Dysphagia, or difficulty in swallowing, can occur in people with MS. While more frequent in advanced disease, it can occur at any time. Both chewing and swallowing require a number of muscles in the mouth and throat to work in a coordinated way. In MS, the nerves that control these muscles can become damaged causing weakness and incoordination that can provoke swallowing problems. In addition, numbness of the mouth and throat can occur that can make chewing and swallowing difficult. MS may affect swallowing in a number of ways by causing difficulty managing solids or liquids, frequent throat clearing during eating or drinking, a feeling that food is stuck in the throat, or coughing or a choking sensation when eating or drinking.
Sometimes medications prescribed for other symptoms or conditions can cause dryness of the mouth which can make swallowing – particularly dry or crumbly foods difficult.
Swallowing problems are important to recognize early. When swallowing problems persist or worsen there is a risk of aspiration – which means food or fluids getting into the lungs – and this is a serious problem.
Treating swallowing problems
Dysphagia is initially diagnosed by a careful history and neurologic examination of the tongue and swallowing muscles. A special imaging procedure called a modified barium swallow can be used to evaluate a person’s ability to chew and swallow solids and liquids. In this test, the person eats and drinks a small quantity of barium, which makes the structures of the mouth, throat, and esophagus visible on x-ray. The movement of these structures is recorded on videotape by a videofluoroscope as the person eats or drinks foods of varying consistencies — thin liquid, thick liquid and solid. The precise location and manner of a swallowing defect can then be identified, and treatment prescribed.
A speech/language pathologist is the professional who diagnoses and treats dysphagia. Treatment typically consists of strategies for safer eating and swallowing, dietary changes, exercises or stimulation designed to improve swallowing.