usually works pretty well. But maybe my mind has got used to the trick.

  • Andrea Traunero says:

    My daughter who is now 17, has had intractable hiccups for 3 years and 7months. We live in Ohio. She has visited Cleveland Clinic and has every possible procedure, scope, biopsy, EEG, CAT scan, Brain MRI, hypnosis, acupunture, thyroid, treatments with Baclofen, Chlropromizine and various other drugs. TENS unit, chiropractics etc. all to no avail. She has them 24/7 with hiccup intervals of 15 - 20 minutes. The only time she quit having the hiccups for any amount of time was when she was heavily sedated with 25 mgs of benedryl for the itching of the EEG pads and glue. Once she was finally out of the sedation and back to norma,l her hiccups came back with a vengance. She had them one right after another for two straight days, and they finally went back to their normal 24/7 every 15-20 minutes. She does not have hiccups when she sings or plays the flute. She gets made fun of at school, has been put into detention from a teacher who thought she was trying to get attention. Even though this is not life threatening, it has caused her a lot of emotional distress. We NEED HELP!!!!

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  • […] “Digital rectal stimulation.” Really. Science finds a cure for intractable hiccups. […]

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