Multiple sclerosis (MS) is a chronic, progressive condition that affects the central nervous system. As MS causes damage to the nerves, it can cause a disruption in how a person moves, thinks, and feels. One of the symptoms MS can cause is difficulty swallowing, which is referred to medically as “dysphagia.”
The normal swallowing process
There are several things that occur during a normal swallow reflex. When things are working properly, this happens without much thought, but when difficulties arise, it can be helpful to understand how the process normally functions. Experts have categorized the swallowing process into three phases:
Oral phase – in the oral phase, food is chewed and combined with saliva to form a bolus. The tongue helps move the food around the mouth for chewing and moves the bolus to the back of the mouth.
Pharyngeal phase – in the pharyngeal phase, the vocal folds close and the epiglottis covers the larynx (the entrance to the lungs) to keep food and liquid out.
Esophageal phase – in the esophageal phase, the bolus moves into the esophagus, the tube that connects the mouth to the stomach.1
Symptoms of trouble swallowing
Dysphagia is characterized by being unable to swallow, having food get stuck in your throat, coughing while swallowing, or a choking sensation. Disturbances to any of the three phases can cause difficulty swallowing.1,3
If an obstruction of food causes choking, immediate attention is required. Fast action can save the life of a person who is choking. Abdominal thrusts, also called the Heimlich Maneuver, can be done by another person or by yourself to force air up the windpipe and expel the lodged food or object.4
How common is it among people with MS?
It’s difficult to give an exact estimate on how many people with MS experience dysphagia. As with many features of MS, each person experiences symptoms uniquely. One study that measured how people with MS swallowed found that 43% of them experienced abnormal swallowing, although almost half didn’t complain of it.2
In our Multiple Sclerosis In America 2017 survey, 24% of survey respondents noted they were currently experiencing trouble swallowing at the time of the questionnaire, and 57% said they had experienced trouble swallowing at some point. Dysphagia that occurs with MS may be occasional, or it may happen frequently or almost all the time.
What you can do
If you’re experiencing trouble swallowing, it’s important to speak to your doctor about it. Your doctor needs to understand all your symptoms to provide you with the best approach for managing your symptoms, and you may also receive a referral to a Speech Language Pathologist. Despite their title, Speech Language Pathologists can assess, diagnose, and treat swallowing disorders, in addition to their expertise in speech and language disorders.5
In addition to getting professional help, some people find that eating slowly, sitting up straight while eating and drinking, and chewing food thoroughly can help reduce the risk of choking.3
Stages of Swallowing, University of Wisconsin Health. Available at https://www.uwhealth.org/voice-swallow/stages-of-swallowing/11463. Accessed 10/24/17.
Thomas FJ, Wiles CM. Dysphagia and nutritional status in multiple sclerosis. J of Neurology. 1999 Aug; 246(8):677-682.
Dysphagia, Mayo Clinic. Available at https://www.mayoclinic.org/diseases-conditions/dysphagia/basics/symptoms/con-20033444. Accessed 10/24/17.
Abdominal thrusts, MedlinePlus, U.S. National Library of Medicine. Available at https://medlineplus.gov/ency/article/000047.htm. Accessed 10/24/17.
American Speech-Language-Hearing Association. Available at https://www.asha.org/Students/Speech-Language-Pathology/. Accessed 10/24/17.