Swallowing, just like breathing or blinking, is a relatively intuitive mechanism that you probably pay little attention to in everyday life. However, if you have ever experienced swallowing problems due to a cold or flu, you will understand how irritating pain when swallowing can be. Here you can find out the potential causes of swallowing problems and what you can do about them!
What is dysphagia
Even if you may not be familiar with this term, you have probably already been affected by it. Medical professionals summarise all types of swallowing difficulties (this includes not only swallowing problems but also pain when swallowing) under the term: dysphagia.
Dysphagia is divided into two groups
- Oropharyngeal dysphagia (difficulty swallowing in the mouth or throat)
- Oesophageal dysphagia (difficulty swallowing in the oesophagus)1
Despite growing nutritional awareness and improved food security in developing countries, malnutrition is a pervasive public health issue. While caloric deficiencies and famines are now history in most countries, deficiencies of individual nutrients due to unbalanced diets are on the rise in some countries.1
How do swallowing difficulties arise
Swallowing is something completely intuitive for you as a human being. You don't need to concentrate on swallowing - it is one of many subconscious mechanisms in your body. Nevertheless, the act of swallowing is more complex and sophisticated than you might think. In order to understand the enormous variety of causes, it is important to understand the mechanism of swallowing. Every swallow you make goes through three phases.
The swallowing process
Phase 1 - The oral phase
The tongue collects liquids and solid food and prepares them for swallowing.
Phase 2: The pharyngeal phase
This phase begins as soon as the tongue pushes the food to the back of the mouth. A swallowing reaction is triggered, during which the food passes through the pharynx or throat. During this phase, the respiratory function is blocked to prevent food or liquids from entering the trachea or lungs.
Phase 3: The oesophageal (gullet) phase
The food then enters the oesophagus. Depending on the consistency of the food, this phase can take a little longer. When swallowing a saturo drink, it probably only takes around 3 seconds, when swallowing a larger tablet or large, solid food a little longer.2
Problems with organs, muscles and nerves can lead to dysphagia
Older adults are most commonly affected by dysphagia.3Dysphagia occurs when there is a problem with the nerve control, muscles or organs that are directly or indirectly involved in the swallowing process.
Here are some of the many potential causes of swallowing difficulties:
Congenital and developmental problems
Sometimes problems with swallowing are due to growth or genetics:
- Cleft lip and palate: A common birth defect that results in a cleft in the upper lip or palate. Also known as harelip.
- Learning disabilities
- Cerebral palsy - a collective term for various neurological conditions that can affect your movement and coordination.[<[sup>4
Nerve damage or irritation
Damage to the nervous system (especially in the brain and spinal cord) can disrupt the nerves responsible for initiating and regulating the swallowing mechanism. Neurological causes include:
- A stroke
- Myasthenia gravis - a rare disease that weakens muscles
- Neurological diseases that cause chronic damage to the brain and nervous system, including Parkinson's disease, multiple sclerosis, dementia and motor neurone disease.[<[sup>5
- Brain tumour
Physical blockages
Conditions that cause a blockage in the throat or narrowing of the oesophagus can make swallowing difficult.
These include:
- Cancer of the larynx or oesophagus
- Throat pouch is a rare condition that usually occurs in older people. A sac forms in the upper part of the oesophagus, which can affect the ability to swallow.
- Radiation therapies can cause scarring, which can narrow the throat and oesophagus.
- GERD (reflux disease) - stomach acid can also lead to scar tissue in the oesophagus, which narrows it.
- Oesophagitis - this inflammation, in which the oesophagus burns, can in turn be caused by various infectious diseases such as thrush or tuberculosis.
Muscular diseases
Rare diseases that affect the muscles used to push food down the oesophagus and into the stomach can cause dysphagia.
These include:
- Scleroderma - the immune system attacks healthy tissue, resulting in stiffening of the throat and oesophageal muscles6
- Achalasia - muscles in the oesophagus lose their ability to relax and open, preventing food and liquid from entering the stomach
Can the causes of swallowing difficulties be psychological?
Psychogenic dysphagia is a rare swallowing disorder without an obvious cause or organic disease. The most common symptom appears to be fear of swallowing. However, psychogenic dysphagia is often misdiagnosed. Doctors may tend to attribute the patient's dysphagia to their mental condition if they cannot find any physical causes.7
Pain when swallowing: What you can do
The serious diseases mentioned above, such as multiple sclerosis, oesophageal cancer or Parkinson's disease, are only rarely the cause of dysphagia.
In particular, swallowing difficulties that are accompanied by pain or swallowing pain alone are usually caused by relatively harmless infections, allergic reactions or inflammation. The most common of these causes are:
- Acid reflux with heartburn
- Chronic cough
- Sore throat
- Cold
- Flu
- An infectious disease in the throat
- Tonsillitis8
- Jaw locking
- Wisdom tooth surgery
- Root canal treatment
If your swallowing pain is accompanied by any of the following symptoms, you should make an appointment with your doctor
- Joint pain
- A foreign body sensation in the neck or neck pain with difficulty swallowing
- A rash
- Bloody cough
- Symptoms, that do not improve and last a week or longer
- A hoarse voice that lasts for several weeks
If you experience any of the following symptoms, you should go to the hospital immediately
- It is difficult for you to opening your mouth
- Breathing problems
- Extreme sore throat that gets worse
If your swallowing pain occurs without any accompanying symptoms and you find it bothersome, you may be able to relieve the pain with the following measures
- . with the following measures
- Drink plenty of fluids. At least eight glasses of water a day will not only hydrate you, but also soothe and moisturise your (probably irritated) throat.
- Mix 1 teaspoon of salt in a glass of water and gargle it down your throat. Then spit out the liquid. The salt water can reduce your swelling and thus relieve the associated pain.
- Drink plenty of warm liquids such as sage tea (sage has an antiseptic and antibacterial effect) or water to relieve pain.
- A humidifier increases the humidity in a room. Breathing in this humid air can soothe sore throats and relieve throat pain. If you don't have a humidifier, you can also take a hot shower and breathe deeply in the steam from the shower cubicle.
- Avoid things that are known to put additional stress on your throat. Various chemicals and smoke from cigarettes and cigars are particularly irritating to the throat.9
Eating with swallowing difficulties
Whether you suffer from chronic swallowing difficulties or they are the result of a temporary infection, they are always annoying. You may then tend to eat less or switch your diet to foods that are easy to swallow. However, as swallowing difficulties are usually caused by illnesses that need to be fought by the immune system, it is important that you nourish your body well to strengthen your immune system.
FAQ
What can cause swallowing difficulties?
As already mentioned, swallowing is a surprisingly complex mechanism involving many organs, muscles and nerves. Accordingly, there is a wide range of potential causes for dysphagia.
What can I do if I have difficulty swallowing?
You should get to the bottom of the cause without worrying unnecessarily. In most cases, common infections or inflammations are responsible for the swallowing difficulties. You can find out above when action is needed. Of course, you can also try to alleviate your symptoms at home with the remedies mentioned above, but these should never replace a consultation with a doctor.
What are swallowing difficulties?
Swallowing difficulties are also known as dysphagia. It is often accompanied by the following symptoms
- Coughing when eating or drinking
- Chronic drooling
- Cannot chew food properly
- Choking food back up, sometimes through the nose
- A feeling that food is stuck in the throat or chest
- A "gurgling" wet-sounding voice when eating or drinking
Are swallowing difficulties dangerous?
Difficulty swallowing can be dangerous or indicate a serious illness. However, this is not usually the case. The majority of swallowing problems can be attributed to the typical annual recurring illnesses and inflammations. Nevertheless, there is a need for clarification if swallowing problems persist for a longer period of time. If the pain suddenly gets much worse or you experience breathing problems, you should always call an emergency doctor.10
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Sources
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- Panara, K., Ramezanpour Ahangar, E., & Padalia, D. (2020). Physiology, Swallowing. In StatPearls. StatPearls Publishing.
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- Chilukuri, P., Odufalu, F., & Hachem, C. (2018). Dysphagia. Missouri medicine, 115(3), 206-210.
- Wiles C. M. (1991). Neurogenic dysphagia. Journal of neurology, neurosurgery, and psychiatry, 54(12), 1037-1039.
- Montesi, A., Pesaresi, A., Cavalli, M. L., Ripa, G., Candela, M., & Gabrielli, A. (1991). Oropharyngeal and esophageal function in scleroderma. Dysphagia, 6(4), 219-223.
- Ravich, W. J., Wilson, R. S., Jones, B., & Donner, M. W. (1989). Psychogenic dysphagia and globus: reevaluation of 23 patients. Dysphagia, 4(1), 35-38.
- Carucci, L. R., & Turner, M. A. (2015). Dysphagia revisited: common and unusual causes. Radiographics : a review publication of the Radiological Society of North America, Inc, 35(1), 105-122.
- Triggs, J., & Pandolfino, J. (2019). Recent advances in dysphagia management. F1000Research, 8, F1000 Faculty Rev-1527.
- O'Rourke, F., Vickers, K., Upton, C., & Chan, D. (2014). Swallowing and oropharyngeal dysphagia. Clinical medicine (London, England), 14(2), 196-199.
