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Difficulty swallowing is one of the most common health problems affecting people following a stroke. Almost half of stroke survivors experience this disorder, but they may recover quickly. Recovery can be conducted with the help of swallowing therapy. However, as long as the swallowing problems occur, there is a risk of aspiration pneumonia or infectious lung disease which is dangerous.
All About Swallowing Difficulties
In medical term, swallowing difficulties are called dysphagia. Dysphagia is often a sign of a problem with the throat or esophagus (a muscular tube that carries food and liquid from the mouth to the stomach). Dysphagia can happen to anyone, but mostly to babies, adults, and others who have problems with the nervous system or brain.
Many health problems can affect the throat or esophagus so it cannot function properly. Some problems are mild, but some others are serious and severe. If swallowing problems occur only once or twice, it may not be a sign of a serious problem. But if you often have trouble swallowing, chances are there is a more serious problem that demands treatment, including swallowing therapy.
Dysphagia can become more common if the underlying condition is not treated. Symptoms of dysphagia include:
- It takes more effort to swallow food or liquid
- Choking or coughing when swallowing
- Food or liquid coming back up through the throat, mouth, or nose
- Sensation that food is stuck in the throat or chest
- Pain when swallowing
- Pain or pressure in the chest
- Heartburn
- Weight loss because not getting enough food
Causes of Swallowing Difficulties
In normal circumstances, the muscles in the throat and esophagus tighten to move food and liquid from the mouth to the stomach without any problem. But sometimes food and liquid are difficult to get to the stomach because of some problems that interfere with muscle and nerve function.
The causes of the problems include:
- Stroke
- Spinal injury
- Brain injury
- Nervous system problems, such as post-polio syndrome, multiple sclerosis, or Parkinson’s disease
- Immune system problems that cause inflammation and weaken muscles, such as dermatomyositis and polymyositis
- Esophageal spasm (the esophageal muscle suddenly tightens)
- Scleroderma or hardening and narrowing of the esophageal tissue which can weaken the lower part of the esophagus
- Gastroesophageal reflux disease
- Inflammation of the esophagus caused by infection or allergies, among others
- Esophageal tumors
Choking Risks and Complications
If you have dysphagia, there is a risk that food, liquid, or saliva go the wrong way from where it should go to the stomach and enters the airway to the lungs. The result is difficulty breathing, coughing, or choking. The risk of choking and its complications can lead to aspiration pneumonia.
Pneumonia is a lung infection. While aspiration pneumonia is an infection that develops after some foreign materials accidentally enter the lungs. This condition has the potential to become a serious problem and requires medical attention. Foreign materials such as food crumbs or liquids can irritate and even damage the lungs. Elderly people are at greater risk of developing aspiration pneumonia due to swallowing problems.
Symptoms of aspiration pneumonia include:
- Cough, either dry cough or cough with yellow, green, brown, or blood-stained phlegm
- Fever with a body temperature of 38 degrees Celsius or more
- Chest pain
- Difficulty breathing even when resting
Swallowing Disorders After a Stroke
Although it seems simple, swallowing is a complex mechanism that requires the brain to coordinate various muscles. So, when the nerves of the brain are damaged because of a stroke, you might experience swallowing problems as the coordination function of the brain does not work appropriately.
Stroke also can make it difficult for you to perform basic activities of daily living, including eating and drinking. Your arms and hands may not be able to hold a spoon or cup properly. As a result, stroke survivors are more likely to experience dysphagia and the risk of choking and its complications, including aspiration pneumonia.
Anyone who has a stroke should undergo a swallowing assessment within four hours of hospital arrival. During the assessment, the patient should not take food, liquid, or medication by mouth. Stroke survivors are more at risk of developing aspiration pneumonia if they have a compromised immune system, chronic obstructive pulmonary disease, or do not maintain good oral hygiene.
How to Deal with It and Who Can Help
Mild swallowing problems may improve in a few days or weeks. However, if there is a serious underlying health condition, medical help is needed to deal with the disorder. Especially for stroke patients who are considered as elderly.
If you have swallowing problems that affect your quality of life, you can access swallowing therapy provided by the hospital. The therapist will assess your condition to identify the problems in order to formulate a solution as needed.
Treatment of swallowing problems by a therapist is important to ensure recovery while preventing the risk of choking and its complications, including lung infection or aspiration pneumonia which can reduce the quality of life and even threaten the patient’s life.
