Multiple Sclerosis: Speech and Swallowing Problems

People with multiple sclerosis (MS) often have swallowing difficulties. In many cases, they are associated with speech problems as well.

What Causes Speech and Swallowing Problems in People With MS?

Like other symptoms of MS, if you're experiencing swallowing or speech difficulties, it's because you have an area of damaged nerves that normally aid in performing these tasks.

Locating the damaged areas responsible for the speech problem is often difficult. Many areas in the brain, especially the brainstem, control speech patterns. Thus, lesions -- damaged areas -- in different parts of the brain can cause several types of changes in normal speech patterns. They range from mild difficulties to severe problems that make it difficult to speak and be understood.

What Are the Symptoms of a Swallowing Problem?

• Coughing or choking when eating
• Feeling like food is lodged in the throat
• Unexplained recurrent lung infections (pneumonia)
• Otherwise unexplained malnutrition or dehydration

When swallowing difficulties are present, food or liquids that you eat may be inhaled into the trachea (windpipe) instead of going down the esophagus and into the stomach. Once in the lungs, the inhaled food or liquids can cause pneumonia or abscesses. Because the food or drink is not reaching the stomach, a person may also be at risk for malnutrition or dehydration.

How Are Swallowing Problems Diagnosed?

Initially, your doctor will ask you many questions about the nature of your problem and perform a physical exam, paying attention to the function of your tongue and swallowing muscles.

Occasionally, your doctor may recommend that you get a test called a modified barium swallow. This is a special imaging procedure where you drink or eat contrast material of different consistencies -- solid, thick liquid, and thin liquids after which a machine takes pictures tracing the path of the contrast material. Thus the precise location and manner of the swallowing problem can be identified.

How Are Swallowing Problems Treated?

A speech therapist (or speech and language pathologist) usually treats swallowing problems. Treatment typically consists of changes in diet, positioning of the head, exercises, or stimulation designed to improve swallowing. In very severe cases that do not respond to these measures, feeding tubes may be inserted directly into the stomach to provide the necessary fluids and nutrition.

Here are some tips that may make swallowing easier:

• Sit upright at a 90-degree angle, tilt your head slightly forward, and/or remain sitting or standing upright for 45 to 60 minutes after eating a meal.
• Minimize distractions in the area where you eat. Stay focused on the tasks of eating and drinking. Do not talk with food in your mouth.
• Eat slowly. Cut your food into small pieces and chew it thoroughly. Do not try to eat more than 1/2 teaspoon of your food at a time.
• You may need to swallow two or three times per bite or sip. If food or liquid catches in your throat, cough gently or clear your throat, and swallow again before taking a breath. Repeat if necessary.
• Concentrate on swallowing frequently. It may help to alternate a bite of food with a sip of liquid. If you have difficulty sucking liquid all the way up a straw, cut the straw down so that there is less distance for the liquid to travel.
• Change the temperature and texture of liquids (make the liquids colder, try carbonated beverages).
• Drink plenty of fluids. Periodically suck on Popsicles, ice chips, lemon ice, or lemon-flavored water to increase saliva, which will increase swallowing frequency.
• If chewing is difficult or tiring, minimize (or eliminate) foods that require chewing, and eat more soft foods. Puree your foods in a blender.
• If thin liquids cause you to cough, use a liquid thickener. You can also substitute thin liquids with thicker liquid choices such as nectars for juices and cream soups for plain broths.
• When taking medication, crush your pills and mix them with applesauce or pudding. Ask your pharmacist for recommendations on which pills should not be crushed and which medications can be purchased in a liquid form.