People with multiple sclerosis, or MS, often have trouble swallowing, a problem called dysphagia. It can also lead to speech problems. It happens when the disease damages the nerves in the brain and spinal cord that make these tasks happen.
For some people, these problems are mild. Others have a harder time dealing with severe symptoms. But treatments and techniques can help you improve your speech and make swallowing easier.
Symptoms of a Swallowing Problem
- Cough or choke when you eat
- Feel like food is lodged in your throat
- Get a lot of lung infections, like pneumonia, that you can’t explain
When you can’t swallow properly, you might inhale food or liquids into your windpipe instead of getting them down your esophagus and into your stomach. Once in the lungs, they can cause pneumonia or abscesses. You could also be at risk for malnutrition or dehydration because your food and water aren’t getting to your stomach.
Symptoms of Speech Problems
The kinds of speech problems MS causes can vary depending on which part of the brain is damaged. Someone with the disease might have mild trouble with words or severe problems that make it hard for them to speak and be understood. A problem that’s subtle in the beginning might get worse over time.
People with MS usually have a few distinctive language problems:
- “Scanning" speech, when a person’s normal speech pattern is disrupted with long pauses between words or syllables
- Slurring words. It usually happens because of weak tongue, lip, and mouth muscles.
- Trouble changing tone of voice
- Nasal-sounding speech
- Difficulty understanding what people are saying
Getting a Diagnosis
Your doctor will ask you about your symptoms and do a physical exam, paying attention to how well your tongue and other muscles in your mouth and throat work. In some cases, your doctor may recommend that you get a test called a modified barium swallow. You’ll drink a special liquid that coats your mouth, throat, and esophagus, and your doctor will give you an X-ray. The fluid makes your insides stand out on the image. The test helps your doctor pinpoint where and why you’re having trouble swallowing. Your doctor might suggest that you see a speech therapist or a speech-language pathologist. They can figure out which part of your speech is affected and study your breathing control and way you move your lips, tongue, and other parts of your mouth.
Treatment for Speech Problems
If muscle stiffness is making it hard for you to speak, medications might help. Your speech therapist might also suggest:
- Exercises to strengthen or relax your vocal cords or improve how you move your jaw, tongue, and lips
- Strategies other than speech that can help you communicate with others. You might focus on using shorter words and phrases or ways to simplify words, sentences, or sounds.
- Practice controlling your breath. It can help you speak longer sentences in one breath or accent specific words.
There are other ways to manage your speech problems, too:
- Don’t feel rushed or pressured when you’re trying to talk. If you feel comfortable, it may help to let the other person know you have a speech problem.
- Try to talk with someone face-to-face whenever possible. Your facial expressions and gestures can help you get your point across.
- If a conversation goes on too long, ask if you can take a break.
- Try to relax. If you can keep a positive attitude, it might put you and the other person at ease so you won’t feel anxious about understanding each other.
Treatment for Swallowing Problems
A speech therapist can also help with swallowing problems. They might suggest changes in diet, positioning of your head, or exercises that can help. In very severe cases, feeding tubes can deliver nutrients and fluids directly into the stomach. Along with therapy, there are things you can do to make swallowing easier:
- Sit upright at a 90-degree angle, tilt your head slightly forward, or stay sitting or standing upright for 45 to 60 minutes after you eat.
- Stay focused on the tasks of eating and drinking. Keep distractions away. Don’t talk with food in your mouth.
- Go slowly. Aim to eat about 1/2 teaspoon of your food at a time.
- You may need to swallow two or three times per bite or sip. If food or liquid catches in your throat, cough gently or clear your throat, and swallow again before you take a breath.
- Concentrate on swallowing often. Try alternating a bite of food with a sip of liquid.
- Try different temperatures and textures of liquids. For example, you can make drinks colder or try carbonated beverages.
- Drink plenty of fluids. Suck on popsicles, ice chips, or lemon-flavored water to get your mouth to make more saliva, which will help you swallow more often.
- If chewing is hard for you, stay away from foods that need a lot of jaw power.
- If thin liquids make you cough, try thickening them. You can also substitute thin liquids with thicker ones — nectars for juices and cream soups for plain broths, for instance.
- When you take medication, crush your pills and mix them with applesauce or pudding. Ask your pharmacist to let you know which pills you shouldn’t crush and which medicines you can buy in a liquid form.