Managing MS swallowing difficulties

Swallowing difficulties of some kind can affect at least a third of people with MS.

Identifying any problems means you and a speech and language therapist can work together to find the best ways to manage it. A dietitian might also be involved.

This page covers:

Tips for managing swallowing difficulties

Your speech and language therapist can recommend simple changes to help manage swallowing difficulties.

Keep a good, upright posture when eating and drinking. Stay upright for at least 30 minutes after a meal.

Keep your head in an upright position or tilted slightly forwards when eating or drinking. This will help to protect your airway and prevent swallowing difficulties.

Eat in a relaxed atmosphere. Being relaxed might help you concentrate on your swallowing, or help your swallowing muscles work as best as they can. It might help to avoid distractions like TV, talking to others or looking at your phone.

Don’t rush a meal or take too big a mouthful. If the swallowing process isn't in perfect working order, it can help to give it time to deal with each swallow in turn.

Chew your food well. This helps get the food ready for swallowing. Chewing mixes the food with your saliva.

For some people, swallowing problems mean that food gets stuck, or travels only very slowly towards the stomach. Drinking between mouthfuls can help keep the food moist and wash it down.

The two different processes - speeking and eating - can interfere with each other and could increase the chance of choking.

Adapting food might mean moistening dry foods with sauce or having softened foods. You might find it easier to have naturally thicker drinks, like smoothies or milkshakes. Or add thickeners to liquids to make them easier to swallow. Speech and language therapists can suggest ways to get the right consistency for you.

Back to top

How can speech and language therapy help with MS swallowing difficulties?

A speech and language therapist can help you find the best swallowing treatments for you, depending on your exact MS swallowing difficulty. For example, they might suggest:

  • Exercises to help strengthen and coordinate the muscles in your mouth and throat
  • Techniques and posture changes that can help you if you’re having swallowing difficulties
  • Changes to texture, consistency and temperature of foods and drink, as well as foods to avoid. A dietitian can help make sure you get the nutrition you need in a way that works for you. And that includes making food as tasty and appealing as possible, even if you’re changing what you eat
  • Changing meal times so you don’t have to eat when you’re tired
  • Finding ways to help you concentrate on eating and drinking

Back to top

How can a dietitian help with MS swallowing difficulties?

If you’ve got MS swallowing difficulties, a dietitian can help you plan what to eat to make sure you get the nutrition you need.

For example, if you find it uncomfortable to eat larger meals, they might suggest smaller, more frequent meals and milky drinks. This can help you get enough calories. They might suggest nutritional supplements.

Your doctor, nurse or speech and language therapist might suggest seeing a dietitian and make a referral.

Find out more about diet and MS

Back to top

Can teeth and gums affect swallowing?

Problems with teeth or gums can make it harder to chew or swallow. It’s important to keep your mouth as clean and healthy as possible, and to have regular check-ups with your dentist.

If you have an ongoing problem with a dry mouth, this can affect the health of your teeth and gums. Some drug treatments can cause dry mouth as a side effect. Your dentist might suggest ways to avoid a dry mouth.

Find out more about oral health

Back to top

Managing anxiety around swallowing difficulties

If you have ongoing worries and anxiety about your swallowing, advice from a health care professional can help. Any new symptom can cause worry and take some adjusting to. And this can be particularly true if it’s an everyday activity like swallowing that’s affected.

Left untreated, anxiety about swallowing can become a vicious cycle – swallowing problems and anxiety might each make the other worse. But there are ways to manage and treat both issues and break the cycle.

Your GP or MS nurse can make a referrals to experts in swallowing and anxiety.

A particular worry for some people with swallowing difficulties is the thought of choking while eating or drinking. With proper care and a good awareness of the issue, choking can be avoided. Your speech and language therapist can teach you signs to look out for and tips for avoiding choking.

As a precaution, people involved in your care could get training in first aid techniques to prevent choking.

Find out about first aid training from St John Ambulance

Find out about first aid training from the Red Cross

Back to top

Managing more severe swallowing problems

If swallowing or chewing become very difficult, you could lose weight or become dehydrated. There is also a risk of food or drink going the wrong way, down your windpipe. This can lead to chest infections (called ‘aspiration pneumonia’).

Softening food, thickening drinks and eating smaller meals might be practical ways to stop these problems. But if that doesn’t work, health professionals might suggest nutritional support with tube feeding. This avoids the need for chewing or swallowing, but makes sure you get the nutrition you need.

Options for tube feeding could include a nasogastric tube, ‘PEG’ or ‘RIG’.

Options for tube feeding

A nasogastric tube is usually only suitable for the short term (usually no longer than two weeks). Liquid food passes through a very thin tube through the nose and into the stomach.

If severe swallowing difficulties persist, PEG might be more appropriate. This is a feeding tube that goes directly into the stomach. PEG can be a relief to people who have severe chewing or swallowing difficulties.

RIG is similar to a PEG tube, but it’s put in using X-ray to guide it into place.

Getting a PEG or RIG fitted

If you have a PEG or RIG fitted, you can still sometimes continue to eat and drink a little by mouth. This gives you the chance to enjoy some of your favourite foods and drinks. The tube itself can be tucked under clothes when it’s not being used.

The tube is usually fitted under local anaesthetic and sedation in hospital. The process is fully reversible if it’s no longer needed. Even so, it can still be a major change for you and your carers. Some adjustments to your lifestyle are inevitable and carers will need to learn to care for the tube.

Who can have a PEG or RIG?

PEG and RIG tubes can be extremely helpful if you have severe ongoing difficulties swallowing. They might lower the chance of chest infections, and help you get the nutrition you need.

But PEG and RIG tubes may not always work, or might not be suitable for everyone. And there are still precautions that you and your carers have to take. For example, to avoid aspiration - when food goes down the wrong way and increases the chance of chest infections. Sometimes the tube needs to be removed if there are infections or complications with the PEG or RIG tube.

Whether to have a PEG or RIG tube will be a very personal decision for you and your loved ones. Your doctor, nurse or dietitian can help you to weigh up the risks and benefits. Most manufacturers of tube feeding systems have 24-hour helplines and employ specialist nurses to help people who use them, and their carers.

Read more about PEG from the charity PINNT (Patients on Intravenous and Nasogastric Nutrition Therapy)

Back to top