Coping with Swallowing Difficulties

Why swallowing problems happen

In most cases, swallowing problems aren’t serious. They have many causes. These include being dehydrated, not chewing long enough, or taking bites of food that are too big. Other swallowing problems stem from gastroesophageal reflux disease (GERD). This condition happens when bile or stomach acid flows back into your food pipe (esophagus).

Many medicines can cause trouble swallowing. These include nitrates, calcium channel blockers, doxycycline, aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), potassium, iron tablets, and vitamin C. Other causes include allergies and even the common cold.

In rare cases, swallowing problems are tied to a serious illness. For example, a stroke, Parkinson disease, or late-stage Alzheimer disease can make it hard to swallow and possibly lead to choking. Diabetes, thyroid disease, a tumor in the mouth or throat, or high blood pressure could be to blame. So could problems with your vocal cords. Other things that can affect how you swallow include:

• Insertion of a breathing tube (tracheotomy)

• Oral or throat surgery

• Radiation treatment

• Narrowing of the esophagus because of cancer, GERD, or other illness

• An allergic condition called eosinophilic esophagitis

• Trouble with how the esophagus contracts

Symptoms of swallowing problems

Be aware of these signs of swallowing problems:

• Feeling of a lump in your throat

• Hoarseness

• Feeling that food or liquid is stuck in your throat or behind your breastbone

• Pain or tightness in your throat or chest

• Weight loss or not getting the nutrition you need because of trouble swallowing

• Choking or coughing caused by bits of food or drink that get caught in your throat

• Drooling

Who is at risk for swallowing problems?

Risk factors for swallowing problems include chronic conditions, such as Parkinson disease, Alzheimer disease, a stroke, GERD, or allergies. Other risk factors include damage to your esophagus from a tracheotomy, throat surgery, or radiation treatment.

How the underlying problem is found

A swallowing problem may be a symptom of an underlying problem. Your healthcare provider will take a full health history and give you a physical exam. Your provider may also order tests, including:

• An endoscopy. This test is done by a gastroenterologist, a healthcare provider who specializes in the digestive tract. During it, a thin tube is put into your esophagus and stomach. The provider examines these areas and takes tissue samples (a biopsy) if needed.

• Barium swallow. For this test, X-rays are taken while you swallow a barium solution. Sometimes a video is made while you swallow different liquids, with a specially trained swallow therapist nearby.

• Motility testing. This may be done to see if your esophagus is contracting and relaxing in the right way.

How the problem is treated

Treatment will be based on the underlying cause of your swallowing problem. Treatment may include lifestyle changes or medicines. Or you may work with a speech or occupational therapist. In rare cases, you may need surgery. 

When to call the healthcare provider

Swallowing problems are rarely serious. So it can be hard to know when to seek help. Contact your healthcare provider:

• If the problem doesn’t clear up quickly

• If you have food stuck in your throat

• If swallowing problems cause you to choke, cough, or have trouble breathing

• If you’re losing weight or having trouble eating 

What you can do about swallowing problems

If your swallowing problems are not linked to a more serious illness, you can take some simple steps at home to make eating and drinking more effort-free.

If your problems stem from GERD, try taking antacids to control your acid reflux symptoms. Prop up the head of your bed. Eat smaller meals, and don’t have any food for about 3 hours before going to sleep. Tobacco, alcohol, and caffeine are also linked to GERD. Not having them may help, too. Obesity and stress are linked to GERD. So exercise and stress-busting activities like yoga may cut down on your symptoms. 

The way you eat and drink can cause swallowing problems. Taking smaller bites, chewing thoroughly, and eating more slowly may help to make swallowing easier.

A speech or occupational therapist can help you relearn how to swallow if your problem was caused by nervous system damage from a stroke. A specialist can also teach feeding methods for eating problems caused by Alzheimer disease. These include using a smaller spoon. Also adding a special thickener to liquids, especially water, can make it easier to drink something without choking.

Your swallowing problems may come from another type of serious illness, such as cancer. Then you may need a comprehensive treatment plan with medicine or possibly surgery.