Managing Swallowing Problems After a Stroke

Updated April 16, 2015.

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Your ability to swallow can be weakened after a stroke. This problem is called dysphagia. While it may sound like a bothersome problem, swallowing trouble is actually more dangerous than it is annoying. Most stroke survivors who have problems with swallowing impairment do not notice that it is difficult to swallow food and drinks, but instead experience problems such as choking and coughing up food.

Swallowing problems cause the risk of a serious side effect, which is aspiration.

What is Aspiration?

Aspiration means that food, drinks or even saliva can go down the wrong pipe towards the lungs instead of towards the stomach, potentially causing trouble breathing or a lung infection called pneumonia.

Aspiration occurs when the misrouted liquid or bits of food block air from getting into the lungs. This can cause a bout of coughing, which is a reflex that occurs to try to dislodge the droplets of liquid or food particles from irritating the throat and obstructing air. When aspiration is severe, excessive material in the lungs may irritate the lungs and cause pneumonia, which is a type of lung infection.

How Does Aspiration Occur?

Your mouth directs food to the esophagus, which leads to the stomach. Your nose and mouth also direct air to the lungs. After food or air enters the mouth, a small passageway (the pharynx) takes in air and food, and then divides to send food down a food pipe (the esophagus) to the stomach or air down a windpipe (the larynx) to the lungs.

Under normal circumstances, a small structure called the epiglottis closes off the windpipe when we swallow to prevent food from going down the wrong pipe.

Aspiration occurs when food, liquids or even saliva enter the windpipe instead of the food pipe. This can happen during swallowing, or the material may even come back up after going down the correct tube, and enter into the wrong tube.

Why Does a Stroke Cause Aspiration?

Swallowing, which we often take for granted, requires perfect coordination of a number of different muscles controlled by the brain. A stroke affects the muscles involved in swallowing, often preventing proper chewing and swallowing so that food enters the wrong tube.

Sometimes, after a stroke, food that has begun to go down the correct tube may return back up and enter the wrong tube.

A stroke may even cause the swallowing muscles to weaken in such a way that saliva may leak down into the wrong pipe- even if you aren’t actively eating. Normally, our bodies produce saliva, and we reflexively swallow to decrease the buildup in our mouths.

One recent clinical research study used a video recording to evaluate stroke patients and demonstrated that the esophagus remains open for a longer period of time with swallowing, possibly allowing material an excessive opportunity to go down the wrong pipe.

Another research study found that stroke survivors who have larger strokes and strokes that affect the right side of the brain (the non-dominant side)  experience more serious swallowing problems.

What Can You Do?

Managing swallowing problems on your own is not recommended, as swallowing is a complex skill. A speech and swallow evaluation is necessary after a stroke, even if you have not noticed obvious problems with swallowing. Your speech and swallow therapist will recommend foods and liquids of a safe consistency and will also provide you with exercises and a plan to help you advance to other foods.

Some safety recommendations include sitting up at a 90 angle angle during and after meals, pacing yourself as you eat and drink, cutting the food into small pieces and avoiding other activities such as talking, while eating. Some people with severe swallowing problems may sleep in a non-flat position to avoid aspiration.

 

Swallowing problems are not usually the most obvious handicap after a stroke. But, like bladder problems that may occur after a stroke, swallowing difficulties can interfere with your quality of life and can even cause serious health consequences. Taking good care of yourself after a stroke includes getting attention for the subtle effects of your stroke.

 

Sources:

The impact of lesion location on dysphagia incidence, pattern and complications in acute stroke. Part 1: Dysphagia incidence, severity and aspirationSuntrup S, Kemmling A, Warnecke T, Hamacher C, Oelenberg S, Niederstadt T, Heindel W, Wiendl H, Dziewas R, European Journal of Neurology, February 2015

Upper Esophageal Sphincter Opening During Swallow in Stroke Survivors, Kim Y, Park T, Oommen E, McCullough G, American Journal of Physical Medicine and Rehabilitation, March 2015