Swallowing Difficulties (Dysphagia)
Swallowing Difficulties (Dysphagia)
Swallowing difficulties, known medically as dysphagia, can make eating, drinking and taking medication more difficult and, in some cases, increase the risk of food or drink entering the lungs.
This page explains the causes and symptoms of dysphagia, how Speech and Language Therapy can help, and practical ways to support safer eating and drinking.
What is Dysphagia?
Dysphagia is the medical term for difficulty swallowing.
Swallowing is a complex process involving around 50 pairs of muscles and many nerves working together to move food and drink safely from your mouth to your stomach.
If these muscles become weak or their movements become uncoordinated, swallowing may become difficult. This can result in food, drink or saliva entering the airway instead of the stomach.
Swallowing difficulties can affect eating, drinking, taking medication and overall quality of life, but many people benefit from assessment and personalised management.
What Causes Swallowing Difficulties?
Swallowing difficulties can develop as a result of a range of neurological and medical conditions.
Common causes include:
- Stroke
- Parkinson’s disease
- Motor Neurone Disease (MND)
- Multiple Sclerosis (MS)
- Dementia
- Brain injury
- Head and neck cancer
The severity and type of swallowing difficulty will vary from person to person depending on the underlying condition.
What is Aspiration?
Aspiration occurs when food, drink or saliva passes into the lungs instead of the stomach.
This can increase the risk of chest infections and aspiration pneumonia.
If swallowing difficulties are suspected, early assessment by a Speech and Language Therapist can help reduce these risks and support safer eating and drinking.
Signs of Swallowing Difficulties
Signs that may indicate a swallowing problem include:
- Coughing or choking while eating or drinking
- A wet or gurgly voice after swallowing
- Food remaining in the mouth after eating
- Taking a long time to finish meals
- Feeling that food is stuck in the throat
- Weight loss
- Wheezing during meals
- Frequent chest infections
- Refusing food or drink
- Watery eyes when eating or drinking
If you notice any of these symptoms, speak to your healthcare professional or Speech and Language Therapy service.
How Can Speech and Language Therapy Help?
Speech and Language Therapists are specially trained to assess and manage swallowing difficulties.
Following a referral, your therapist may:
- Assess the muscles used for swallowing
- Observe you eating and drinking different food and drink consistencies
- Identify what makes swallowing safer or more difficult
- Recommend personalised swallowing strategies
- Develop an individual management plan
If further investigation is needed, you may be referred for a Videofluoroscopy (VF) swallowing assessment, which is a moving X-ray used to assess swallowing.
If your swallowing problem is thought to originate lower in the oesophagus, you may be referred to an Ear, Nose and Throat (ENT) or Gastroenterology specialist.
Managing Swallowing Difficulties
Everyone’s swallowing difficulties are different.
Your Speech and Language Therapist will recommend a management plan based on your individual assessment.
This may include changes to food textures, drinks, eating techniques or specialist equipment.
Food Texture Changes
Some people swallow certain food textures more safely than others.
Speech and Language Therapists use the International Dysphagia Diet Standardisation Initiative (IDDSI) framework to recommend suitable food consistencies.
Examples include:
- Level 4 – Pureed
- Level 5 – Minced & Moist
- Level 6 – Soft & Bite-Sized
Your therapist will explain which texture is most appropriate for you if needed.
Thickened Drinks
Some people find thickened drinks easier and safer to swallow than thin fluids.
Your therapist may recommend:
- Naturally thicker drinks, such as smoothies
- Prescribed thickening powder added to drinks
Always prepare thickened drinks according to the advice provided by your Speech and Language Therapist.
Positioning and Swallowing Techniques
Simple changes to posture and swallowing technique can improve safety.
Your therapist may recommend:
- Sitting upright during meals
- Remaining upright for at least 30 minutes afterwards
- Taking small mouthfuls
- Taking small sips
- Eating and drinking more slowly
- Specific swallowing techniques based on your individual needs
Equipment
Some people benefit from equipment that makes eating and drinking safer or more independent.
Examples include:
- Adapted cups
- Plate guards
- Adapted cutlery
- Drinking aids
Your therapist will discuss whether any specialist equipment may be helpful.
Looking After Your Mouth
Maintaining good oral hygiene is an important part of managing swallowing difficulties.
Keeping your mouth clean helps reduce bacteria and may lower the risk of chest infections caused by aspiration.
To maintain good oral health:
- Brush your teeth or clean your mouth at least twice a day.
- Clean your mouth even if you wear dentures or have no natural teeth.
- Consider using SLS-free toothpaste if regular toothpaste produces too much foam.
- Speak to your therapist or GP if you experience a dry mouth.
- Clean your mouth after meals if food tends to collect inside your mouth.
Everyday Tips for Safe Eating and Drinking
These simple tips can help make eating and drinking safer:
- Sit fully upright and stay alert during meals.
- Avoid eating or drinking while lying down.
- Reduce distractions such as televisions or radios.
- Take small bites and small sips.
- Eat slowly and avoid rushing meals.
- Make sure dentures fit comfortably.
- Avoid dry, crumbly or difficult-to-chew foods unless advised otherwise.
- Follow the recommendations provided by your Speech and Language Therapist.
Further Information
If you have concerns about swallowing difficulties or have noticed changes in your eating or drinking, speak to your healthcare professional or contact your local Speech and Language Therapy service.
Specialist Community Neurology Service
Speech and Language Therapy
Bristol, North Somerset and South Gloucestershire
Telephone: 0300 125 5550
Email: sirona.neuro@nhs.net
