Therapy for Swallowing Problems

There are over 30 muscles and nerves involved in swallowing. People with multiple sclerosis (MS) sometimes have problems swallowing. These problems result from damage to the brain caused by MS.^1,2

In people with MS, the muscles involved in swallowing may work slowly. Swallowing problems increase the risk of food or liquid going into your lungs. If you have a swallowing problem, a speech-language pathologist (SLP) will examine how you swallow. Then, they will decide what therapies may help you.^1,2

What swallowing problems occur in MS?

There are several types of swallowing problems people with MS may experience.

Dry mouth

MS can lead to a decrease in the production of saliva. The resulting dry mouth (xerostomia) makes it harder to swallow. Some medications can lead to dry mouth, which may be one reason this can occur in people with MS.²

Delayed swallowing response

It takes longer than normal for the muscles involved in swallowing to turn on in some people with MS. This can cause liquids and food to leak out of the mouth or get stuck in the throat. Delayed swallowing responses can lead to choking, coughing, and inhaling food or liquid into the lungs (aspiration). They can also cause weight loss and malnutrition when severe.²

Reduced pharyngeal peristalsis

This is a disorder that affects the way you swallow. It happens when the muscles in your throat cannot properly contract during swallowing. The condition can lead to problems moving food and liquids from the back of your throat to your stomach. It can make you choke, cough, or aspirate.²

Reduced laryngeal function

This is a swallowing disorder that occurs when the muscles of the voice box (larynx) are weakened or do not work properly. This can lead to problems controlling saliva, which can cause drooling. Also, the condition can make it hard to speak and may make your voice hoarse.²

Reduced lingual function

This is a condition that affects your tongue muscles and can cause tongue weakness. Tongue weakness can lead to issues controlling saliva, speech problems, and aspiration.²

What are the signs of a swallowing problem?

If you or a family member notices signs of a swallowing problem, report them to your doctor. Signs of swallowing problems can be hard to detect at first, but they might include:²

• Choking or coughing while eating or drinking
• “Pocketing” of food in your mouth (keeping food in your mouth for a long time before swallowing)
• Trouble keeping food or liquid in your mouth while eating or drinking
• Drooling
• Frequent heartburn or sore throat
• Unexplained weight loss

Diagnosis of swallowing problems

The first step in fixing a swallowing problem is an evaluation by an SLP. The SLP will ask you questions about your swallowing problems. They will also look at your mouth and throat to see what might be causing the problem.²

Finally, they will watch you eat and swallow on an x-ray video (videofluoroscopy). In this exam, you will swallow a bit of food that contains a contrasting dye. This will help your SLP see how your swallowing process works.²

Treatment of swallowing problems

Speech therapy can help people with MS who have speech and eating difficulties. An SLP can help with many issues related to communication. They can help you speak, understand language, and swallow better.²

SLPs use a wide range of methods to treat swallowing problems. These methods include:²

• Exercises to increase the strength and range of motion of your tongue
• Ways to position your head and neck while eating or drinking to prevent problems
• Ways to thicken food and liquids to make them easier to swallow
• Exercises to clear the food from your throat after swallowing

The goal of treatment for swallowing problems is to help you be able to swallow food and liquids safely and get the nutrition you need. Talk to your doctor if you suspect a swallowing problem. A referral to an SLP is usually easy and can help solve your swallowing problems.²