In a hospital in Haifa, a man recovering from acute pancreatitis found himself caught in a hiccup that would not yield to anything doctors tried, until an unlikely remedy was attempted in 1990. The story sits within a long human habit of seeking relief from small bodily nuisances, where a single striking success can linger for decades without the confirmation that would make it knowledge. Its meaning is quieter than its strangeness suggests: the report offers a provocative idea, yet the wider record still lacks the proof that would turn hope into guidance.
Rectal Massage Stopped One Man's Hiccups Twice, but the Evidence for the Technique Remains Anecdotal
Two days of hiccups, everything tried, then a gloved finger
Mark
Why does a 1990 case report about hiccups still get attention?
Mimi
Because it's a strange, concrete story. A man with pancreatitis, two days of hiccups, everything tried, and then two massages that each ended them.
Mark
And the reasoning behind it?
Mimi
The vagus nerve. Many hiccup tricks aim at it, and the authors noted that pressure-sensitive nerves in the rectum belong to the same parasympathetic system.
Luke
I'd flag that as their proposal. The mechanism is a hypothesis, not something the report demonstrated.
Mark
What about the five other patients?
Mimi
They reported success in a later letter, saying they used it before drugs or riskier maneuvers.
Luke
But the letter gives few details. Five successes with little description is not much to lean on, and we don't know how many tried it and failed.
Mark
Could the hiccups have stopped on their own?
Luke
That's the problem. Hiccups sometimes resolve spontaneously, and with no controlled trial, nobody can say the massage caused it. Though in the 1990 case, the timing, stopping twice, is suggestive.
Mimi
And the wider field is thin too. A 2015 review found 341 patients across 15 studies and no high-quality data.
Mark
So what should a reader take away?
Mimi
Hiccups past two days deserve a clinician, not a home experiment, and vagal stimulation can slow the heart.
Der Puls
- A 60-year-old pancreatitis patient in Haifa could not stop hiccuping after a nasogastric tube was placed, and nothing seemed to work.
- After standard maneuvers and medications failed for two days, doctors turned to digital rectal massage, a remedy few would have expected.
- The hiccups stopped abruptly, returned hours later, and stopped again after a second, slow circular massage.
- The team's reasoning rests on the vagus nerve, yet no controlled trial has ever tested whether the massage actually caused the relief.
- Reviews find no high-quality evidence for any hiccup treatment, and the rectal technique remains an anecdote rather than an approved option.
In a hospital in Haifa, a man recovering from acute pancreatitis found himself caught in a hiccup that would not yield to anything doctors tried, until an unlikely remedy was attempted in 1990. The story sits within a long human habit of seeking relief from small bodily nuisances, where a single striking success can linger for decades without the confirmation that would make it knowledge. Its meaning is quieter than its strangeness suggests: the report offers a provocative idea, yet the wider record still lacks the proof that would turn hope into guidance.
A 60-year-old man in a hospital in Haifa, Israel, was being treated for acute pancreatitis when the hiccups began. They had started after a nasogastric tube was placed, and they refused to end. Removing the tube changed nothing, and neither did medication or a series of physical tricks. After two days, his physicians tried something few patients would ever request: digital rectal massage.
The hiccups stopped at once. They returned several hours later, and a second massage, slow and circular, stopped them again. They stayed away for the next five days, and the man went home free of symptoms. Majed Odeh, Harry Bassan and Arie Oliven of Bnai Zion Medical Center described the case in 1990 in the Journal of Internal Medicine.
The team had first worked through the usual list: sugar swallowed by the spoonful, a catheter to stimulate the throat, straining against a closed airway, neck pressure, eyeball pressure, and standard doses of several drugs. None worked. Their proposal was that the rectum, rich in nerve fibers tied to the same parasympathetic system as the vagus nerve, might be used to calm the reflex. They called the technique simple and safer than some of the alternatives.
The idea has rarely been tested since. A few later letters reported five more successes with little detail, and the Haifa team shared an Ig Nobel Prize in 2006. Yet no controlled trial has ever examined the method, and hiccups sometimes fade on their own, which makes the cause of relief hard to prove. Reviews of hiccup treatments find thin evidence overall, with baclofen, gabapentin and metoclopramide among the few drugs studied prospectively.
The most useful lesson may lie in the beginning of the story rather than its remedy. Hiccups that last beyond two days can signal problems such as reflux, infection or nerve irritation, and they deserve medical attention rather than home experiments.
A 60-year-old man lay in a hospital in Haifa, Israel, being treated for acute pancreatitis, and he could not stop hiccuping. The hiccups had started after doctors placed a nasogastric tube. Taking the tube out changed nothing. Neither did medication or a run of physical maneuvers. After two days, his physicians tried a remedy few patients would ask for: digital rectal massage.
The hiccups stopped abruptly. They came back several hours later, and a second round of massage, this time a slow, continuous circular motion, stopped them again. They did not return over the next five days, and the man went home without symptoms. Majed Odeh, Harry Bassan and Arie Oliven of Bnai Zion Medical Center described the case in February 1990 in the Journal of Internal Medicine.
Before the massage, the team had worked through the usual list. According to their report, the patient swallowed a teaspoon of granulated sugar, had the back of his throat stimulated with a nasal catheter, and tried the Valsalva maneuver, which means straining against a closed airway. Carotid sinus massage on the neck and pressure on the eyeballs failed too. So did standard doses of metoclopramide, diazepam and haloperidol.
A hiccup is an involuntary spasm of the diaphragm followed by a sudden closure of the vocal cords, which makes the familiar sound. Many of those folk tactics target the vagus nerve, which helps carry the reflex signals behind hiccups. The authors noted that nerve fibers in the rectum respond to pressure and belong to the same parasympathetic system. Massaging the rectum, they proposed, could raise vagal tone and interrupt the reflex. They also cited a report in which rectal massage ended a dangerously fast heart rhythm after other vagal maneuvers failed, as evidence the technique can strongly stimulate the nerve. They called the maneuver easy and safer than carotid massage, the Valsalva maneuver or eyeball pressure, and suggested trying it before drugs.
Theirs was only the second reported case. The first came from Francis Fesmire, an emergency physician, in a brief 1988 report in Annals of Emergency Medicine. In 1993, Odeh and Oliven wrote to the journal now called JAMA Otolaryngology–Head & Neck Surgery, pointing out that a recent review of hiccups had left the technique out. They reported success in five more patients with intractable hiccups, and said they used it before potentially dangerous maneuvers such as carotid sinus massage or eyeball compression, and before drugs. In 2006, Fesmire and the Haifa team shared the Ig Nobel Prize in Medicine, according to Improbable Research, which runs the awards.
Most hiccups end on their own within minutes. Those lasting more than 48 hours are considered persistent, and those lasting more than a month are called intractable; they can disrupt eating, sleep and recovery from illness. Decades after the Haifa report, the evidence for any treatment is thin. A 2015 systematic review in Alimentary Pharmacology & Therapeutics found reports covering 341 patients in 15 studies, but no high-quality data. Small randomized trials support baclofen and metoclopramide, and observational data suggest gabapentin and chlorpromazine help. The authors suggested baclofen and gabapentin first, as they are less likely than older antipsychotics to cause side effects over long use, keeping metoclopramide and chlorpromazine in reserve.
A 2017 review in the Journal of Emergency Medicine noted that chlorpromazine is the only drug approved by the U.S. Food and Drug Administration for hiccups, and concluded the evidence did not support specific treatment recommendations. Of 10 drugs reported to work, only baclofen, gabapentin and metoclopramide had been studied prospectively.
The rectal massage reports have clear limits. The 1990 paper covers one patient, and the follow-up letter gives few details on the five others. No controlled trial has tested the technique, and because hiccups sometimes stop spontaneously, it is hard to know whether the massage caused the relief. Stimulating the vagus nerve can also slow the heart, which is why clinicians are cautious with vagal maneuvers.
The case's starting point may matter more than its remedy: the hiccups began after a medical procedure during a serious illness, and persistent hiccups can point to problems from reflux to infection or nerve irritation. Anyone whose hiccups last more than two days should see a clinician rather than experiment at home.
Bemerkenswerte Zitate
Rectal massage is easy and safer than carotid massage, the Valsalva maneuver or eyeball pressure, and could be tried before drugs.— Odeh, Bassan and Oliven, paraphrased from their 1990 report
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