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Dysphagia is when someone has difficulty eating, chewing, drinking or swallowing following a stroke.
Up to 65% of people have difficulty swallowing after a stroke.
Many people with dysphagia can be at risk of aspiration (food and/or drink entering the lung).
If dysphagia is severe, you may need to be tube fed. This can be short or long-term. Suitability for tube feeding depends on many factors, and will be discussed by the medical team and you/your family.
What are the risks of dysphagia
You might be at a higher risk of
- Choking
- Dehydration and/or malnutrition
- Weight loss
- Aspiration pneumonia/chest infections
- Psychological and social distress
- Reduced quality of life
- Longer hospital stay
- Death
Signs and symptoms of dysphagia
- Coughing before or after eating/drinking
- Choking on food/drinks
- Wet/gurgly voice when eating or drinking
- Pocketing i.e. food left on the tongue and/or mouth
- Pain e.g. feeling of food sticking in the throat
- Drooling with drinks/saliva
- Food spilling out of the mouth
How to help with dysphagia
- If you have difficulty swallowing tablets, a pharmacist can advise you on alternatives (e.g. liquids or crushable tablets)
- Not all tablets are suitable to be crushed/mixed with water/food and it’s always best to check with a pharmacist first
- Altering the texture of drinks and food helps reduce risks
- Thickened fluids and/or altered diet texture (e.g. pureed, mashed or soft and tender food) can make swallowing easier and safer for some people
- Thickener does not change the taste and smell of food/drink
- There are a range of thickened oral supplements if you need these to help with your nutrition
- Supplements need to be requested via referral to a dietitian or by a GP
- Foods which are crumbly, crispy, stringy or crunchy may be more difficult for some people
- Your speech and language therapist will advise on the safest food/drink options
Exercises
Your speech and language therapist may provide you with specific exercises to improve the effectiveness and safety of your swallow.
- Sit upright for all eating, drinking and for 20 minutes afterwards
- Reduce distractions, for example TV/radio and avoid talking when eating and drinking
- Ensure the mouth (tongue, cheeks, roof of mouth) is clean and clear, using a toothbrush if needed
- If wearing dentures, make sure they are secure before and after eating and drinking
- Feed yourself if possible
- If help is needed, the person helping should wait and watch to check you have swallowed each mouthful and sit close whilst helping
- Monitor for tiredness and change in position, for example slipping down the bed or chair and leaning to one side. Reposition yourself if necessary
- If assisting with feeding, be positive about modified diet and fluids which have been recommended for safety
Nutrition and hydration
Things to consider
- Weakness and visual changes can affect your ability to feed yourself
- Taste changes can make eating less enjoyable
- Post-stroke pain, bowel changes, tiredness or low mood can affect your appetite
- You may feel scared or embarrassed to eat in public due to your swallowing difficulties
- Changes to concentration, attention and memory may impact on how you eat and drink
- Loss of independence (e.g. needing assistance with eating/drinking) might feel undignified
Malnutrition
Malnutrition is the unbalanced amount of nutrients or food needed to stay healthy. It is common after stroke and can affect rehabilitation potential.
People with dysphagia may be more likely to be malnourished.
Poor nutrition is associated with poor recovery and reduced independence at 6 months after stroke. It can also lead to infections and skin damage and, sometimes, an increased risk of dying.
More resources
You can on the Stroke Association website.