Swallowing Problems

Medically Reviewed by Zilpah Sheikh, MD on August 17, 2023
6 min read

Dysphagia is when you find it difficult, sometimes impossible, to swallow. Swallowing seems simple, but it's actually pretty complicated. It takes your brain, several nerves and muscles, two muscular valves, and an open, unconstricted esophagus (your swallowing tube) to work just right.

The act of swallowing normally happens in three phases, and dysphagia can occur at any of them.

Oropharyngeal dysphagia. In the first phase of swallowing, food or liquid is contained in the mouth by the tongue and palate (oral cavity). This phase is the only one you can control.

Pharyngeal dysphagia. The second phase begins when your brain makes the decision to swallow. At this point, a complex series of reflexes begin. The food is thrust from the oral cavity into the throat (pharynx). At the same time, two other things happen: A muscular valve at the bottom of the pharynx opens, allowing food to enter the esophagus, and other muscles close the airway (trachea) to prevent food from entering the airways. This phase takes less than half a second.

Esophageal dysphagia. The third phase starts when food enters the esophagus. The esophagus, which is about 9 inches long, is a muscular tube that produces waves of coordinated contractions (called peristalsis). As the esophagus contracts, a muscular valve at the end of the esophagus opens and food is propelled into the stomach. The third phase of swallowing takes 6 to 8 seconds to complete.

A wide range of issues can cause dysphagia. These include:

  • Disturbances of the brain such as those caused by Parkinson's disease, multiple sclerosis, or ALS (amyotrophic lateral sclerosis, or Lou Gehrig's disease)
  • Problems with the oral or pharynx muscle, such as from a stroke
  • Loss of sphincter muscle relaxation (called achalasia)
  • Contractions of the esophagus after swallowing known as diffuse spasms 
  • Esophageal stricture, which is when your esophagus narrows, making it difficult for food to pass. This may be caused by GERD (gastroesophageal reflux disease), which can lead to tumors or scar tissue.
  • Blockage in your throat or esophagus by objects such as food, which is more likely in older people who wear dentures and have trouble chewing
  • An esophageal ring, or narrowing in the lower esophagus
  • Eosinophilic esophagitis, which may be related to a food allergy 
  • Frequent heartburn, which can weaken your esophagus when acid backs up into the esophagus
  • Inflammation and scarring of the esophagus caused by radiation therapy for cancer 

The most common complication of dysphagia is choking or coughing when you can't swallow food correctly and your airways are blocked. Due to fear of choking, you may avoid eating and drinking. That could lead to poor nutrition or dehydration. 

You can also develop chest infections such as pneumonia because of dysphagia. This can happen when you inhale a small piece of food, irritating your lungs. 


Under normal circumstances, people rarely choke during a meal. Occasionally, food will stick in the esophagus for a few seconds. But it most often passes on its own or can be washed down easily with liquids. But there are a number of symptoms that could signal a possible swallowing problem, including:

  • Frequent choking on food
  • It takes more than a few seconds to swallow
  • Pain when swallowing
  • Repeated pneumonia, which could mean food is going into the lungs rather than the esophagus

Call 911 or go to the emergency room if food is lodged in your esophagus for more than 15 minutes and doesn't pass spontaneously or with liquids.

Some people have swallowing problems and don't realize it. They may unconsciously choose foods that are easier to eat, or they may eat more slowly. But untreated swallowing problems raise the risk of choking.

If you think you have a swallowing problem, talk to your doctor. You may get tests such as:

Cineradiography: This is an imaging test in which a camera is used to film internal body structures. You'll swallow something that includes barium (a liquid or other form that lights up under X-ray). Your doctor will use an X-ray machine to watch it pass through your esophagus. This is often done under the guidance of a speech pathologist, an expert in swallowing as well as speech.

Upper endoscopy: A flexible, narrow tube (endoscope) is passed into your esophagus. It projects images of the inside of the pharynx and esophagus on a screen.

Manometry: This test measures the timing and strength of esophageal contractions and muscular valve relaxation.

Impedance and pH test: This test can tell if acid reflux is causing a swallowing problem.

Treatment depends on the type of dysphagia you have. Sometimes, a swallowing problem will resolve itself without treatment. Other times, swallowing problems can be managed easily. Complex swallowing problems may require treatment by a specialist or several specialists.

If you have a chewing or swallowing problem, there are several things you can do to make eating and drinking easier and safer:


  • Sit upright at a 90-degree angle.
  • Tilt your head slightly forward.
  • Remain sitting upright or standing for 15 to 20 minutes after eating a meal.

Dining environment

  • Minimize distractions in the area where you eat.
  • Stay focused on the tasks of eating and drinking.
  • Don't talk with food in your mouth.

Amount and rate

  • Eat slowly.
  • Cut food into small pieces and chew it thoroughly. Chew food until it becomes liquid in your mouth before swallowing.
  • Don't try to eat more than 1/2 teaspoon of 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 often.

Saliva management

  • Drink plenty of fluids.
  • From time to time, suck on ice pops, ice chips, or lemon ice or drink lemon-flavored water to boost saliva production. That will increase swallowing frequency.

Food consistency

  • Avoid foods that are tough to chew.
  • Puree food in a blender.
  • If thin liquids make you cough, use a liquid thickener (your speech pathologist can recommend one). Substitute thicker liquids for thin ones, such as nectar for juice and cream soup for broth.

Taking medications

  • Crush pills and mix them with applesauce or pudding.
  • Ask your pharmacist for their recommendations on which pills shouldn't be crushed and which medications you can get in liquid form.

Dysphagia is when you can't swallow correctly, leading to problems eating and drinking. Many things can cause swallowing problems, most having to do with the esophagus. If you regularly choke during meals, talk to a doctor. 

  • What is the main cause of dysphagia?

    There are many causes of dysphagia. But it's usually caused by another health condition such as cancer, a condition that affects the nervous system (dementia, stroke, or head injury), or gastroesophageal reflux disease (GERD)

  • What is the first symptom of dysphagia?

If you have pain when you swallow or frequently choke on your food, you may have dysphagia and should speak with a doctor.

  • What disease is related to difficulty swallowing?

Diseases of the esophagus could be the underlying reason for dysphagia. Conditions such as esophageal ring or eosinophilic esophagitis may lead to trouble swallowing,

  • When should I be worried about trouble swallowing?

If you regularly choke on your food, it takes longer than usual for your food to go down, you have pain when you swallow, or you have repeated cases of pneumonia, talk to your doctor about dysphagia.