Multiple Sclerosis and Dysphagia

Swallowing can be difficult if you have multiple sclerosis (MS). Because the condition affects muscle strength and motor coordination—both of which are involved in swallowing—you may experience discomfort or distress when eating or drinking, and you can even choke on your saliva.

Swallowing impairment, also called dysphagia (derived from the Greek dys meaning “difficulty” and phagein meaning “to eat”), can affect between one third to half of people living with MS. While it doesn't usually pose a danger, dysphagia in MS may actually make you avoid eating or drinking, and it can cause severe choking, potentially resulting in aspiration pneumonia.

You can adapt to dysphagia by getting help from a swallow therapist who might advise adjusting your diet or participating in swallowing therapy.

Dysphagia can begin slowly with subtle symptoms. You may start to sputter slightly after taking a drink or you could accidentally choke on a piece of food once in a while. If the problem becomes persistent, you may have a swallowing problem.

Specific symptoms of dysphagia can vary and may include:

If you repeatedly experience persistent coughing or choking when you eat, the very act of eating can cause anxiety and even panic, which may prompt you to eat less. This worry leads some people with MS-associated dysphagia to experience weight loss, dehydration, and malnutrition as the condition persists or worsens.

If your dysphagia causes food or liquid to become trapped in your lungs, you may develop aspiration pneumonia, a type of pneumonia caused by the bacteria in food. While it is not common, you could develop a throat or lung abscess.

While dysphagia tends to affect people with advanced MS, it can happen at any stage with symptoms ranging from subtle to severe.

Swallowing is a complex process that involves voluntary actions and involuntary reflexes and can use up to 30 different muscles. MS can undermine this process by damaging neural pathways throughout the brain, especially in the brain stem—a region of the brain where many of these nerve pathways converge.

In addition to the disease process itself, dry mouth, which is a complication of several medications used for MS symptoms, can further worsen your dysphagia.

Depression is commonly associated with MS, and antidepressants often cause dry mouth. Another medication type, anticholinergics, which are used to treat bladder control problems in MS, can cause dry mouth as well.

You should tell your doctor and physical therapist as soon as you begin to have swallowing problems. There are several steps your medical team will take to identify the cause of your swallowing issues and to determine the best route of treatment for you.

Diagnosis typically involves one or more of these tests:

• Oral motor exams, performed by a speech pathologist, can assess how your muscles move in your throat and what your voice sounds like
• Videofluoroscopy, a type of X-ray that records the swallowing process, may identify muscle weakness or incoordination
• Fiber-optic endoscopy involves the use of a tiny camera inserted into your nose or throat to view the process of swallowing

If your doctor is concerned about another problem, you might need imaging tests or interventional diagnostic tests to assess these specific issues.

Your dysphagia treatment is focused on maintaining your safety and nutrition. Your medical team will work with you on selecting food that is safe to swallow, maintaining awareness and control of your chewing and swallowing, and rehabilitation exercises to optimize your abilities.

Among the possible options involved in your therapy:

• Modifying your diet to maintain good nutrition and hydration: This may include softening hard foods with water or choosing foods with a softer, thinner consistency. It's often best to work with a dietitian to ensure you meet your nutritional needs.
• Taking smaller bites and chewing longer
• Adjusting the position of your head and neck: This can sometimes ease swallowing difficulties. This process may involve tucking your chin, tilting your head, or sitting up straight to better ensure that food goes down the right way.
• Strengthening muscles involved in swallowing: Your speech pathologist can teach you exercises that may help improve some of the problems you are experiencing.

Like most effects of MS, dysphagia requires a combination of strategies to optimize your nutrition, minimize your discomfort, and prevent infection and weight loss.

You may also need to speak with a therapist or dietitian if you are losing the enjoyment of food or feeling exhausted by the prospect of eating. Professionals who work with MS or dysphagia patients on a regular basis will be able to help you manage these issues to make eating a more pleasant experience for you.

Be sure to stay in touch with your doctor and your speech-language pathologist regarding your swallowing, as it may improve or worsen over time and could require a change in your treatment plan.