MS & Swallowing Problems

Many people living with multiple sclerosis (MS) experience trouble swallowing, also known as dysphagia. MS and swallowing difficulty are linked because the condition can affect the nerves and muscles that control chewing and swallowing. This may lead to coughing, choking, or the feeling that food is getting stuck.

MS and Swallowing Difficulty Symptoms

As a symptom of MS, you may experience: 

• The feeling that food is stuck in your throat 
• Difficulty in moving your food around your mouth
• Slow movement of food going down
• Food or drink coming back up
• Problems when trying to keep food or liquid in your mouth
• Taking longer than usual to finish a meal 
• Choking sensations or coughing and spluttering when eating 
• Frequent throat clearing while eating
• Difficulty chewing food 
• Dribbling, caused by your mouth making excess saliva 
• Numbness of the mouth and throat
• Food and drink going into your lungs in severe cases
• Changes in your speech alongside problems swallowing food

Swallowing problems can often occur in advanced stages of MS, although it can occur at any time. It happens because the nerves that power the muscles which control swallowing and chewing function are damaged by MS. This results in the muscles becoming uncoordinated or weak. 

Some medications can also cause side effects such as a dry mouth, which can make swallowing harder, especially when eating dry foods. 

It is vital, if you experience any swallowing problems with MS, that you talk to your doctor. If left untreated, there is a risk that it could become more serious, with fluids or foods getting into your lungs, potentially causing severe infection.

Treating dysphagia problems

Any anxiety you may feel as a result of having MS and trouble swallowing can make the problem worse, especially since these issues can themselves be a symptom of a panic attack, so it is important that you find a way to relax and manage any stress. One of the steps in the Overcoming MS Program is meditation, as it is clinically proven to reduce stress. There is also a clinically recognised link between stress and MS progression, both in terms of relapses and degeneration.

To be diagnosed with dysphagia you will need to have a detailed neurological examination of the swallowing muscles. This may involve a test called a modified barium swallow which will allow the specialist to see how you chew and swallow food and liquid. During the test you will drink a small amount of a barium-containing liquid. This will allow the structure of your throat, oesophagus and mouth to be seen on an x-ray. Videofluoroscopy will then record the movement of these areas as you eat and drink different consistencies of solids and liquids. This will enable the doctor to see the exact swallowing problem to be treated. 

There are specialists who may manage your treatment for dysphagia, including a speech and language therapist (SLT) and a dietitian.

Treatment can include: 

• Strategies for safer swallowing and eating 
• Dietary changes
• Swallowing exercises
• Feeding tubes

A dietitian will make sure that you are still having a healthy, balanced diet, including softer foods and thickened fluids that you may find easier to swallow. Feeding tubes can be a solution in severe cases that put you at risk of dehydration and malnutrition.

There are also things you can do to help:

• Make sure that you eat when you have time, so that you don’t rush. Take small mouthfuls. Chew your food well, and concentrate on swallowing. 
• Take small sips of water with your meal. 
• Have smaller meals, more often. Eat your largest meal of the day when you are not fatigued — that may be at lunch time or mid-morning, rather than the evening.
• Use the best posture that you can while sitting to eat. 
• Make note of the foods which cause your problems when swallowing and avoid them (i.e. dry foods like bread or rice or ‘thin’ liquids).