How Does MS Affect Swallowing?

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Multiple Sclerosis (MS) is caused by a demyelination process in parts of the central nervous system that disrupts the communication between the brain and rest of the body.  This leads to a multitude of symptoms including muscle weakness, fatigue, impaired coordination, and cognitive deficits. A lesser known yet significant MS symptom is dysphagia, or difficulty swallowing. Dysphagia can significantly affect quality of life and can lead to serious health issues if it is not properly managed or treated. Dysphagia can lead to frequent respiratory infections such as aspiration pneumonia, malnutrition, dehydration, and airway obstruction.

The swallow function is a complex process that involves coordination amongst several muscles in the mouth, throat, and esophagus.  There are four phases (oral preparatory, oral, pharyngeal, and esophageal) involved in the swallow function that rely on very precise coordination between the nerves and muscles. With MS, a disruption in these pathways can make the swallow function more difficult or unsafe. Changes in your swallow can occur when there has been damage to the brain stem, spinal cord, or cerebellum. The severity of dysphagia will vary depending on the extent and location of the damage or demyelination. Dysphagia not only affects foods, beverages, and your own saliva, but swallowing pills as well.

What are the symptoms of dysphagia in people with MS?

The symptoms include but are not limited to:

• Difficulty keeping food or liquids in your mouth when eating or drinking.
• Excessive drooling.
• Difficulty chewing food well (this could also be a result of fatigue or decreased endurance during meals).
• Food getting stuck in the sides of your mouth (cheeks), tongue, roof of your mouth (palate).
• Sensation of food or drink getting stuck/caught in your throat during or after your swallow.
• Coughing or throat clearing during and after eating or drinking.
• Difficulty moving food from the front of your mouth to the back of your mouth.
• Trouble initiating a swallow (Do you find yourself saying, “I really have to think about swallowing”?).
• Frequent respiratory infections or aspiration pneumonia.
• Weight loss because of difficulty eating.

What do I do if I have these symptoms?

• Let your neurologist know.
• Keep a food log of your daily eating/drinking habits to see which textures/consistencies you have more difficulty with.
  • Once you identify which foods/liquids you have difficulty with, ask yourself if you can modify it to make it easier to eat.
  • Consider cutting meat/fish into smaller pieces or eating ground meat, adding sauces to drier textures, etc.
  • If you find that your dysphagia is more severe later in the day or when you are typically more fatigued, consider adjusting the timing of your meals/snacks to avoid these times.
• See a speech language pathologist and get evaluated. Depending on the evaluation, a speech language pathologist can refer you for additional imaging, provide recommendations for the safest consistencies/textures, teach you exercises to strengthen your swallow, and provide education/training on compensatory strategies during meals.

What can I do to make swallowing easier with MS?

• Maintain an upright posture during and after meals for at least 30 minutes. This gives your muscles enough time to get the solids/liquids through the swallowing phases, thereby minimizing risk to your airway.
• Take small bites and sips.
• Take 1-2 bites of your food and follow it with a sip of your beverage to help clear any remaining residue and help the food to pass through the pharyngeal and esophageal phases of your swallow.
• Avoid dry, hard crunchy textures.
• Use effortful swallows.
• Complete an additional swallow with each bite and sip to make sure you have swallowed everything.
• Complete oral hygiene (i.e. brushing your teeth) after all meals. This ensures you get rid of any food particles and bacteria.
• If you are getting tired quickly during meals, consider eating 4-6 smaller meals a day instead of 3 big meals.
• If you are having difficulty with swallowing pills, try taking them whole in pudding/yogurt. You can also consult with your medical team (neurologist, pharmacists) and determine if any of your medications can be cut in half or taken in liquid form.

Dysphagia is a more common symptom of MS than we think. If you are experiencing dysphagia, please consult with your medical team and have further evaluation completed by a speech language pathologist. It is critical to make sure you can maintain your quality of life, get the nutrients you need, and stay hydrated.