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What treatments are available?

Treatment for dysphagia is available, so if you do find swallowing difficult it is extremely important that you ask your Primary Healthcare Professional for help. The problem will not usually be cured, but there are so many ways to make eating and drinking easier, that you should not hesitate to seek professional advice.

People who find it hard to swallow need help for two important reasons.

  • Firstly, so that they do not become dehydrated or malnourished.
  • Secondly, to reduce the chance of food and drink ‘going down the wrong way’ and ending up in the airways and lungs, which can lead to pneumonia.

Before treatment can begin it is important that an accurate diagnosis of your difficulty is made because treatment will depend on which of the four stages of the normal swallow is affected.

Treatment falls into four different categories:

  • Surgery/switching medical prescription
  • Physical modification
  • Swallow modification
  • Food modification

How successful the treatment is will depend to a certain extent on you. The more you understand what is going on and take an active role in your treatment, the more encouraged you will feel, the more confidence you will gain, and the more satisfied you will become.

Surgery/switching medical prescription

  • Occasionally, the problem can be helped by surgery, but for the majority of people this is not possible.
  • Sometimes dysphagia is triggered by a medication prescribed for another condition: some drugs to control epilepsy and insomnia for example, can make swallowing hard, so it is worth checking with your GP to see if these may be the cause of your problem.

Physical modification

  • Always sit up as straight as possiblewith your shoulders level.
  • If food gets stuck – for even a short time – stand up, stretch the top half of your body and walk around, it may help the food slip down into your stomach – never lie down.
  • If the muscles in your jaw and tongue are weak you can be taught exercises to strengthen them so that chewing becomes more effective.
  • Learn to take deep long breaths (speech therapists can teach people how to breathe more effectively as well as help people strengthen the muscles in their tongue and larynx).
  • If you have false teeth, make sure they are fitting properly.
  • Do not eat less than three hours before you go to bed. If food gets stuck in your oesophagus overnight it can be very uncomfortable and sometimes painful.

Swallow modification

  • Cut up your food into small mouthfuls or ask someone to do this for you.
  • If you have lost your sense of smell and taste you will not always produce enough saliva to soften your food. Make sure that your food looks as appetising as possible and that your meals have plenty of colour.
  • Have plenty of drinks to hand to help food to pass.
  • Make sure you have plenty of time to eat and you are not rushed.
  • Try to eat in peace and quiet, without stress and without other people standing over and watching you.

Food modification

If your problem is in the lower part of your oesophagus you may find it impossible to eat any solid food at all. In this case you will need to modify your food and change the texture so that it can be swallowed safely.

  • Liquids need to be thickened: you might think that water and liquids are easier to swallow, but when you have little control over the flow, it is all too easy for them to pass into your airways and lungs. Thickening agents are available to you on prescription through your Primary Healthcare Practitioner or a Dietitian.
  • Food that is a bit sour, served with lemon, for example can trigger the swallowing reflex automatically.
  • Food needs to look good to stimulate appetite. Puree meat and vegetables separately so they do not look unappetising. Use deep-coloured vegetables – broccoli and spinach, for example.
  • Solid foods need to be pureed or softened, so they need less chewing and require less propulsive force to clear them through the pharynx.

Tips for managing life with dysphagia

Food to avoid if you are able to eat some solid food

  • Meat, unless it is well cooked and casseroled
  • Fresh fruit
  • Uncooked vegetables
  • Sticky types of bread: white bread and doughnuts, for example
  • Fruit yoghurts with pieces of fruit

Tips for serving food

  • Serve your food on small plates: anything large looks intimidating and can kill off your appetite
  • Serve small portions – you can always come back for more
  • Make sure fluid is at hand, making sure it is of the correct texture
  • Make sure you can eat in peace and quiet

If you are preparing food and feeding someone who cannot feed themselve

  • Always make sure the patient is sitting upright
  • Place the plate near to hand so that they can reach it easily
  • Do not rush, or hover over them
  • If they wear glasses, a hearing aid, or have false teeth, check that all are in place before food appears
  • Check that you can be heard
  • Sit below the person so they can see you
  • Let the person see, smell and taste the food to encourage saliva to flow and to improve their appetite before you start feeding
  • Avoid contact with teeth to avoid biting the spoon
  • Put a small amount of food on the spoon
  • Place food in the middle of the mouth in the front third of the tongue, and push tongue down (this stops the tongue falling back into the mouth and getting in the way of the swallow)
  • Give plenty of time for chewing and swallowing
  • Make sure the mouth is empty before offering next portion
  • The patient should remain upright for at least 20 minutes after they have finished their meal.

SAMPLE MENU
 
Breakfast

Thickened coffee or tea; suitable cereal e.g. porridge or rice pudding (served with brown sugar and whipped cream)*
 
Mid-morning

Thickened juice, smooth full fat yoghurt or fortified milkshake
 
Lunch

Thickened soup; mashed potato, pureed spinach, pureed fruit

Afternoon

Thickened coffee, tea, soft cakes and biscuits
 
Evening

Thickened soup; pureed meat, mashed potato; soft-boiled vegetables; fruit (banana or stewed fruit) Thickened tea
 
Late evening

Thickened juice
 
* For people requiring fortified meals to reduce the risk of malnutrition