Trouble Swallowing?

Eating and drinking are among life's greatest pleasures, yet about 15 million Americans have difficulty swallowing foods and/ or liquids, a condition known as dysphagia.

Everyone knows what it feels like when a bite of food "gets stuck" or a sip of liquid "goes down the wrong pipe." It's an uncomfortable but rare problem that can be corrected by coughing or drinking a small amount of liquid.

However, when dysphagia begins to occur with greater frequency (generally, more than once per month), you should see your doctor to determine the cause. Prompt treatment will help you avoid serious complications, such as dehydration, malnutrition, choking and aspiration (when food or liquid leaks into the airways), pneumonia and even death.

Caution: If a swallowing problem leads to an obstruction that interferes with your breathing in any way, have someone perform the Heimlich maneuver on you.

What to do: While standing behind you, the person should place the thumb side of his/her fist just above your navel...grasp his fist with his other hand, and give four quick inward thrusts. This should be continued until the obstruction is removed. If this technique does not help, have someone call 911. If you are alone, you can perform the inward thrusts on yourself.

Are You At Risk?

Aging can affect our ability to swallow. That's because our muscles, including those in the mouth and throat, weaken as we grow older. Even healthy adults may begin to notice subtle swallowing and eating problems, such as difficulty swallowing pills or eating dry or crunchy foods, by age 60. However, serious problems are not a normal sign of aging and should be promptly evaluated by a doctor.

Several medical conditions can cause dysphagia. Chronic heartburn increases risk for dysphagia-stomach acid backs up into the esophagus, sometimes damaging esophageal tissue, which may lead to swallowing difficulties. A stroke or head injury may affect the coordination of the swallowing muscles or limit sensation in the mouth and throat. Neurological disorders, such as Parkinson's disease and multiple sclerosis, also can cause swallowing problems.

A tumor in the esophagus can narrow this passageway, making it difficult to swallow. Surgery, radiation and chemotherapy for head and neck malignancies also can irritate the esophagus and/or lead to a buildup of scar tissue that interferes with swallowing.

Related problem: About 2,000 medications, ranging from diuretics (water-excreting drugs) to drugs used to treat such conditions as insomnia, can cause xerostomia, a drying of the mouth that often makes swallowing food difficult.

Get A Correct Diagnosis

A primary care physician often is the first health care professional to suspect dysphagia. Depending on the cause of the disorder, you may be referred to an otolaryngologist (ear, nose and throat specialist), a gastroenterologist (specialist in diseases of the digestive system) or a neurologist (specialist in diseases of the nervous system).

A process known as video fluoroscopy is the most common and effective way to diagnose dysphagia. This test videotapes the entire swallowing process so the doctor can see how a patient's tongue and throat movements affect the flow of food, fluid and medication.

Best Treatment Options

Treatment for dysphagia depends on what's causing the disorder. People with heartburn can make lifestyle changes, such as not eating for at least two hours before bedtime, and/or take medications, such as ranitidine (Zantac) or omeprazole (Prilosec), to reduce stomach acid. People who have suffered a stroke may be asked to perform muscle exercises to strengthen weak facial, tongue and throat muscles.

Dysphagia improves for some people when they follow certain practices while eating, such as turning the head to one side or looking straight ahead with the chin tucked toward the chest. These steps help direct food and fluids away from the airway and into the esophagus.

Tips On Eating And Drinking

What helps one individual with a swallowing difficulty may not help another. However, there are many basic strategies that allow people to swallow food and drink with greater ease. For example...

Sit upright in a chair while eating—do not eat in bed.
Swallow a single bite or sip before taking another, and put eating utensils down between bites.
Limit bite sizes (to one-half inch or less) and limit the amount of liquid taken with each swallow.
Eat one type of food texture at a time. Swallow a bite of mashed potatoes, for example, before chewing and swallowing a piece of chicken.
Choose soft foods, such as cooked cereal, mashed potatoes, soft-cooked eggs, cottage cheese, applesauce, yogurt and soups.
Thicken thin fluids, such as tea, apple juice and water, if necessary. This allows more time for throat muscles to get into position to ensure safe swallowing

Natural thickeners include many flours (tapioca flour is often used), instant potato flakes and oats. To determine the amount of natural thickener to be added to a liquid, ask your doctor for a referral to a nutritionist or speech and language pathologist (a clinician with expertise in swallowing problems).

Easier Pill Swallowing

Even people who do not have trouble swallowing food or liquid sometimes have difficulty with pills. In addition to sitting upright or standing when taking a pill...

Take a sip of water before you take a pill. A moist mouth helps the pill go down easier. Also take a few sips with and after each pill—to prevent the pill from getting stuck in the esophagus.
Swallow one pill at a time. Putting more than one pill at a time in your mouth can cause you to choke.
Do not throw your head back when you take your pills. This can increase your risk for choking.