Swallowing and speech difficulties

Reviewed by Executive Manager Client Engagement and Wellbeing Jodi Haartsen who is a registered MS Nurse Consultant with over 20 years’ experience at Eastern Health MS service in Australia.

Studies have found that about a third of people with MS experience some swallowing difficulties to varying degrees. This is known as dysphagia. The symptoms that cause significant problems are more likely if you have more advanced MS.

Weakness and lack of coordination in the muscles of the neck, mouth, cheeks and throat can interrupt the complex process of swallowing. The messages in the brain that trigger the swallowing response can also be affected in MS. This can affect many parts of swallowing including:

• the process of chewing and preparing food for swallowing
• pushing the food to the back of the throat readying it for swallowing
• initiating the swallowing reflexes
• moving the food into and down the oesophagus into the stomach.

This can result in food or liquids going into or blocking the windpipe (trachea) instead of the oesophagus. This can cause pain or discomfort while swallowing, drooling, hoarseness, food regurgitation or indigestion (heartburn) and coughing or choking which can, in more serious cases, cause severe chest infection or pneumonia.

Difficulty finding words can also occur in MS. This is a complex problem caused by damage in different parts of the brain.

MS can cause damage to myelin, a protective layer around your nerves in the brain and spine. This can make it harder for your brain to send signals to your muscles, including how you sense and process food and drink in your mouth and throat.

As a result, MS can cause dysphagia (difficulty swallowing).

Dysphagia is more frequent in more advanced cases of MS.

If you have dysphagia:

• Chewing food may be harder or more tiring.
• You may need to swallow more times to chew away a mouthful.
• Food may feel like it is stuck in your throat.
• You may have episodes of coughing or choking when you are eating or drinking.
• Fluid or food may enter the throat, rather than your stomach, causing coughing which can lead to pneumonia or chest infections.
• Your coughing muscles could be weaker, making it harder to eject any food particles that enter your lungs.
• Your saliva may not be swallowed as often as needed which can use drooling.

If you’re having difficulty swallowing, talk to your GP, MS nurse or neurologist. They can give you advice and may refer you to an allied health specialist, such as a speech pathologist.

• Take your time when eating – take smaller bites and concentrate on chewing and swallowing.
• Sip on drinks slowly throughout your meal and if you have any food lodged in your throat.
• Eat smaller meals more often or have your largest meal when you have the most energy.
• Use good posture while you sit to make it easier to swallow.
• Be aware of foods that are harder to eat and may cause swallowing issues, such as dry food, crumbly textures or thin liquids that go down quickly.
• Relax and avoid speaking while you eat.
• Stay upright for at least 20 minutes after eating.
• Make sure your mouth is empty before continuing to eat or drink.
• If you’re prone to choking, eat with someone who knows how to help you.
• The Australian Government has advice on what to do if someone is choking.

Speaking involves several parts of the body that need to work together. This includes the lungs, diaphragm, vocal cords, lips, tongue and nasal cavity.

Damage caused by MS to the areas that control any of these elements can affect your speech. Fatigue or weakness can also affect any part of the process.

Speech problems can include:

• Slurring of speech.
• Problems with volume, strength or quality of your voice.
• Weakness of the chest muscles, making breathing and speech harder.
• Difficulty remembering specific words.
• Difficulty following longer or more complex conversations.

For most people with MS, speech problems will be relatively mild and manageable.

If you’re having difficulty speaking, see your GP, MS nurse or neurologist. They can give you advice and may refer you to an allied health specialist, such as a speech pathologist or physiotherapist.

If you have speech problems, there are some things you can do:

• Try to speak slowly and keep sentences short.
• Plan to have important conversations when you are less tired, as fatigue can make communication more difficult.
• Prepare for important conversations with written notes you can refer to.
• Use other tools to help communicate messages including emails, texts, photos, images, facial expressions or gestures.
• Check with the other person to make sure they understand what you’re saying.