Multiple Sclerosis Dysphagia

What It Is and What You Can Do

Man in wheelchair cutting fruit
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Swallowing is not something that takes much thought, right? Be that as it may for most people, swallowing is actually a complicated process that involves muscle coordination of the mouth, jaw, and face as well as 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 brain stem.

You may already know this if you have MS and are experiencing swallowing difficulties. 

At least a third, and potentially nearly half, of all people with MS will experience swallowing problems at some point. However, these changes may be so subtle that they can be hard to recognize as a problem, such as occasional coughing fit after something “goes down the wrong way.” 

I’ve got to say, I was not pleased 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. While multiple sclerosis dysphagia is more prevalent in late stages of the disease, it can really happen at any time. 

What Does Multiple Sclerosis Dysphagia 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 afterward
  • 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

    Is Multiple Sclerosis Dysphagia Dangerous?

    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.

    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.

    What Causes MS-Related Swallowing Problems, Anyway?

    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 the lack of saliva or dry mouth. Some medications used to control MS symptoms can cause a dry mouth, including:

    How Do I Manage It? 

    Just like other MS symptoms, dysphagia can come on during a relapse and disappear completely or greatly improve. If you're experiencing any swallowing difficulties, it's important that you:

    • See your neurologist (or the physician treating your MS), who 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 videofluoroscopy, 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.
    • Learn the Heimlich Maneuver, and encourage your family or whomever you live with to learn it as well. 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 You’ll be glad you did.
    • Change your eating habits. 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. Don't eat on the run or rush through your meals. Consider trying some of these other tips for dealing with swallowing difficulties.


    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.

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