Swallowing Difficulties in Multiple Sclerosis: Causes, Symptoms, and Management

How Does MS Affect Swallowing?

Among many other symptoms, MS individuals can also experience trouble swallowing, which can feel like a sore throat. In multiple sclerosis, throat tightness or dysphagia can occur due to the dysfunction of muscles involved in swallowing.

Swallowing difficulties in MS happen because the nerves that control swallowing and chewing are damaged. This can lead to muscle weakness, stiffness, numbness, trouble controlling saliva, and changes in sensation in the mouth and throat. This can manifest as dribbling, coughing, choking while eating, feeling something stuck in the throat, or difficulty in swallowing solids. MS-related dysphagia can manifest in different ways, ranging from mild to severe difficulties that pose a risk of aspiration (inhaling food or liquid into the lungs).

Dysphagia due to MS can affect dental and oral health, too. Because swallowing doesn’t work well, food and germs can stay in the mouth, causing plaque to build up. Some MS medications can also cause the mouth to feel dry, which may lead to cavities or tooth decay.

What Are the Causes of Dysphagia in Multiple Sclerosis?

People with MS can have trouble swallowing, and this is called dysphagia. It happens because MS can hurt the nerves in the brain that help the muscles work together when we swallow. When these nerves don’t send the right messages, swallowing can become hard or feel different.

The causes of dysphagia in MS are:

• Lesions in the CNS (central nervous system) (which occur because the immune system attacks the myelin sheath, causing scarring in these areas) can affect the nerves that control swallowing, disrupting the coordination and function of the muscles involved in it.

• When the muscles that help you swallow get weak, it can make it harder to swallow.

• Reduced sensation or numbness in the mouth and throat due to MS can also affect the ability to feel food and liquids being swallowed.

• MS can impact the coordination between the muscles involved in swallowing, making the swallowing process less efficient.

• Fatigue, the most common symptom of MS, can affect the overall energy needed for swallowing.

What Are the Symptoms of Dysphagia in Multiple Sclerosis?

The symptoms of dysphagia in MS individuals are

• Difficulty swallowing: People with MS may experience difficulty swallowing and may feel as though something is stuck in their throat or chest.

• Choking or coughing: Frequent coughing or choking may also occur during meals.

• Weight loss: Dysphagia can lead to reduced food intake, which in turn can result in weight loss.

• Dehydration: Difficulty in swallowing liquids can also occur, which can lead to dehydration.

• Others: Other MS-related throat symptoms include voice changes, sudden contraction of the muscles around the vocal cords (laryngospasm), constriction in the throat, and gagging while eating.

How to Diagnose MS Dysphagia?

Diagnosing dysphagia in MS requires a thorough evaluation by healthcare professionals.

This includes:

• Clinical evaluation: A detailed history of the patient's medical history, symptoms, eating habits, and patterns is necessary.

• Videofluoroscopic swallow study (VFSS): This imaging study helps assess your swallowing technique. It involves consuming a contrast agent, and images are taken using X-rays to assess the swallowing mechanism.

• Fiberoptic endoscopic evaluation of swallowing (FEES): This specialized test enables doctors to observe how a person swallows. A tiny, bendy tube with a small camera is gently inserted through the nose, allowing the doctor to observe how food and drinks move when someone swallows. It helps them find the best way to make swallowing safer and easier!

How to Manage MS Dysphagia?

To help MS people with dysphagia, a whole team of doctors works together! These are neurologists, speech therapists, dietitians, and occupational therapists.

Their primary goal is to:

• Make swallowing easier and safer.

• Stop any problems like choking or coughing.

• Help the person feel better and enjoy their meals again!

Management includes:

• Speech-language therapy: A speech therapist can teach fun exercises to strengthen the swallowing muscles. These exercises help people swallow food and drinks more easily and safely.

• Dietary modifications: Dietitians help people eat healthy and choose foods that are easy to swallow. They suggest soft foods or thicker drinks so eating feels safer and smoother. Sometimes, they also add vitamins or supplements to keep us strong.

It is also essential to:

• Sit up straight while eating.

• Chew food really well.

• Eat slowly.

• Pay attention while eating (no talking).

• Assistive devices: Sometimes, people with MS can use special tools to make eating and drinking easier. These can include special spoons, spill-proof cups, or plates that are easier to hold. These tools help people eat safely and feel more at ease during mealtime.

• Medications: Muscle relaxants can reduce spasticity (stiff muscles).

• Hydration: Ensuring adequate hydration is very important. Adjusting the consistency of liquids may be necessary.

• Medication management: Some medications may contribute to dysphagia. Therefore, it is necessary to review the medications with the doctor.

How to Deal With the Psychological and Emotional Impact of Multiple Sclerosis Dysphagia?

Having MS and trouble swallowing can sometimes make people feel sad, worried, or stressed. But there are many ways to feel better!

Here are some helpful tips:

• Join a support group to meet others who understand what you’re going through.

• Take deep breaths or try mindfulness to stay calm and relaxed.

• Talk openly with your family, friends, and doctors; sharing your feelings helps!

• Try special therapies like talking with a counselor to chase away negative thoughts.

• Make mealtime easier by taking small bites and eating soft, easily chewable foods.

• Ask a food expert (dietitian) for advice on what to eat.

Conclusion:

Trouble swallowing can be a common symptom of MS, but it requires attention from doctors and family. It is essential to know the cause of the swallowing problem and how to help. This way, we can take good care of people with MS and help them eat and drink safely. By addressing the challenges of swallowing problems, one can enhance one's overall well-being and empower oneself to lead a fulfilling life.

Key Takeaways:

• Dysphagia can occur in people with MS because the nerves that help you swallow get damaged.

• Studies show that about 33% to 45% of people with MS have trouble swallowing.

If you have MS and are having trouble swallowing, talk to our iCliniq neurologist. They can make a special plan just for you to help you feel better!