We all have problems swallowing sometimes. We may eat too fast, not chew our food well enough, or have a drink “go down the wrong way,” making us cough and choke.[i] While occasional difficulty swallowing is not usually cause for concern, persistent dysphagia, or trouble swallowing, may indicate a serious medical condition requiring treatment.[ii]
People with dysphagia may be completely unable to swallow. Others may experience challenges safely swallowing liquids, foods, or saliva.[iii] Because June is National Dysphagia Awareness Month, it is important to understand the causes of dysphagia, its signs and symptoms, how it can be treated, and the resources available for patients and caregivers.[iv]
Swallowing is complex. About 50 pairs of muscles and nerves work to receive food and liquid into the mouth, prepare it, and move it from the mouth to the stomach. Dysphagia can occur during one or more of the three stages in the swallowing process:
- Oral phase, or the process of sucking, chewing, and moving food or liquid into the throat.
- Pharyngeal phase, which includes starting the swallowing reflex, squeezing food down the throat, and closing off the airway to prevent food or liquid from entering the airway (aspiration) or to prevent choking.
- Esophageal phase, or the action of relaxing and tightening the openings at the top and bottom of the feeding tube in the throat (esophagus) and squeezing food through the esophagus into the stomach.
There are numerous conditions that can cause dysphagia, including the following, which can weaken or damage the muscles and nerves used for swallowing:
- Brain injury
- Spinal cord injury
- Parkinson’s disease
- Multiple sclerosis
- Alzheimer’s disease
Problems with the head, neck, and esophagus may also lead to swallowing issues, such as:
- Cancer in the mouth, throat, or esophagus
- Mouth or neck surgery
- Bad teeth, missing teeth, or dentures that do not fit well
Signs and symptoms
Signs and symptoms of a swallowing problem may include:
- Coughing during or immediately following a meal
- Wet or gurgling voice during or after eating or drinking
- Extra effort or time needed to chew or swallow
- Food or liquid leaking from the mouth
- Food getting lodged in the mouth
- Difficulty breathing after meals
Because they are not able to swallow safely, those with dysphagia might experience dehydration or malnutrition as a result of being unable to eat enough of the right foods to stay healthy or maintain an ideal weight. Dysphagia can also cause aspiration, which occurs when food or fluids enter the lungs. Because many dysphagia patients have trouble coughing adequately, aspiration can result in a life-threatening chest infection called aspiration pneumonia.[v]
To prevent aspiration, many patients with dysphagia must eat slowly and carefully, tilt or turn their heads in a certain direction while swallowing, and modify their diets by switching to soft or liquefied foods. When mealtimes become burdensome, many avoid dining with friends and family, which can lead to social isolation and depression.[vi]
While the treatment of a swallowing problem depends on its cause and symptoms, all patients should consult with a speech-language pathologist, dietitian, or healthcare professional. After conducting an initial examination, the swallowing specialist might make the following recommendations:
- Designing a modified diet consisting of thickened foods and liquids that are easier and safer for some patients to chew and swallow. These recipes made with Thick-It® brand nutrition products, including Puréed Breakfast Casserole, Puréed Southwest Style Chicken Tacos, and Puréed Berry Pound Cake, make it possible for those with dysphagia to enjoy a tasty and nutritious meal at home.
- Suggesting strategies to help patients swallow safer and easier. For example, some people may have to eat with their head turned to one side or looking straight ahead.
- Teaching muscle exercises that can improve coordination of muscle movements in the mouth and throat.
A dysphagia diagnosis can be alarming for patients and their caregivers. For a list of helpful organizations, articles, and information about swallowing disorders, review the Thick-It® brand Dysphagia Resource Guide for Patients and Caregivers.