What Are the Most Common Swallowing Difficulties?

Swallowing is a complex process that involves the mouth, throat, and oesophagus working together. It is something most people do without thinking, but for many, this process can be disrupted. Swallowing difficulties, known medically as dysphagia, can occur at any age but are more common in older adults or people with certain medical conditions.

When swallowing becomes difficult or unsafe, it can affect eating, drinking, and even taking medication. It may lead to discomfort, choking risks, aspiration of food or drink into the lungs, and poor nutrition or dehydration. Understanding the most common swallowing difficulties is important for recognising symptoms early and providing the right care.

What Dysphagia Means

Dysphagia is the term used for any problem with swallowing. It can happen at different stages of swallowing:

• Oral stage: Problems in the mouth when chewing or moving food to the back of the mouth.
• Pharyngeal stage: Problems in the throat when food or drink passes down towards the oesophagus.
• Oesophageal stage: Problems when food or drink is moving down the oesophagus towards the stomach.

Different causes and types of swallowing difficulty affect different stages of the process.

Common Swallowing Difficulties

Difficulty Chewing Food Properly

Some people cannot chew food well because of weak jaw muscles, missing teeth, dental pain, or poorly fitting dentures. If chewing is not thorough, large pieces of food may be swallowed, increasing the risk of choking.

This issue is common in older adults, or those with conditions like muscular dystrophy or advanced arthritis in the jaw. Chewing difficulties may also appear in people recovering from mouth or jaw surgery.

Weak Tongue Muscles

The tongue plays a major role in moving food from the front of the mouth to the back for swallowing. Weakness in the tongue muscles can slow or prevent that movement. This can cause food to remain in the mouth or spill back out. It may result from a stroke, neurological conditions like Parkinson’s disease, or after head and neck cancer treatment.

Poor Coordination in the Mouth and Throat

Some people struggle to coordinate the muscles needed to move food smoothly from the mouth into the throat. This can cause coughing during eating or a sensation of food going the wrong way. Multiple sclerosis and cerebral palsy are conditions that may affect muscle coordination in swallowing.

Pain When Swallowing

Pain during swallowing, called odynophagia, can make people reluctant to eat or drink. Pain may result from mouth ulcers, throat infections, acid reflux, or injury from swallowing something sharp. Burns from very hot food or drink can also cause temporary painful swallowing.

Feeling Like Food is Stuck

Many people with swallowing difficulties report a sensation that food is stuck in the throat or chest. This may be caused by narrowing of the oesophagus from scarring after acid reflux, growths, polyps, or inflammation. This type of problem is often more noticeable with solid foods than liquids.

Choking and Coughing During Eating

Choking happens when food or drink blocks the airway rather than moving down the oesophagus. Frequent coughing during meals may mean food or drink is entering the airway, a problem known as aspiration. Aspiration can lead to chest infections, including aspiration pneumonia.

Regurgitation

Regurgitation is when swallowed food or drink comes back up into the mouth. This can happen soon after eating and may bring an unpleasant taste. It can be linked to problems with oesophageal muscles, damage to the lower oesophageal sphincter, or certain digestive disorders.

Difficulty Initiating the Swallow

Some people find it hard to trigger the start of a swallow. This can lead to food or liquid staying in the mouth for longer than normal. This difficulty is often related to neurological damage such as after a stroke or brain injury.

Dry Mouth and Lack of Saliva

Saliva helps to moisten food and make it easier to swallow. A dry mouth, known as xerostomia, can make swallowing uncomfortable and lead to sticking of food in the throat. Causes can include side effects of medication, dehydration, certain autoimmune diseases, or cancer treatments.

Disorders and Conditions Linked to Swallowing Difficulties

There are many health conditions that cause or contribute to the swallowing difficulties listed above.

Some common examples include:

• Stroke: Can affect muscle strength and coordination.
• Parkinson’s disease: Causes muscle rigidity and slower movements, affecting the stages of swallowing.
• Multiple sclerosis: Damages nerves controlling swallowing muscles.
• Motor neurone disease: Weakens muscles progressively, including those used for swallowing.
• Head and neck cancers: Can damage structures involved in swallowing or lead to scarring after surgery or radiotherapy.
• Dementia: May reduce awareness of swallowing difficulties and affect coordination.
• Oesophageal stricture: Narrowing in the oesophagus.
• Gastro-oesophageal reflux disease (GERD): Causes irritation and potential scarring in the oesophagus.

Signs and Symptoms to Look Out For

Recognising these signs can help in identifying swallowing difficulties early:

• Coughing or choking during meals
• Sensation of food sticking in the throat or chest
• Wet or gurgly voice after eating
• Repeated chest infections
• Unexplained weight loss
• Taking much longer than normal to finish meals
• Pain when swallowing
• Drooling during meals
• Regurgitation of food

Impact of Swallowing Difficulties

Swallowing problems can affect physical health, nutritional status, and emotional wellbeing. People may lose interest in eating, leading to weight loss or malnutrition. Fear of choking can cause anxiety during meals. Social aspects of eating can be disrupted, with some avoiding meals in company.

Chest infections from aspiration can become frequent and severe. Dehydration may develop if drinking causes discomfort or coughing.

Management Approaches

Management depends on the type and cause of swallowing difficulty. Speech and language therapists often assess and treat dysphagia. They might recommend changes such as:

• Altering food texture to make chewing easier
• Thickening liquids to reduce aspiration risk
• Positioning strategies during eating
• Muscle strengthening exercises for tongue and throat
• Specialised feeding methods for severe cases

Medical treatments may be needed for conditions causing swallowing difficulty, such as treating infections or reflux.

Preventing Complications

Preventing aspiration and maintaining nutrition are main goals in care. Strategies include:

• Eating slowly and in small bites
• Avoiding distractions during meals
• Sitting upright when eating or drinking
• Adjusting texture to match swallowing ability
• Regular oral care to reduce bacteria in the mouth, lowering infection risk

Final Thoughts

Swallowing difficulties are varied and can range from mild inconvenience to serious health risks. Many are linked to underlying medical conditions, while others result from temporary problems like throat infections or dental issues. Recognising signs early and seeking professional assessment is important for safety and health.

When addressed with appropriate strategies and support, many people with swallowing difficulties maintain safe eating and drinking. Continued monitoring helps to spot changes in the condition and adapt care as needed, reducing risks like choking, aspiration, and malnutrition.