Dysphagia – what is it?
Dysphagia is not a term that is often used in everyday conversation. It is the medical term that refers to difficulty eating and/or swallowing. Swallowing is generally an automatic process that we do without thinking. In fact the more we think about it, the more it becomes a challenge. A functioning swallow constitutes the transference of food or liquid from the mouth safely to the stomach. Most of us won’t ever consider the question – what happens when something goes wrong with my swallow?
To some extent, we’ve all experienced Dysphagia. Occasionally food or drink goes down the wrong way and we cough and splutter our way through. Dysphagia is a problem when there is a breakdown in normal swallow function. Dysphagia can occur due to difficulty at any point of the swallow, from the mouth to the oesophagus.
Dysphagia symptoms can vary in nature and severity. Some characteristics of Dysphagia may include:
- Coughing during or after swallowing food or drink
- Pain on swallowing
- Sensation of ‘something’ stuck in the throat
- Multiple swallows to try and get food/fluid ‘down’
- Difficulty chewing and controlling food in the mouth
It is important to recognise that Dysphagia in and of itself is a symptom of another condition or change in health. A variety of conditions can lead to Dysphagia. Some of these include:
- Neurodegenerative diseases (e.g. Parkinson’s, Motor Neurone Disease, Myasthenia Gravis, Huntington’s disease)
- Muscle disease (e.g. muscular dystrophy)
- Head and neck injury
- Head and neck cancer
- Chronic Obstructive Pulmonary Disease
- Cleft palate
- Cerebral palsy
Dysphagia can significantly affect a person’s health and engagement in daily activities of life. Some of the health outcomes include:
- Malnutrition: This results from people avoiding or not being able to eat enough of the right foods to maintain a healthy weight.
- Dehydration: 60% of our body weight is made up of water. Water also helps us to remove waste and toxins from our bodies. Dysphagia can lead to people avoiding or not being able to drink enough fluids to maintain adequate hydration.
- Chest Infection: If someone has Dysphagia, there is an increased risk of food and fluids entering their lungs. Food and fluid chewed in the mouth often picks up bacteria. This is usually eliminated by our stomach acid. However, if these bacteria enter the lungs as a result of difficulty swallowing, it can lead to serious chest infections and pneumonia. Whilst most infections and pneumonia’s are treatable, there is a risk that if untreated, there will be ongoing complications and risk of death.
Dysphagia can also have social and emotional impacts. Eating and drinking is often at the core of social events, parties, family gathering’s etc (Think about the last time you went to a social event and there was no food or drink…possibly never). Dysphagia can lead to changes to the types and textures of foods that can be tolerated, the length of time it takes to eat a snack or a meal, and/or feelings associated with eating. To understand these impacts, it is worth watching this short film about Dysphagia from the perspective of someone with Dysphagia.
Depending on the cause of the Dysphagia, management options may only be needed in the short term. In other instances however, Dysphagia can require ongoing management over an extended period, sometimes across the lifespan.
Assessing Dysphagia usually consists of a speech pathologist taking a full medical history, discussing with family members or other staff members regarding current eating patterns or difficulties, assessing the nerves and muscles required for swallowing, observing the person eating and drinking a range of different textured food and fluids and, where it is deemed necessary, referring the person for a scan of the swallow – known as a Modified Barium Swallow.
Once Dysphagia has been identified, a speech pathologist works as part of a multi-disciplinary team to achieve the best outcome for the person with Dysphagia. The team can include professionals such as a doctor, dietitian and occupational therapist. Treatment strategies are personalised to meet the needs of each individual. Management options may include:
- Modifying the thickness of drinks to increase control of fluids.
- Mincing or softening food textures.
- Reducing the size of mouthfuls taken at a time.
- Adjusting seating and utensils for eating (in conjunction with occupational therapy recommendations).
- Allowing extra time for meals.
- Specific rehabilitation exercises for swallowing as specified by the treating speech pathologist.
If the Dysphagia is considered to be severe, a speech pathologist may recommend that a person stop eating and drinking (termed ‘Nil by Mouth’). This should be a team decision in the best interest of a person’s health. If it is deemed to be a longer term management option, alternative methods of feeding are considered and implemented to maintain nutrition and hydration.
Management should include education of the person with Dysphagia and their family and friends to ensure the whole team is equipped to support optimal management.
Should you have any questions about dysphagia or problems with eating and drinking, contact your local doctor, who will arrange for you to see a speech pathologist. We‘ll provide you with a straightforward, efficient and very effective treatment plan targeted to your concerns.
For more information about dysphagia see the Department of Health Victoria website, click here.