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Swallowing

Swallowing

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

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

For some people, these 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.

But however your swallowing is affected, there are things you can do to make swallowing as easy, comfortable and safe as possible.

Swallowing problems might include:

  • Changes in your speech (these can go hand in hand with small changes in swallowing)
  • Problems chewing
  • Food 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
  • Taking longer than usual to finish meals
  • Your mouth making too much saliva, which may cause dribbling
  • Food or drink 'going down the wrong way' and getting into your lungs ('aspiration')

Keeping an eye on these signs could help you avoid more serious problems that might develop if left unchecked.

So, even if problems are not serious, let your doctor or MS nurse know if you are aware of one or more of these signs.

Because 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. After investigating, a speech and language therapist can recommend ways to manage the problem.

There's more detailed information in our booklet on swallowing difficulties.

Managing swallowing problems

Tips for managing swallowing difficulties

Different techniques help with different problems, which is why it is important to have the advice of a health professional to help find what suits you. They may suggest some of the following techniques for you, your family or carers:

Good posture

Keep a good, upright posture when eating and drinking. A physiotherapist can help with this. Stay upright for at least 30 minutes after a meal. You may also want to read MS Essentials Factsheet: Posture and movement 1 - an introduction and MS Essentials Factsheet: Posture and movement 2 - moving well with MS.

Relaxed atmosphere

Eat in a relaxed atmosphere. Swallowing can be easier if you're relaxed. Being relaxed might help you concentrate on your swallowing, or help your swallowing muscles work as best as they can. Some people find it best to eat in a quiet atmosphere, without radio, TV or conversation for distraction.

Eat slowly

Don’t rush a meal. If the swallowing process is not in perfect working order, allowing it the time to deal with each swallow in turn can be helpful.

Chew well

Chewing well helps get the food ready for swallowing, mixing it well with your saliva.

Alternate liquid with solid

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.

Avoid speaking whilst eating

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

Adapt the food you choose

There are ways of adapting the food you like to suit you better. If very thin liquids are likely to go down the wrong way, thickeners could make them easier to swallow. You might try eating softened foods, or moistening dry foods, perhaps with a sauce. Speech and language therapists can suggest ways to get the right consistency for you.

Get nutritional advice

To make sure you get the nutrition you need, a dietitian can help you plan what you eat. For example, if you find it uncomfortable to eat larger meals, then smaller, more frequent meals and milky drinks might help you get enough calories.

Nutritional supplements are helpful for some people.

> Find out more about diet and MS

Risk of choking

A particular cause of anxiety for some people is the thought of choking while eating or drinking. With proper care and a good awareness of the issue, choking can be avoided.

As a precaution, people involved in the care of someone with swallowing difficulties can be trained in first aid techniques to prevent choking.

St John Ambulance or the Red Cross can arrange this training.

Who can help?

To find out more, your doctor or MS nurse might refer you to a speech and language therapist. After investigating, a speech and language therapist can recommend ways to manage the problem.

A therapist will ask questions about your swallowing and speech. They may also watch you eating and drinking, to discover the exact difficulties you are having. This helps them to notice any issues in the mouth or throat.

If it is still hard to tell what is happening with your swallowing, they might suggest you have a ‘video-fluoroscopy’. This is a moving x-ray of the swallowing process, watching how food goes backwards through the mouth and seeing if anything goes the wrong way (towards the lungs). Another approach could be to use a tiny, flexible video camera to look at the back of the mouth, the throat and oesophagus while you swallow. This is called a ‘fibre-optic endoscopy’.

Treating aspiration (food going down the wrong way)

‘Aspiration’ is when food or drink trickles down the windpipe into the lungs – when it ‘goes down the wrong way’. This can be very subtle and you might not even be aware it is happening (‘silent aspiration’). But aspiration can lead to chest infections. If you get several chest infections, it is important that the causes are investigated fully, so that aspiration and swallowing difficulties are not overlooked.

Severe swallowing problems

If swallowing or chewing becomes very difficult, weight loss or dehydration could become an issue. Softening food, thickening drinks and eating smaller meals might be practical ways to stop these problems. But if that doesn’t work, using a direct liquid feed might help.

In the short term (usually no longer than three or four weeks), some people benefit from ‘nasogastric tube feeding’. Liquid food passes through a very thin tube through the nose and into the stomach. This avoids the need for chewing or swallowing. If severe swallowing difficulties persist, a PEG (‘percutaneous endoscopic gastrostomy’) might be more appropriate. This allows nourishing liquid food to go directly through a tube into the stomach and can be a relief to those who have severe chewing or swallowing difficulties.

> The charity PINNT (Patients on Intravenous and Nasogastric Nutrition Therapy) has more information in its factsheet on PEG feeding.

Many people who have difficulty swallowing may also have some problems with speech.

> Read more about speech problems

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