Swallowing

Difficulty swallowing (also known as dysphagia) is a possible symptom of multiple sclerosis. Support is available to help manage the effects of swallowing problems.

MS may affect swallowing in a number of ways:

• difficulty chewing food or controlling liquids in your mouth
• food getting stuck, or feeling as if it is stuck in your throat
• episodes of coughing or choking when eating or drinking
• difficulty controlling saliva may cause you to dribble

These can all affect the safety of your eating and drinking but also your enjoyment of mealtimes.

Chewing and swallowing involves the coordination of a number of muscles in the mouth and throat, including those which protect your windpipe when food and drink pass through your throat. Muscles can be weakened or the coordination of their movements disrupted by damage to the central nervous system caused by MS. This can also affect the way you sense the presence of food and drink in your mouth and throat.

• If the muscles are weak, chewing can be effortful and tiring and food may lodge in your throat. You may need to swallow several times to clear one mouthful away.
• If the muscle movements are slow or lack coordination, fluid or food particles might enter the windpipe, causing coughing.
• If MS has weakened the coughing muscles too, it may be more difficult to eject the particles and they may enter your lungs (called aspiration) or choking may occur.
• Sometimes, reduced sensation in the mouth means that saliva is not swallowed away so automatically. This can result in dribble escaping from the lips.

Studies have found that around a third of people with MS experience swallowing difficulties to some degree. More significant symptoms are more likely if you have more advanced MS. However, mild or occasional difficulties can be present early on in MS and can also occur during relapses.

• If swallowing problems mean it takes longer to eat, try to have meals when you can take your time. Control the amount of food on your fork and the size of your mouthfuls of drink. Chew your food well and try to concentrate on swallowing.
• Taking sips from a drink with your meal can sometimes help if you are finding food tends to lodge in your throat. Sometimes having smaller meals more often is a useful strategy, or having your largest meal when you are least fatigued.
• Using the best posture for you to swallow can help. For more information see good posture when sitting.
• Be aware of types of food that are more likely to cause problems for your swallow. If dry food or ‘thin’ liquids (that is, quick moving drinks like plain water) are more likely to be difficult, find ways to make them easier to swallow, such as altering the size of the mouthful you take, the cutlery you use or how you cook the foods. A speech and language therapist can help with this.

If you are prone to choking whilst eating, try to eat whilst there is someone with you who knows how to help you. The NHS Choices website has information on what to do if someone is choking.

A speech and language therapist can assess how your swallowing is affected. The therapist can advise on posture, consistencies of food and drinks, eating environment and possible exercises to strengthen muscles involved in swallowing. They may work with their physiotherapy colleagues to help you achieve the posture which makes swallowing easiest. They will work with their colleagues in the dietitian team to advise you on ways of maintaining your calorie intake or the need to alter food and drink consistencies.

If your swallowing problems are more advanced and eating or drinking is putting you at risk of malnutrition, dehydrating, choking or severe chest infections, there are other options for providing your nutrition which your medical and therapy team can explore with you. One of these is a procedure called percutaneous endoscopic gastrostomy (PEG).

• Swallowing hard: dysphagia and MS - (blog)
• Speech problems
• Symptoms of MS