Coping with Swallowing Difficulties

As we go through daily life, swallowing is as common as breathing. We rarely give it a second thought as we swallow hundreds of times each day.

Swallowing difficulties can happen for reasons ranging from dehydration to illness. Most cases are short-lived. But sometimes you might need medical treatment or special home care. If you have trouble swallowing, it is important to be evaluated by your healthcare provider. In some cases, swallowing difficulties may be due to serious problems.

Why swallowing problems happen

In most cases, swallowing problems aren’t serious. Swallowing problems have many causes. These include dehydration, or not chewing long enough or taking bites of food that are too big. Other swallowing problems stem from gastroesophageal reflux disease (GERD). This happens when bile or stomach acid flows back into your esophagus, or food pipe. Many medicines, such as nitrates, calcium channel blockers, doxycycline, aspirin, NSAIDs, potassium, iron tablets, and vitamin C, can cause difficulty swallowing. 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. Problems with your vocal cords; insertion of a tracheotomy, or breathing, tube, or oral or throat surgery, or radiation treatment can affect the way you swallow. Narrowing of the esophagus, due to cancer, GERD, or other illness, can also cause swallowing difficulties. An allergic condition called eosinophilic esophagitis often causes trouble swallowing. Trouble with how the esophagus contracts can cause the problem, too. 

Symptoms of swallowing problems

Be aware of these signs of swallowing difficulties:

• Feeling of a lump in your throat

• Hoarseness

• Sensation 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

What are the risk factors?

Risk factors for swallowing difficulties include chronic conditions, such as Parkinson disease, Alzheimer's, a stroke, GERD, or allergies. Other risk factors include damage to your esophagus due to 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 thorough history and perform a physical exam. He or she may order tests including an endoscopy. This is an exam performed by a gastroenterologist. He or she inserts a thin tube into your esophagus and stomach to look for changes in your esophagus and to obtain a biopsy if needed. Another way to find out what the problem could be is a barium swallow. For this test, X-rays are taken while a barium solution is swallowed. Additional tests may include motility testing to determine if your esophagus is contracting and relaxing properly.

How the problem is treated

Treatment will be based on the underlying cause of your swallowing difficulty. Treatment may include lifestyle changes, medicines, working with a speech or occupational therapist, or, rarely, surgery. 

When to call the healthcare provider

Swallowing problems are rarely serious, so it can be difficult 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 difficulties are not related 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 avoid food for about 3 hours before going to sleep. Tobacco, alcohol, and caffeine are also linked to GERD. Eliminating them may help, too. Obesity and stress are connected 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. Take smaller bites and chew thoroughly. Eat more slowly 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 techniques for eating difficulties caused by Alzheimer disease. These include a smaller spoon. Also adding a special thickener to liquids, especially water, can make it easier to drink beverages without choking.

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