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Problems Swallowing as a Symptom of Multiple Sclerosis

Dysphagia Can Be Subtle, But Dangerous

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Updated May 30, 2014

It seems like swallowing would just be second nature, not something we have to think about in order to do safely. However, swallowing is a complicated process that involves all sorts of muscle coordination and feedback to and from the brain through certain nerves and neural pathways. Multiple sclerosis (MS) can damage any of these nerves as well as the area of the brain responsible for coordinating swallowing, the brainstem. This can lead to swallowing difficulties, called dysphagia.

What Do MS-Related Swallowing Problems Feel Like?

Dysphagia includes many different problems with the swallowing process, even those that don't seem directly related to swallowing food, including:
  • Difficulty chewing
  • Coughing while eating or immediately afterwards
  • Excessive saliva or drooling
  • Choking
  • Food sticking in the throat
  • A weak, soft voice
  • Feeling that it is hard to swallow food or move it to the back of the mouth
  • Aspiration, meaning food or drink is going down the windpipe into the lungs
  • Vomiting food back up

    How Common Are MS-Related Swallowing Problems?

    Between 30 and 40 percent of people with MS experience swallowing problems at some time. However, for many people with MS-related dysphagia, these changes are so subtle that they may not be aware of them, besides experiencing the occasional coughing fit after something “goes down the wrong way.”

    What Causes MS-Related Swallowing Problems?

    Several different factors can contribute to swallowing problems, but the main cause of dysphagia are lesions in the part of the brain that controls swallowing (primarily the brainstem) or the nerves that provide feedback to the brain.

    Dysphagia can also be caused or made worse by lack of saliva or dry mouth. Some medications used to control MS symptoms can cause a dry mouth, including:

  • Anticholinergics, prescribed for bladder dysfunction or diarrhea, including: propantheline, (Norpanth, Pro-Banthine) and dicyclomine (Bentyl)
  • Tricyclic antidepressants, such as amitriptyline (Elavil, Endep), desipramine (Norpramin), doxepin (Sinequan), imipramine (Tofranil-PM), nortriptyline (Pamelor).
  • Selective Serotonin Reuptake Inhibitors (SSRIs), including fluoxetine (Prozac), sertraline (Zoloft), citalopram (Celexa) and paroxetine (Paxil).
  • Norepinephrine Reuptake Inhibitors, a newer class of antidepressants, which includes venlafaxine (Effexor) and duloxetine hydrochloride (Cymbalta).

How Severe Can MS-Related Swallowing Problems Get?

Dysphagia can become so severe that people become dehydrated or malnourished. If the tips for managing swallowing difficulties (such as chewing your food thoroughly and adding thickener to your drinks) don’t work, it may be necessary to use a feeding tube.

Aspirated food or liquids can also cause aspiration pneumonia. This is a particularly dangerous lung infection, especially in people that are not very mobile, and is actually a leading cause of death in people with MS.

Additional Points/Information

Can Come and Go: Just like other MS symptoms, dysphagia can come on during a relapse and disappear completely or greatly improve.

Silent Aspiration: Aspiration of food or drink can be happening even when you don’t realize it, causing infections of the respiratory tract and lungs. If you have many chest infections, make sure the cause is investigated and that your swallowing is evaluated so that you can avoid problems in the future.

Who Can Help? Your neurologist (or the physician treating your MS) can refer you to a speech and language pathologist for evaluation. This person will probably watch you while you eat and drink, in order to determine what kind of difficulties you may be having during the swallowing process. You may also have to take a test called a videofloroscopy, which is an x-ray video of the swallowing process. A dietitian can also provide guidance and even recipes for food of the appropriate consistency, as well as make sure that you are maintaining adequate nutrition.

The Heimlich Maneuver: Everyone in your household, including yourself, should learn the Heimlich Maneuver. The Heimlich Maneuver is a preventive emergency measure to use to dislodge food when someone is choking. You can perform this on yourself. Learn the Heimlich Maneuver at www.heimlichinstitute.org. You’ll be glad you did.

My Experience

I’ve got to say, I was not overly excited to find out that dysphagia is yet another MS symptom that I might have, much less how common it is. However, this does explain how frequently I’ve coughed so hard when trying to take a vitamin tablet that I have nearly passed out. I also have learned the hard way that I should not have dinner with people that I find extremely amusing, as laughing and eating are a very dangerous mix for me, causing choking and sputtering and all sorts of undignified efforts to catch my breath.

When I learned that MS-related dysphagia was probably causing many of my “episodes,” I looked at some of my habits. I was pretty much eating on the run, slouching over my food like a starving refugee and rushing through my meals. I have been working on eating slowly and mindfully, not talking with food in my mouth, sitting up straight and a bunch of other things to prevent swallowing problems, and I haven’t had one of my dinnertime “spells” in awhile.

If you suspect you might have dysphagia and your habits are making your problems worse, try this: Pay attention next time you are watching television or a movie and a scene of people eating comes on. Watch how they eat – they take small bites, they don’t ever talk with their mouths full, they eat slowly. Now picture yourself eating. How would you like to watch yourself during a typical meal on the “big screen?” If your response is “YIKES!” consider trying some of these Tips for Dealing with Swallowing Difficulties.

Sources:

Courtney, Susan Wells. Symptom Awareness: Difficulties with Swallowing. The Motivator. (Published by the Multiple Sclerosis Association of America) Fall 2007; 38-39.

Randall T. Shapiro. Managing the Symptoms of Multiple Sclerosis (5th ed.). New York: Demos Medical Publishing, 2007.

The Multiple Sclerosis Resource Centre. Swallowing Difficulties.

Related Video
How to Do the Heimlich Maneuver
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