Swallowing problems (dysphagia) are often seen in people with multiple sclerosis (MS). Swallowing problems can occur in the mouth, back of the throat or esophagus. Available research has varying estimates of how often swallowing problems happen in people with multiple sclerosis. The range is from 3% to 51%.
Multiple sclerosis (MS) is a chronic autoimmune disorder affecting movement, sensations, bodily functions and more. It is caused by destruction of the myelin insulation covering nerve fibers (neurons) in the central nervous system(brain and spinal cord). When the myelin is destroyed, nerve messages are sent more slowly and less efficiently. Patches of scar tissue, called plaques or lesions form over the affected areas, further disrupting nerve communication. Symptoms of MS occur when the brain and spinal cord nerves no longer communicate properly with other parts of the body. MS causes a wide variety of symptoms and can affect vision,balance,strength,sensation, coordination,and bodily functions. MS rates are higher in the United States, Canada, and Northern Europe than in other parts of the world. Over 2.4 million people suffer from multiple sclerosis globally.
Common symptoms include the following:
- Problems chewing
- Food sticking in the throat sensation
- Food or drink coming back up
- Difficulty starting to swallow
- Excessive saliva
People with multiple sclerosis are more likely to develop problems swallowing (dysphagia) as their multiple sclerosis progresses. While more frequent in advanced disease stages, it can occur at any stage.
The person may cough after drinking liquids, or choke while eating certain foods, particularly those with crumbly textures. When this kind of coughing or choking occurs, the food or liquids are inhaled into the trachea (windpipe) instead of going down the esophagus (gullet) and into the stomach. Once in the lungs, the inhaled food or liquids can cause pneumonia or abscesses. Because the food or drink is not reaching the stomach, a person may also be at risk for malnutrition or dehydration.
A person can also inhale small amounts of food or liquids without being aware of it. This is called silent aspiration.
Swallowing problems can lead to complications including poor nutrition, dehydration and lung infections caused by swallowing “down the wrong pipe” (aspiration pneumonia). In addition, it can interfere with enjoyment of meals, a major source of social interaction and pleasure for many individuals.
Recognizing the problem early can help with finding effective ways to manage dysphagia problems and help avoid possible complications both present and future. You may be aware of problems yourself or friends/family notice problems. Some symptoms of dysphagia aree obvious and others may be more subtle. You may have already found ways of coping with it and do not even realize it.
Dysphagia is initially diagnosed by a careful history and neurologic examination of the tongue and swallowing muscles. A special imaging procedure called a modified barium swallow (videofluoroscopy) is used to evaluate a person’s ability to chew and swallow solids and liquids. In this test, the person drinks a small quantity of barium, which makes the structures of the mouth, throat, and esophagus visible on x-ray. The movement of these structures is recorded on videotape by a videofluoroscope as the person eats or drinks foods of varying consistencies — thin liquid, thick liquid and solid. The precise location and manner of a swallowing defect can then be identified, and treatment prescribed.
Treatment techniques for swallowing problems may include direct treatments aimed at increasing the strength or movement of the swallowing structures or compensations designed to improve the swallow without directly treating a deficit .
A speech/language pathologist is the professional who diagnoses and treats dysphagia. Treatment typically consists of strategies for safer eating and swallowing, dietary changes, exercises or stimulation designed to improve swallowing. In very severe cases that do not respond to these measures, feeding tubes may be inserted directly into the stomach to provide the necessary fluids and nutrition.
There are many treatment techniques available for persons who have swallowing problems secondary to multiple sclerosis. The research supporting these treatments is, however, quite limited. Clinicians and other consumers of swallowing problems management techniques should carefully consider treatment options.
Some of the better knows solutions are:
- Chewing very well
- Adapt the food you eat so it suits you condition better
- Avoid speaking whilst eating
- Do not rush eating or drinking
- Alternate liquid with solid foods while eating
Texture adjustments of the diet, most often thickened liquids, are often recommended to manage swallowing problems. It is important to consider this as it also affords a higher risk of becoming dehydrated. For that reason, this option should be considered as a last resort.
Do some searches for websites that have recipes that are easier to swallow and consume such as:
Tips From Readers:
- I try to be super-aware of just focusing on eating/drinking and not talking or slouching (or breathing!).
- The size of some vitamins/pills I need a cut with a knife to swallow (note: Do not do with time-release meds)
- Use a straw while drinking
- Keeping a good, upright posture while eating and remaining in this posture for 30 minutes to an hour afterwards.