Difficulty swallowing or difficult deglutition can be unpleasant, even frightening. However, there are solutions to this problem.

What is difficult deglutition?

For most people, the action of swallowing (called deglutition) happens naturally, without much thought. The swallowing process allows for fluid and food to pass from the mouth to the digestive tract.

After having been chewed and mixed with saliva, food forms a lump called “alimentary bolus”. It is propelled to the back of the throat by the tongue. Then, through mechanical action by the pharynx muscles, it passes through the first canal of the digestive tract: the oesophagus. The ultimate destination is the stomach, where digestion begins.

In some individuals, this process is hampered. We refer to this as difficult deglutition, also called by the medical term dysphagia. The person experiences a sensation of discomfort or obstruction during deglutition, which is often indicative of the presence of an obstacle or a dysfunction of some kind.

What are the causes of difficult deglutition?

Difficulty swallowing is generally the symptom of an underlying problem. Here are some possible causes:

• neurological problems due to CVA (cerebrovascular accident or stroke), Parkinson’s disease, Alzheimer’s disease, etc.)
• pharynx infection (pharyngitis)
• gastroesophageal reflux
• insufficient saliva production
• cancer of the oesophagus, head or neck
• radiation therapy, and
• surgery

What are the risks and consequences?

Difficulty swallowing can have significant consequences on health and well-being. First, it can cause very unpleasant symptoms:

• pain when swallowing
• coughing during or after meals
• excess salivation
• impression that food is lodged in the throat
  • feeling or fear of choking

Individuals affected by dysphagia sometimes have a lower food intake than their nutritional needs, and often have a less varied diet. Therefore, difficulty swallowing can lead to malnutrition, weight loss and dehydration. Taking medication can also be problematic.

Difficulty swallowing can also cause regurgitation or vomiting. Food or fluids sometimes infiltrate the bronchi and the lungs, which can cause an infection of the airways (e.g., pneumonia). Additionally, this passage “in the wrong tube” significantly increases the risk of choking.

Therefore, it is important to see a doctor in the case of a persisting deglutition problem. The doctor will be able to diagnose the underlying problem and recommend adapted and effective care.

How to manage this type of problem

Because difficult deglutition is a complex problem, it is often appropriate to call on the expertise of a team of professionals: doctor, nurse, nutritionist, speech therapist, occupational therapist, etc. A personalized treatment plan should be initiated and must take several factors into account, including the causes of dysphagia, the person’s age, health issues, lifestyle and preferences.

The CLSC in your area can inform you about the resources provided for people dealing with a difficult deglutition problem. You can also speak with a healthcare professional, such as a doctor or pharmacist.

What measures can be taken to make deglutition easier?

Certain measures can make nutrition easier for people who have difficulty swallowing. Here are a few examples.

• Eat smaller meals more frequently.
• Cut food into smaller pieces.
• Eat slowly; take the time to chew every bite properly.
• Try foods with different textures in order to identify and avoid the ones that are more likely to cause difficult deglutition or choking. Be careful of foods that tend to be problematic, like garden peas, corn (popcorn or kernels), hazelnuts, peanuts, grapes, raisins, small candies, etc.
• Favour creamy foods with a honey-like consistency to liquids. Creamy substances increase oral sensitivity and make deglutition easier. For instance, fruit compote will replace fruit juice, and yogurt will replace milk. Cold drinks like milkshakes can be thickened with bananas.
• Add sauces to foods to facilitate deglutition.
• Ensure adequate hydration throughout the day to avoid dry mouth.
• Avoid eating in cases of acute fatigue.

Your pharmacist can inform you about the ways to facilitate taking medication to reduce the risk of choking. You can also find products and dietary supplements at the pharmacy that can improve nutrition for people with a deglutition problem. Don’t hesitate to ask your pharmacist for advice!