Understanding Swallowing Difficulties (Dysphagia)

Swallowing difficulties, medically known as dysphagia, can be distressing and overwhelming for sufferers, impacting daily life in unexpected ways. Whether you're experiencing hesitation when swallowing, discomfort or even choking episodes, understanding these challenges is the first step toward finding relief and regaining control. So, with that in mind, let's explore the different aspects of swallowing difficulties, from their types and symptoms to their causes, treatment options, and how seeking help from a speech pathologist could make a significant difference in your life.

Symptoms of Dysphagia

Let's start by identifying the common symptoms presented by dysphagia. Although swallowing difficulties come in various forms, each with their own set of symptoms and impacts on well-being, the following are often presented by those suffering from the condition:

• Difficulty Swallowing: You might find it hard to initiate the swallowing process or feel as though food is getting stuck in your throat.
• Pain or Discomfort: Swallowing may cause pain or discomfort in your throat, chest or even abdomen.
• Choking or Coughing: Episodes of choking or coughing, especially during meals, can be frightening and pose serious risks.
• Drooling: Difficulty managing saliva can lead to embarrassment and social withdrawal.
• Weight Loss or Malnutrition: Persistent swallowing difficulties may result in inadequate nutrient intake and weight loss.
• Social Isolation: Feeling self-conscious about your swallowing difficulties might lead you to avoid social situations involving food.

How Swallowing Works

To understand why these symptoms can present themselves, it helps to understand how swallowing actually works, from the moment food or drink enters our mouths to the time it enters our stomachs. Swallowing, though often taken for granted, is a remarkably intricate process that involves precise coordination of muscles and nerves throughout the oral cavity, pharynx, and oesophagus.

The Three Phases of Swallowing

Swallowing can be divided into three main phases: the oral phase, pharyngeal phase and oesophageal phase. Each phase plays a crucial role in transporting food or liquid from the mouth to the stomach while ensuring that it bypasses your airway to prevent aspiration (going down the wrong way!).

1. Oral Phase: This is where it all begins. You take a bite of food or a sip of liquid, and your tongue starts moving it around in your mouth. Saliva helps make everything nice and slippery, so it's easier to swallow.
2. Pharyngeal Phase: Once your mouth has done its job, the swallowing action becomes automatic. The food or liquid moves to the back of your throat (pharynx), and your body takes over. Muscles in your throat close off your airway to make sure nothing goes down the wrong pipe. At the same time, your throat muscles push the food or liquid down into your oesophagus, like squeezing toothpaste out of a tube.
3. Oesophageal Phase: Now that the food or liquid is in your oesophagus, it's time for a one-way trip to your stomach. Muscles in your oesophagus contract in a wave-like motion (peristalsis) to push everything down into your stomach. A valve at the bottom of your oesophagus opens up to let everything through and then it closes tight again to keep stomach acid from coming back up.

Muscles & Nerves Involved in Swallowing

Swallowing requires the precise coordination of numerous muscles and nerves throughout the oral cavity, pharynx and oesophagus. Key muscles involved in swallowing include:

• Tongue & Throat Muscles: Your tongue has muscles like the genioglossus and styloglossus that help move food around in your mouth. Meanwhile, muscles in your throat, such as the superior, middle and inferior pharyngeal constrictors, work to push the food or liquid down your throat during swallowing. Think of them like a team of movers, working together to get everything where it needs to go.
• Nerves: Your brain sends signals to all these muscles, telling them when to move and how. It's like your brain is the conductor of an orchestra, directing each muscle to play its part in perfect harmony. These signals are carried by cranial nerves such as the trigeminal nerve (CN V), facial nerve (CN VII), glossopharyngeal nerve (CN IX), vagus nerve (CN X) and hypoglossal nerve (CN XII), which help coordinate the swallowing process.

Problems With SWALLOWINg

As with any complex system, unfortunately sometimes things don't go according to plan! That's when a swallowing difficulty, or dysphagia, can present itself. These difficulties can occur for various reasons, but most are manageable with proper care and attention. Here are some of the common causes:

1. Gastroesophageal Reflux Disease (GERD): Acid reflux, when stomach acid flows back into the oesophagus, can irritate the lining and sometimes cause discomfort or difficulty swallowing.
2. Aging-related Changes: As we age, our muscles and nerves may not work as well as they used to, which can lead to swallowing difficulties. This is a normal part of aging called presbyphagia.
3. Muscular Disorders: Certain conditions, such as myasthenia gravis or muscular dystrophy, can weaken the muscles needed for swallowing, making the process more challenging.
4. Structural Abnormalities: Sometimes, there might be physical obstacles in the throat or oesophagus, like tumors or scar tissue, that make it harder for food or liquid to pass through smoothly.
5. Psychological Factors: Feeling anxious or nervous about swallowing, especially if you've had a choking incident before, can sometimes make it harder to swallow comfortably.
6. Neurological Conditions: Conditions like stroke, Parkinson's disease, or multiple sclerosis can affect the way your brain sends signals to the muscles involved in swallowing, causing them to not work as efficiently.
7. Medications: Some medications, like muscle relaxants or drugs that reduce saliva production, might make swallowing feel more difficult. It's always a good idea to talk to your doctor if you notice any changes after starting a new medication.
8. Head & Neck Cancer: While less common, tumors in the head or neck area can sometimes affect swallowing by putting pressure on the throat or oesophagus.

Remember, experiencing occasional swallowing difficulties isn't uncommon and often doesn't indicate a serious problem. However, if you notice persistent or worsening symptoms, a speech pathologist can help you understand what is happening and provide options to improve your swallowing function and overall well-being.

How Can a Speech Pathologist Help With Dysphagia?

Speech pathologists play an important role in diagnosing and treating swallowing difficulties. Here's how they can help:

1. Assessment: Your speech pathologist will start by getting to know you and your unique swallowing challenges. They'll ask about your symptoms and any concerns you have, then they'll conduct gentle tests to see how well your swallowing muscles are working.
2. Understanding Your Needs: Once they have a clear picture of what's going on, they'll explain everything in a way that's easy to understand. They want to make sure you feel comfortable and confident in the process.
3. Creating a Plan Together: Together, you and your speech pathologist will come up with a plan that fits your lifestyle and goals. They'll teach you exercises and techniques that you can practice at home to strengthen your swallowing muscles and make eating and drinking easier.
4. Support Every Step of the Way: Throughout your journey, your speech pathologist will be there to support you. They'll offer encouragement, answer your questions, and celebrate your progress with you.
5. Practical Strategies: They'll share practical tips and tricks to make swallowing safer and more comfortable. From how to take smaller bites to adjusting the consistency of your food and drinks, they'll help you find what works best for you.
6. Empowering Education: Your speech pathologist will empower you with knowledge about dysphagia and how to manage it. They'll make sure you feel confident in making informed decisions about your health and well-being.
7. Ongoing Support: Dysphagia management is often a journey rather than a one-time fix. Your speech pathologist will be there for you each step of the way, offering ongoing support, guidance and encouragement.

Are you suffering with swallowing difficulties? Don't let these challenges hold you back. At Exploring Speech, we're here to help both children and adults to manage and/or overcome these challenges. Call 0000 000 000 today or submit an online enquiry.