MS and swallowing difficulties (dysphagia)

At least a third of people with MS probably experience swallowing difficulties at some time. Health care professionals might call swallowing difficulties ‘dysphagia’ (diss-FAY-jee-ah).

Changes might be so small they're hard to notice. But even picking these up can help avoid possible complications.

For some people, swallowing changes come and go, or happen during a relapse and never re-appear. But for others, they can be an ongoing issue. Any changes to swallowing can feel strange and worrying, even if they are small changes.

There are things you can do to make swallowing as easy, comfortable and safe as possible.

On this page:

What swallowing problems can MS cause?

MS can cause different swallowing problems. They might be mild or more obvious, and they could come and go, or be longer lasting. MS swallowing symptoms can include:

  • Problems chewing
  • Feeling as if food is sticking in your throat
  • Food or drink coming back up
  • Sluggish movement of food going down, or difficulty moving food back through your mouth
  • Coughing and spluttering during and after eating and drinking
  • Taking longer than usual to finish meals
  • Dribbling when you’re eating or drinking
  • Changes in your speech (these often happen at the same time as swallowing problems)

Swallowing difficulties can lead to more serious problems if left unchecked, including:

  • Aspiration – when food or drink goes down the wrong way, into the windpipe down to the lungs. This can be very subtle and you might not even be aware it’s happening. But it can lead to chest infections.
  • Malnutrition – this is when your body can’t get all the energy and nutrients it needs from food.
  • Dehydration – when you don’t get enough fluids.
  • Choking – if food gets lodged in your airway.

Recognising swallowing difficulties early on can help you avoid these complications.

It’s important to let your doctor or MS nurse know if you notice any signs, even if they don’t seem serious. You can ask them to refer you to your local speech and language therapy department for a swallowing assessment.

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What causes MS swallowing problems?

MS can cause swallowing problems if there’s damage or inflammation in any part of the brain that controls swallowing. This includes an area called the ‘brainstem’, which connects your brain to your spinal cord.

The effects of MS in the brain could:

  • make it harder to feel food and drink in your mouth
  • affect the automatic actions (reflexes) involved in swallowing, so these don’t happen at the right time, or in a smooth, co-ordinated way
  • weaken the muscles in your mouth and throat

The nerves in the brainstem help control lots of muscles in the body. And people who have other physical problems because of MS are more likely to experience swallowing difficulties too. But changes can also happen during a relapse, with the symptoms disappearing as the relapse passes.

Triggers for MS swallowing problems

You might find certain things trigger your MS swallowing problems, or make them worse at different times of the day. Triggers might include:

Finding ways to manage these things could also help you manage swallowing difficulties. Health care professionals can help.

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How do we swallow?

Diagram of how we swallow

Swallowing usually happens without us having to think about it. But it’s actually quite a complicated sequence of events. It involves dozens of muscles and lots of sensory messages that go to and from your brain.

Before you even begin to swallow, you have to hold food in your mouth and chew it. Even this is a complicated process. It all needs the coordination of the tongue, lips and teeth.

When you’ve chewed your food and it’s ready to be swallowed, it’s known as a ‘bolus’ (a ball).

There are several stages to swallowing. They all have to happen in the right order, at the right time.

Stage 1

We start swallowing by pushing the bolus up and backwards with our tongue – towards the throat.

Stage 2

The soft palate at the back of the mouth lifts up, blocking off the passages going upwards to your nose. As the bolus enters your throat, your voice box and a flap of tissue called the epiglottis, close off your airway (‘windpipe’). This is what stops food going down the wrong way, to your lungs.

Your throat muscles squeeze together, pushing the bolus further down, into your oesophagus. This is the pipe that leads to the stomach.

Stage 3

Muscles in the oesophagus tighten and relax in turn, to carry along the bolus to the stomach. This coordinated movement of the muscles is called ‘peristalsis’. The entrance to the stomach opens to let the food in and closes behind to stop things escaping back into the oesophagus. When this opening to the stomach doesn’t close properly we can get what’s called ‘heartburn’.

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Identifying swallowing problems

Identifying swallowing problems means you can start finding the best ways to manage them. This can avoid complications that can happen if they’re left untreated.

You might have noticed swallowing difficulties yourself, or it might be friends and family who notice the changes. It could be your doctor or MS nurse.

Some of the signs will be obvious, others could be more subtle. And you might have developed ways of coping with minor changes almost without realising.

Swallowing is a complicated process, with different stages. It can help to find out exactly which part is not working properly. To find out more, your doctor or MS nurse might refer you to a speech and language therapist. You can ask to be referred for an assessment, if you think you need one. And in some areas you can get in touch directly (‘self refer’).

After investigating, a speech and language therapist can recommend ways to manage your MS swallowing problem. At an assessment, they'll ask questions about your swallowing and your speech. And they might:

  • watch you eating and drinking different foods and liquids, to discover the exact difficulties you’re having
  • arrange a test called a ‘video-fluoroscopy’. This is a moving x-ray of the swallowing process
  • arrange a ‘fibre-optic endoscopy’. This uses a tiny, flexible video camera to look at the back of your mouth and throat, including your voice box, while you swallow. It can assess the movements of your lips, tongue and throat muscles

If things change

Swallowing problems can change over time. If you think your needs have changed, ask for a new assessment. The therapist can check with you that the techniques are still right for you. If you don’t still have the details of your speech and language therapist, your GP or MS nurse can refer you again.

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Treating and managing swallowing problems

There are lots of different ways to treat and manage swallowing problems. It depends on the exact issue. You'll usually work with a speech and language therapist to find the best solution for you. Treatments for managing MS swallowing problems can include:

  • exercises to strengthen the muscles involved in swallowing
  • learning techniques to manage the specific swallowing difficulties you’re having
  • simple changes you can make when you’re eating meals
  • help to deal with any anxiety – anxiety can make swallowing problems worse
  • getting nutritional support if you have more severe swallowing problems

Read more about managing swallowing problems

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