Dysphagia (difficulty swallowing)
It usually is a sign of a problem with your throat or esophagus - the muscular tube that moves food and liquids from the back of your mouth to your stomach. Those with dysphagia require more time and effort to move food or liquid from the mouth to the stomach.
Occasional difficulty swallowing usually isn't cause for concern, and may simply occur when you eat too fast or don't chew your food well enough. But persistent difficulty swallowing may indicate a medical condition requiring treatment. A dry mouth can make dysphagia worse. There may not be enough saliva to help move food out of the mouth and down through the esophagus. A dry mouth can be caused by medicines or another health problem.
More than 15 million Americans are affected by dysphagia. Difficulty swallowing can occur at any age, but it's more common in older adults. The prevalence may be as high as 22% in those over 50 years of age.
What causes dysphagia? 1
There are two types of problems that can make it hard for food and liquids to travel down your esophagus:
- The muscles and nerves that help move food through the throat and esophagus are not working correctly. This might be caused by:
Something is blocking the throat or esophagus. This may happen if you have:
- A prior stroke or a brain or spinal cord injury.
- Certain problems with the nervous system, such as post-polio syndrome, multiple sclerosis, muscular dystrophy, or Parkinson's disease.
- An immune system problem that causes swelling (or inflammation) and weakness, such as polymyositis or dermatomyositis.
- Esophageal spasm. This means that the muscles of the esophagus suddenly squeeze. Sometimes this can prevent food from reaching the stomach.
- Scleroderma. In this condition, tissues of the esophagus become hard and narrow. Scleroderma can also make the lower esophageal muscle weak, which may cause food and stomach acid to come back up into your throat and mouth.
- Gastroesophageal reflux disease (GERD). When stomach acid backs up regularly into your esophagus, it can cause ulcers in the esophagus, which can then cause scars to form. These scars can make your esophagus narrower.
- Esophagitis. This is inflammation of the esophagus. This can be caused by different problems, such as GERD or having an infection or getting a pill stuck in the esophagus. It can also be caused by an allergic reaction to food or things in the air.
- Diverticula. These are small sacs in the walls of the esophagus or the throat.
- Esophageal tumors. These growths in the esophagus may be cancerous or not cancerous.
- Masses outside the esophagus, such as lymph nodes, tumors, or bone spurs on the vertebrae that press on your esophagus.
How is Dysphagia treated?
The treatment is a function of what is causing the dysphagia.
Non-Invasive treatment for dysphagia includes:
- Changing the foods you eat. Your doctor may tell you to eat certain foods and liquids to make swallowing easier.
- Thickening the foods you eat. Food and Beverage thickeners [link to Thick-It!] added to your food will produce a desired consistency quickly, easily and in a controlled manner without changing the taste or appearance of hot and cold foods and beverages. These thickeners typically dissolve instantly, do not change appearance or taste of food or beverages, are easily digested, and do not bind fluids. For those seeking easier and more time efficient ways for meal preparation, there are also ready-to-eat purees and ready-to-drink liquids, both of which are pre-thickened [link to Thick-It!]
- A registered speech pathologist can perform a swallowing evaluation and provide appropriate treatment.
- Such an assessment may include:
- Examination of strength and movement of the lips, tongue, jaw, and palate.
- A challenge tray of various food textures and liquid consistencies.
- A Modified Barium Swallow Study (MBSS), which is a state-of-the-art radiographic (x-ray) procedure conducted by a speech pathologist and a radiologist.
- The treatment options may include some of the following:
- Adaptive equipment
- Deep pharyngeal neurological stimulation &nash; an intense stimulation program of the oral-pharyngeal muscles
- Thermostimulation &nash; a technique to trigger the automatic swallowing reflex
- Muscle strengthening of the oral/pharyngeal muscles
- Posture changes
- Prescribed food and liquid consistencies
Invasive treatment for dysphagia includes:
- Dilation. In this treatment, a device is placed down the esophagus to carefully expand any narrow areas of the esophagus.
- Endoscopy. In some cases, a long, thin scope can be used to remove an object that is stuck in the esophagus.
- Surgery. If you something is blocking the esophagus (such as a tumor or diverticula), surgery may be an alternative to remove it.
- Medicines. For dysphagia related to GERD, heartburn, or esophagitis, prescription medicines may help prevent stomach acid from entering the esophagus.
Other Resources on Dysphagia:
Following are additional sources of information:
Irritable Bowel Syndrome (IBS)/Constipation 1
Irritable bowel syndrome (IBS) is a disorder that leads to abdominal pain and cramping, changes in bowel movements, and other symptoms.
The intestine is connected to the brain. Signals go back and forth between the bowel and brain. These signals affect bowel function and symptoms. The nerves can become more active during stress, causing the intestines to be more sensitive and squeeze (contract) more.
IBS can occur at any age, but it often begins in the teen years or early adulthood. It is twice as common in women as in men. About 1 in 6 people in the U.S. have symptoms of IBS. It is the most common intestinal problem that causes patients to be referred to a bowel specialist (gastroenterologist).
Symptoms range from mild to severe. Most people have mild symptoms. Symptoms are different from person to person.
The main symptoms of IBS are abdominal pain, fullness, gas, and bloating that have been present for at least 3 days a month for the last 3 months. The pain and other symptoms will often:
- Be reduced or go away after a bowel movement
- Occur when there is a change in how often you have bowel movements
People with IBS may switch between constipation and diarrhea, or mostly have one or the other.
- People with diarrhea will have frequent, loose, watery stools. They will often have an urgent need to have a bowel movement, which may be hard to control.
- Those with constipation will have a hard time passing stool, as well as fewer bowel movements. They will often need to strain and will feel cramps with a bowel movement. Often, they do not release any stool, or only a small amount.
For some people, the symptoms may get worse for a few weeks or a month, and then decrease for a while. For other people, symptoms are present most of the time.
Most of the time, your doctor can diagnose IBS based on your symptoms, with few or no tests. Eating a lactose-free diet for 2 weeks may help the doctor check for a possible lactase deficiency.
There is no test to diagnose IBS. Tests may be done to rule out other problems:
- Lifestyle changes can help in some cases of IBS. For example, regular exercise and improved sleep habits may reduce anxiety and help relieve bowel symptoms.
- Dietary changes can be helpful. However, no specific diet can be recommended for IBS, because the condition differs from one person to another. The following changes may help:
- ☒ Avoid foods and drinks that stimulate the intestines (such as caffeine, tea, or colas)
- ☒ Avoid large meals
- ☑ Increase fiber in the diet [link to Fiber Juice in Products]
- Over-the-counter medications may help, but consult your physician before taking anything.
- Anticholinergic medications (dicyclomine, propantheline, belladonna, and hyoscyamine) taken about a half-hour before eating to control intestinal muscle spasms. Bisacodyl to treat constipation. Loperamide to treat diarrhea. Lubiprostone for constipation symptoms.
Other sources of information on IBS:
Following are additional sources of information: