Multiple Sclerosis Dysphagia

Swallowing problems caused by progressive nerve injury

Man in wheelchair cutting fruit
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Swallowing is something that we take for granted. But for people living with multiple sclerosis (MS) (MS), this simple act can cause extreme distress when they find themselves suddenly less able to gulp, eat, or drink.

Doctors refer to this symptom as dysphagia (derived from the Greek dys meaning “difficulty” and phagein meaning “to eat”). It's a perplexing and sometimes serious condition that can affect anywhere from a third to a half of people living with MS at some point in their disease course.

Causes of Dysphagia in Multiple Sclerosis

Swallowing is a complex process that involves both voluntary actions and involuntary reflexes. MS can undermine this process by damaging certain nerves and neural pathways in a part of the central nervous system, known as the brain stem, which regulates this process.

MS not only weakens the swallowing muscles, it can interfere with the timing by which the windpipe (called the trachea) is meant to be close once food enters the feeding pipe (called the esophagus). When this closure fails to happen, a person may end up coughing, choking, or getting liquids or food directly into their lungs.

While dysphagia tends to affect people with advanced disease, it can really happen at any stage (even early on) with symptoms ranging from subtle to severe.

Dysphagia can be further worsened by the chronic lack of saliva (known as dry mouth), and dry mouth is a common side effect of certain medications used to treat various symptoms of MS like antidepressants and anticholinergics used to treat bladder control problems.

Symptoms of Dysphagia

Dysphagia can begin almost imperceptibly in people with MS. When this happens, a person may start to sputter slightly after taking a drink or accidentally choke on a piece of food (usually crumbly foods) in a way that is not entirely unusual.

It's only when the problem becomes persistent that people begin to realize that their swallowing problem is more than incidental.

By this time, the very act of the eating can cause anxiety and even panic, leading some to eat less and less for fear of choking.

All in all, the symptoms of dysphagia are related to the specific stage of the swallowing process affected by MS. Given that this process can take up to 30 different muscles, the types and severity of symptoms can vary significantly from person to person and may include:

  • Difficulty chewing
  • Coughing during or after swallowing food
  • Excessive saliva or drooling
  • Food sticking in the throat
  • Choking on food or drink
  • Having a weak, soft voice
  • Inability to swallow or move food into the back of the mouth
  • Coughing or vomiting up food
  • Getting (aspirating) food or liquid into the lungs

Due to the difficulties in swallowing, it's not uncommon for people with MS-associated dysphagia to experience weight loss, dehydration, and malnutrition as the condition persists or worsens.

Even worse, when dysphagia causes food or liquid to become trapped in the lungs, a person may develop abscesses or aspiration pneumonia (a type of pneumonia by which bacteria in food causes infection). Both are dangerous conditions and are among the leading causes of death in people with advanced MS.

Diagnosing Dysphagia

Dysphagia may not be much of a problem in the early stages and, in fact, may never progress to being anything more than an annoyance.

However, it's important to advise your doctor if you’re having any swallowing problems—if only to evaluate what’s going on and to better monitor symptoms moving forward.

Diagnosis typically involves one or more routine examinations:

  • Oral motor exams are performed by a speech pathologist to see how your muscles move in your throat and listen to what your voice sounds like.
  • Videofluoroscopy is a type of X-ray that records the swallowing process.
  • Fiberoptic endoscopy involves the use of tiny camera inserted into your nose or throat to view the process of swallowing.

Managing Dysphagia

Depending on the severity of symptoms, treatment will typically involve changing to how you eat rather than applying any direct medical intervention.

Among the possible options:

  • Modification of diet is central to maintaining good nutrition and hydration. This may include softening hard foods with water or choosing foods with a softer, thinner consistency. Taking smaller bites and chewing longer also help. It's often best to work with a dietician to ensure you meet your nutritional needs.
  • Adjusting the position of your head and neck can sometimes ease swallowing difficulties. This is a trial-and-error process which may involve tucking your chin, tilting your head, or sitting up straight to better ensure the food goes down the right way.
  • Performing muscle strengthening exercises is something your speech pathologist can teach you and may help improve some of the swallowing problems you may be experiencing.

In severe cases, a feeding tube (enteral nutrition) may be needed to deliver food and fluids directly to the stomach.  

A Word From Verywell

Like most symptoms of MS, treating dysphagia requires a combination of therapies to optimize nutrition, minimize your discomfort, prevent infection and weight loss, and treat the psychological and other physical consequences of your dysphagia (for example, loss of pleasure during mealtime or feeling exhausted during meals).

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

Sources

Miller, R. and Britton, D. (2011) "Demyelinating Disease of the Central Nervous System (CNS)." Dysphagia in Neuromuscular Disease. San Diego, California: Plural Publishing, pp 161-183.

National MS Society. Dysphagia.

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