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Dysphagia – Swallowing difficulties

Dysphagia, or difficulty in swallowing, means that a person has difficulty eating, chewing, swallowing and transporting food from the mouth to the stomach.

Here you can read more about what causes dysphagia and how you can treat dysphagia using IQoro.

What does dysphagia mean?

Dysphagia means that there is a disturbance in the eating and swallowing capacity. This is also known as having swallowing difficulties and means that a person has difficulty, for example, chewing, swallowing or transporting food and drink from the plate to the stomach.

The medical term dysphagia comes from the Greek “dys”, meaning bad or disordered, and “phag”, meaning eat.

Why do you have swallowing difficulties?

Find out with a simple 3 minute self-test
— immediate results.

What causes dysphagia?

Dysphagia can be caused by many things and anyone can be affected, from babies, children and youths to adults and senior citizens.

Some common reasons for difficulties in swallowing are:

  • weakened muscles
  • neurological illnesses (Parkinson, MS, ALS)
  • paralysis after a stroke
  • cancer
  • Down’s syndrome
  • cleft palate
  • over or underbite

Problems can occur in different places

Dysphagia can occur at one or several levels of the swallowing process and are therefore separated into four different types of swallowing difficulties, depending on which part of the process the swallowing difficulties occur in.

Some people experience greatest discomfort at the introductory phase of eating. They may find it difficult to chew or keep food in their mouth. Others have problems lower down, for example with food easily getting stuck in the windpipe, or having a blocked feeling in their chests when they try to swallow.

Below, you can read more about the different types of dysphagia, what the root causes are, and why problems occur.

If you have swallowing difficulties, it is important that you seek medical advice in order to get to the cause behind the problems and to rule out other illnesses.

A lot of people have difficulties swallowing

In Sweden a million people a year suffer from varying degrees of dysphagia. To that one can add the further million people, who have not received optimal treatment or any treatment at all, that have dysphagia from before.

In total it is estimated that approximately two million people in Sweden suffer from dysphagia. But because public knowledge of dysphagia is limited, the actual number is probably greater. This makes dysphagia one of the greatest obstacles to normal function that we have, but perhaps also the one that we talk about least.

Treatment of dysphagia

Because we normally swallow approximately 600 times a day, it is easy to understand that difficulty in swallowing becomes a constant battle that can lead to anxiety and a lot of suffering.

For that reason, it is also very important to also treat dysphagia so that the affected person can return to a normal life.

We have already mentioned that dysphagia can be due to several different problems, but common to all of these is that the causes behind it are either weakened muscles or poor function in the neurological pathways of the swallowing process. This can be treated with IQoro.

Take a simple self-test and find out whether weakened muscles (a hiatus hernia) are the underlying cause of the swallowing difficulties.

IQoro against dysphagia

IQoro is a neuromuscular training tool that activates nerves and strengthens the muscles of the whole swallowing process.

Treatment with IQoro is simple to perform, but it does require a daily routine. Training takes 30 seconds per session and to get the best results, it should be carried out three times a day, preferably before meals.

There are two primary things that happen to the body when being treated using IQoro that makes it effective for people with different types of swallowing difficulties.

  1. All 148 muscles that are part of the swallowing process are activated, from the lips, tongue and throat, down to the oesophagus, diaphragm and upper section of the stomach. When you use IQoro it is high intensity training that, if carried out regularly, strengthens the weakened muscles that is the cause of the discomfort.

    It helps to gain control over the swallowing process so that food is safely transported to the stomach.
  2. The neural pathways between the mouth and the brain – and then back to the pharynx, oesophagus and diaphragm – are exercised, and over time will give stronger contact between the brain and the body’s different functions.

    This gives the different parts of the swallowing process a chance to start working normally again after being damaged or weakened.
    If you want to read more about the nerves involved in the swallowing process, we recommend reading the following:

More about the nerves in the swallowing process

Four different types of dysphagia

In the same way as the swallowing process can be divided into four different phases, so can the different types of dysphagia – swallowing difficulties. These are the four vital stages:

  1. Pre-oral phase – when the food is transferred from plate to mouth.
  2. Oral phase – when the food is chewed and processed in the mouth: also called ’mouth phase’.
  3. Pharyngeal phase – when the bolus passes the front palate (anterior palatal arch) and the pharynx: also called ’pharynx phase’.
  4. Esophagal phase – when the food is transported through the esophagus: also called ’esophagus phase’

Below we go into more detail on each of these different phases in the reverse of the natural order shown above: beginning with the esophagal phase, and working our way upwards to the pre-oral phase.

Esophagal dysphagia

This is what we call the swallowing problem that affects the esophagus’ function.

Esophagal dysphagia can be further divided into two subgroups:

Intermittent esophagal dysphagia – the problem comes and goes

This is the most common type of dysphagia – one in ten people that are otherwise-healthy have hiatus hernia which causes this type of dysphagia. [5]

It is common that those that suffer from a hiatus hernia experience some of the following symptoms, either during, or shortly after, swallowing. The problem comes and goes to start with, but after a while becomes more persistent. A full list of the usual symptoms is shown under hiatus hernia.

If untreated, symptoms can worsen with time, and more symptoms can occur, creating problems in everyday living. From an initial position that the problem comes and goes, it can worsen until it is experienced at almost every mealtime. For this reason it is extremely important to get started with treatment as early as possible.

Read more under hiatal hernia about the usual symptoms, why your body reacts as it does.

Constant esophagal dysphagia – always a block in the chest

With constant dysphagia there is always a block in the chest with food morsels you try to swallow that are larger than a certain size. This can be caused by some form of narrowing of the esophagus caused for example by scar tissue, or by pockets along the oesophagus, or by a tumour.

Achalasia cardiae – is a rare type of constant oesophagal dysphagia whose symptoms can sometimes be similar to hiatus hernia. The differences however are several: for example a person with achalasia cardiae will have constant difficulties in swallowing food, experience rapid weight loss, be victim to repeated pneumonias, but will not experience acid reflux or heartburn.

Read more on the differences under achalasia cardiae

If you suspect some form of constant esophagal dysphagia you should immediately ask for a referral to an Ear, Nose and Throat (ENT) doctor, a surgeon or a gastroenterologist.

Causes of esophagal dysphagia

Various reasons for this type of dysphagia can be: hiatal hernia, achalasia cardiae, tumors, malformations or schleroderma. 

Pharyngeal dysphagia

It is typical for this type of dysphagia that food ’goes down the wrong way’ into the airways because of misdirected swallowing; and that the patient’s voice sounds odd as a result. This can be caused by reduced feeling or muscle strength to close the epiglottis to protect the airway during swallowing.

Morsels of food can also remain in the pharynx after swallowing, and later work their way up into the nose. Misdirected swallowing can also be caused by a muscular inability to be able to open the upper mouth of the esophagus, or a lack of strength to transport the bolus through the pharynx to the esophagus.

Causes of pharyngeal dysphagia

Various reasons for this type of dysphagia can be: stroke or some type of neurological disease like Parkinson’s, MS, or ALS. Pharyngeal dysphagia can also occur after radiation injurieswhiplash injuries or a conditioned reflex.

Oral dysphagia

This type of dysphagia means that you find it hard to chew, mix the food with saliva in your mouth, to transport the food backwards towards your pharynx, and that sometimes it can remain in your mouth because the swallow reflex has not cut in.

Here, the affected areas are primarily the oral cavity including the lips’, cheeks’ and tongue’s functions, together with the swallow reflex from the anterior palate.

Causes of oral dysphagia

Various reasons for this type of dysphagia can be: strokeDown syndrome, cleft palateParkinson’s disease, ALS, MS, Sjögrens syndrome, dryness in the mouth, medicine-induced dryness in the mouth, tumorsradiation injuries, extreme anxiety, poor bite, bad teeth, poor jaw function, senility or conditioned reflex.  

Pre-oral dysphagia

This form of dysphagia is concerned with the problems in being able to transport food from your plate to your mouth yourself.

For example, after a stroke which has caused paralysis in one arm, an inability to hold the head and body in balance in an upright position, difficulties in focusing and seeing the food, and also tiredness and a lack of initiative can all be a problem.

Causes of pre-oral dysphagia

Various reasons for this type of dysphagia can be: stroke, with paralysis in an arm or leg which can cause poor posture or difficulties in sitting up straight, cerebral palsy, Parkinson’s disease, ALS, multiple sclerosis, paralysis caused by injury, age-related weakness, senility, dementia or Alzheimer’s disease.

To be able to look after yourself, and transport your own food from your plate to mouth has a huge effect on your mealtime experience and quality of life.

Medical consequences of dysphagia

To be able to express our emotions facially, eat, suck, swallow, breathe and talk are abilities that we take for granted – until the day someone close to us loses those functions. Only then do we realise that problems in the mouth, pharynx and esophagus affect our most fundamental and important life functions that are crucial for our well-being.

The oral cavity plays a central role in an individual’s development, and we must stimulate and use the involuntary musculature that is involved when we eat, suck, chew, swallow, breathe and talk.

Injuries or impairment in this area can lead to changes in the normal pattern of swallowing, which in their turn can create alarming new symptoms with grave medical consequences.

An impaired swallowing capacity, where muscles in the face, mouth, and throat are dramatically weakened, can lead to secondary difficulties. Poor facial development can lead to speech-, sucking-, and chewing difficulties, deformed appearance, breathing problems, sleep apnoea and bite- and jaw impairment.

Reduced life quality – the victims suffer in silence

Food and drink are almost always involved when we meet with friends, family, colleagues at work, business partners or when we celebrate events. This means that people with swallowing difficulties – dysphagia – are often embarrassed, hold themselves back, or simply don’t participate.

Dysphagia has a negative effect on both healing and rehabilitation, which is strongly correlated to extended care periods, more complicated care interventions, reduced quality of life and great personal suffering for those that are affected, and those close to them.

Dysphagia meets WHO’s criteria for being a handicap and means, for those who are affected by it, a hidden physical, psychological and social suffering.

Limited understanding from those close by

Depending upon what caused the swallowing difficulties, it can be more or less difficult for relatives and friends to accept the problem and see how they can best support the sufferer.

If you are affected, it is common to be met with scepticism, fear and lack of understanding because most people are not acquainted with dysphagia and lack knowledge about it. Unfortunately for many, it can be that when they seek help from healthcare professionals they are misunderstood until they come in contact with a specialist.

If you are otherwise fit but, for example, suffer from a hiatus hernia, it can be difficult for those around you to understand that this is a huge problem in your daily life. Often, you may be told by others, and you might believe yourself, that it’s all in your head – which is completely wrong.

This is something that we want to change, together with those that are suffering. We’ll do this by spreading knowledge on what dysphagia is, explaining the causes behind the dysfunction and showing how, nowadays, this can be treated.

Reference sources

  1. Svensson, P. (2008) I Hartelius, L., Nettelbladt, U. & Hammarberg, B. (red.). Logopedi. Lund: Studentlitteratur.
    (English translation: ”Speech therapy”).
     
  2. Logemann, J.A. (ProEd) (1998). Evaluation and treatment of swallowing disorders(2nd ed) Austin, Texas: San Diego College
     
  3. O’Neill, P.A. (2000). Swallowing and prevention of complications. British medical bulletin, 56(2), 457-65.
     
  4. Tibbling-Grahn L, broschyr 03 Svenska Dysfagiförbundet, Stoppar maten upp i bröstet när du äter? Mellangärdesbråck – En vanlig matstrupssjukdom i alla åldrar.(pdf).
    (English translation: ”Does food get stuck in your chest when you eat? Hiatus hernia – A common sickness in people of all ages”).
     
  5. Kjellén G, Tibbling L. Manometric oesophageal function, acid perfusion test and symptomatology in a 55-year-old general population. Clinical Physiology. 1981; 1:405-15
     
  6. Ekberg O, (2011), Röntgendiagnostiska avdelningen, Universitetssjukhuset MAS, Malmö, Normal sväljning inclusive anatomi och fysiologi, (pdf). Hämtad 2015-12-05, kl 15.00,
    http://media1.dysfagi.se/2011/06/svaljningssvarigheter.pdf
    (English translation:” Normal swallowing including anatomy and physiology”).
     
  7. 1177.se, (2016), Muskler och senor, Hämtad 2016-09-20, kl 13.45,
    https://www.1177.se/gavleborg/liv–halsa/sa-fungerar-kroppen/muskler-och-senor/
    (English translation:”Muscles and sinews”).

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