Swallowing Problems
What is dysphagia?
Dysphagia means that you have problems swallowing. You may not be able to swallow at all or you may have problems swallowing certain foods, liquids, pills and/or your saliva. Swallowing problems can cause concern because it may affect your health.
Causes of Dysphagia Include:
- Stroke
- Brain injury
- Spinal cord injury
- Neuromuscular diseases (Huntington’s Disease, Parkinson’s Disease, Multiple Sclerosis)
- Motor neuron diseases (Amyotrophic Lateral Sclerosis called ALS)
- Some cancers (cancer of the tongue, esophagus, stomach, mouth, and throat)
- Cancer treatment (Radiation, Chemotherapy, Surgery)
- Cerebral palsy
- Alzheimer's disease
- Certain medicines
- Breathing tube in place for a long time
What are the signs and symptoms of dysphagia?
- Coughing or choking during or after eating or drinking
- Food staying in your mouth after swallowing
- Food or liquid leaking from your mouth
- Feeling like food is stuck in your throat or chest
- Drooling
- Repeat pneumonias
- Hoarse or wet gurgling voice
- Pain when you swallow
- Heartburn
- Gag or vomit
- Losing weight without trying
- Not drinking enough fluid
Sometimes symptoms are not seen but there may still be swallowing problems. Signs to watch for are:
- Changes in your lungs and breathing (pneumonia, or having a hard time breathing after eating or drinking)
- Changes in your voice, such as gurgling voice, weaker voice or no voice at all
- Problems being awake enough to eat a meal
If you have difficulty swallowing, the following problems could happen:
- May not be able to drink enough fluids
- Pneumonia
- Poor nutrition
- Weight loss
- Feeling very tired
- Weakness
- Longer hospital stay
How is a swallowing problem diagnosed?
If your doctors or nurses think you have swallowing problems, they will ask a swallow therapist to check your swallow.
What is a bedside swallow evaluation?
A licensed speech-language therapist (swallow therapist) from the UW Voice and Swallow Clinic will come to your room to test your swallow. You will sit upright in your bed or in a chair. The swallow therapist will check to see if you are able to swallow water, semi-solid and solid foods. They may feel your neck while you swallow. While you swallow, the therapist will watch and listen for signs of swallowing problems. If the therapist thinks that you have problems swallowing, they may do one of the tests below.
What is a videofluoroscopic swallow study (VFSS)?
You will go to the Radiology Department for this test. During this test, you will swallow barium liquids, semi-solid and solid foods, and possibly pills. While you are swallowing, a video x-ray will be taken of your mouth and throat to see if and where you are having problems swallowing.
What is a fiberoptic endoscopic evaluation of swallow (FEES)?
This test is done at the bedside or in clinic by a swallow therapist. You will sit upright in your bed or a chair for this test. A small camera called an endoscope will slide through your nose so the swallow therapist can look at your throat and watch where the food and liquid are going when you swallow.
These tests will show if and where you are having trouble swallowing. If you have swallowing problems, the swallow therapist will tell you the type of diet and fluid textures you need as well as the best way to take your medicine. Sometimes a person may not be able to eat any food or drink liquids because of the high risk of them going into the lungs.
Prescribed Diet
Based on the results of your swallow study, your diet may be changed to make it easier for you to swallow. Sometimes, certain food textures or thicker liquids make swallowing easier.
The different diet types are
- NPO - nothing by mouth
- General – normal diet
- Dysphagia pureed - foods with smooth textures (applesauce, pudding)
- Dysphagia minced - 1/8 inch cubes
- Dysphagia mechanically altered diced - 1/4 inch cubes
- Dysphagia advanced – most foods are okay, except sticky and chewy foods
Different liquid textures include:
- No liquids
- Honey thick liquids – thickest
- Nectar thick liquids – thinner than honey
- Thin liquids – regular liquid textures
Supervision – Sometimes you will need to have someone with you while you eat. This is to make sure you are swallowing okay.
- 1 on 1 – constant watching
- Intermittent – someone will check in on you.
- Independent – you can eat on your own
Your medicine may need to be given in a special way. You may need:
- Only liquid medicine
- Crushed in puree – pills will be crushed and put in a pureed food
- Whole in puree – pills do not need to be crushed but will still be given in a pureed food
- Whole with thickened liquids – the whole pill is given with a glass of thickened liquids
- Whole with thin liquids – the whole pill is given with a glass of water
You may need to use special ways when you swallow to help the food and liquids go into the stomach. For example, there may be positions or feeding methods that help foods or liquids to move safely past your windpipe. The swallow therapist will know if exercises are needed based on the results of the tests and will teach you what you need to do to swallow safely. They may teach you swallowing exercises to help the muscles used for swallowing get stronger. The swallowing therapist and care team will write a plan to manage your swallowing problems before you leave the hospital or at an outpatient appointment.
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 05/29/2013
Copyright © 02/14/2011 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#7086
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