Trouble Swallowing After Stroke (Dysphagia)

Your stroke may cause a swallowing disorder called dysphagia. If not identified and managed, it can lead to poor nutrition, pneumonia and disability.

Aspiration is a common problem for people with dysphagia. It occurs when something you’ve swallowed enters the airway and lungs. Normally, aspiration causes a violent cough, but a stroke can reduce sensation. In this case, you may not know you’re aspirating (silent aspiration).

While in the hospital after a stroke, you are screened to determine your ability to swallow safely. If you have a problem with swallowing safely, you may not be allowed to eat until a speech-language pathologist evaluates how well:

• Muscles in your mouth move.
• You can swallow.
• Your voice box works.

Your health care team will also want to determine the best consistency of foods and liquids for you to swallow. Adequate nutrition is essential. If it’s not safe for you to swallow, a feeding tube may be suggested to help meet your nutritional needs.

The American Speech-Language Hearing Association (ASHA) describes swallowing this way:

“Swallowing happens in three stages, or phases. You can have a problem in one or more of these phases. They include:

• Oral phase (mouth) – sucking, chewing, and moving food or liquid into the throat.
   
• Pharyngeal phase (throat) – starting the swallow and squeezing food down the throat. You need to close off your airway to keep food or liquid out. Food going into the airway can cause coughing and choking.
   
• Esophageal phase – opening and closing the esophagus (the tube that goes from the back of your throat to your stomach). The esophagus squeezes food down to the stomach. Food can get stuck in the esophagus. You may also throw up a lot if there is a problem with your esophagus or if you have acid reflux (commonly known as indigestion or heartburn).”

ASHA identifies these signs of trouble swallowing:

• coughing during or right after eating or drinking
• clearing your throat often after eating or drinking
• having a wet or gurgly voice during or after eating or drinking
• feeling like something is stuck in your throat or chest after eating or drinking
• needing extra work or time to chew or swallow
• having food or liquid leak from your mouth
• food getting stuck in your mouth
• having a hard time breathing after meals
• losing weight 

Common Precautions

These common precautions may help you swallow more safely:

• Sit up straight when you eat or drink.
• Modify the texture of food (softening, chopping or pureeing), adjusting the thinness or thickness of liquids)
• Take small bites and sips.
• Take your time.
• Clear all food from your mouth.
• Avoid distractions to focus on eating.
• Use positioning techniques and maneuvers to redirect the movement of the food. This information is usually provided during the course of therapy. For guidance, consult your medical team or Speech-language pathologist.