A stroke can cause a swallowing disorder called dysphagia, which affects the way food is moved around in the mouth and the ability to swallow. Dysphagia can cause food or drink to go down the wrong way and get into the lungs, which can lead to aspiration pneumonia. This is when food or fluids enter the lungs instead of the stomach, causing a life-threatening chest infection. While in the hospital after a stroke, patients are screened to determine their ability to swallow safely, and if there is a problem, they may be referred to a speech-language pathologist for further evaluation and treatment. The recovery of swallowing function varies, with some people regaining the ability within a few weeks, while others may have long-term or permanent difficulties.
Characteristics | Values |
---|---|
Prevalence of dysphagia after a stroke | 23% to 50% of stroke patients |
Definition of dysphagia | A disruption of bolus flow through the mouth and pharynx |
Definition of aspiration | The incursion of food material into the airway and beyond the true vocal cords |
Risk of aspiration pneumonia for dysphagic stroke patients | Sevenfold increased risk |
Risk of mortality for dysphagic stroke patients | Threefold increased risk |
Risk of malnutrition for dysphagic stroke patients | High |
Risk of dehydration for dysphagic stroke patients | High |
Risk of weight loss for dysphagic stroke patients | High |
Risk of lung infections for dysphagic stroke patients | High |
Risk of pneumonia for stroke patients | High |
Risk of silent aspiration | High |
Treatment for dysphagia | Speech-language therapy, diet changes, exercises, electrical stimulation, tube feeding |
What You'll Learn
What is dysphagia?
Dysphagia is the medical term for difficulty swallowing. It is a common symptom following a stroke, affecting more than 50% of stroke survivors. It can also be caused by nervous system and brain disorders, muscle disorders, physical blockages in the throat, and injuries to the head, neck, and chest.
Swallowing is a complex process involving approximately 50 pairs of muscles and many nerves. It can be divided into three stages: the oral phase, the pharyngeal phase, and the esophageal phase. During the oral phase, the tongue collects food or liquid, making it ready for swallowing. The tongue and jaw move solid food around in the mouth so it can be chewed and mixed with saliva. In the pharyngeal phase, the tongue pushes the food or liquid to the back of the mouth, triggering a swallowing response that passes the food through the pharynx, or throat. During this stage, the larynx (voice box) closes to prevent food or liquid from entering the airway and lungs. Finally, in the esophageal phase, food or liquid enters the esophagus, the tube that carries food and liquid to the stomach. The esophagus squeezes the food or liquid down in a wave-like motion until it reaches the stomach.
Dysphagia occurs when there is a problem with the neural control or the structures involved in any part of the swallowing process. Weak tongue or cheek muscles may make it difficult to move food around in the mouth for chewing. A stroke or other nervous system disorder may make it difficult to initiate the swallowing response, allowing food and liquids to move safely through the throat. Weak throat muscles, such as those affected by cancer surgery, may be unable to move all of the food toward the stomach. Dysphagia may also result from disorders of the esophagus, such as narrowing, blockages, or structural issues.
Dysphagia can have serious complications if left untreated. It can lead to poor nutrition, weight loss, and malnutrition as individuals may not be able to eat enough of the right foods to stay healthy. It can also cause aspiration, where food or liquid enters the airway and lungs, leading to aspiration pneumonia. Therefore, it is important to seek medical attention if you experience any signs of dysphagia.
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What are the signs of dysphagia?
Dysphagia, or difficulty swallowing, is a common problem after a stroke. It can cause serious complications, so it is important to be aware of the signs and seek medical advice if you have any concerns. Here are some of the key signs and symptoms of dysphagia:
- Coughing or choking when eating or drinking. This is often one of the most noticeable signs and can indicate that food or drink is going down the "wrong way" and entering the airway.
- Bringing food back up, sometimes through the nose. This is known as "regurgitation" and can be a sign that the swallowing reflex is not functioning properly.
- A feeling that food is stuck in the throat or chest. This sensation, called "dysphagia globus", can be very distressing and may be accompanied by a fear of choking.
- A gurgly, wet-sounding voice during or after eating or drinking. This is caused by food or liquid entering the airway and can indicate aspiration, which is a serious complication.
- Drooling and difficulty chewing food. Dysphagia can make it hard to control the movement of food and saliva in the mouth, leading to excess saliva and difficulty managing chewing and swallowing.
- Weight loss, dehydration, and repeated chest infections. Over time, dysphagia can lead to these symptoms as a result of inadequate nutrition and hydration.
It is important to note that not all of these signs may be present, and dysphagia can vary in severity. If you or someone you know is experiencing any of these symptoms, especially after a stroke, it is crucial to seek medical advice as soon as possible. A speech-language pathologist or a doctor can assess swallowing function and provide appropriate treatment to improve swallowing ability and reduce the risk of complications.
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What are the risks of dysphagia?
Dysphagia, or swallowing difficulties, can lead to several complications and increased health risks. One of the most common problems is coughing or choking when food goes down the 'wrong way' and blocks the airway. This can lead to aspiration pneumonia, a chest infection that develops after accidentally inhaling something. Other pulmonary complications include toxic aspiration syndromes, bacterial infections, and pulmonary fibrosis.
Dysphagia can also cause malnutrition and dehydration as a result of individuals avoiding eating and drinking due to a fear of choking. This can also lead to weight loss and repeated chest infections.
Additionally, dysphagia can negatively impact an individual's quality of life, preventing them from enjoying meals and social occasions. It can also cause anxiety or panic during mealtimes, and many individuals with dysphagia tend to avoid eating with others.
In rare cases, dysphagia can lead to acute respiratory distress syndrome (ARDS), where the lungs become filled with fluid, preventing them from functioning properly.
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How is dysphagia treated?
Dysphagia, or difficulty swallowing, is a common problem after a stroke, affecting more than 50% of stroke survivors. While it often improves within two weeks, some people experience long-term issues. Dysphagia can be dangerous, as it may lead to aspiration, where food or liquid enters the lungs and causes pneumonia. It can also cause malnutrition and dehydration.
There are two types of dysphagia: oropharyngeal and oesophageal. Oropharyngeal dysphagia is caused by the weakening of throat muscles, making it difficult for food to move from the mouth into the throat and oesophagus. Causes include neurological disorders, neurological damage, and cancer. Oesophageal dysphagia is when food gets stuck at the base of the throat or in the chest after swallowing. It has many underlying causes, including foreign bodies, radiation therapy, and GERD.
Treatment for Oropharyngeal Dysphagia
- Speech and swallowing therapy: A speech and language therapist can teach techniques to strengthen throat muscles and improve swallowing. They may also advise on swallowing exercises and recommend softer foods and thickened fluids to make swallowing easier.
- Dietary changes: A dietitian can advise on dietary changes to ensure a healthy, balanced diet. They may recommend eliminating hard-to-swallow foods and focusing on softer, easier-to-swallow options.
- Feeding tubes: In severe cases, feeding tubes may be necessary to provide nutrition and prevent malnutrition and dehydration. There are two types: nasogastric tubes, which are temporary and inserted through the nose, and percutaneous endoscopic gastrostomy (PEG) tubes, which are more long-term and inserted directly into the stomach.
Treatment for Oesophageal Dysphagia
- Medication: Medication can be used to treat the underlying causes of oesophageal dysphagia. For example, proton pump inhibitors (PPIs) can be used to treat GERD, and Botox can be used to treat achalasia by paralysing tightened muscles.
- Surgery: Surgery may be recommended if medication and therapy do not improve oesophageal dysphagia. Obstructions can be removed, and a stent can be placed to open up a narrowed oesophagus.
- Endoscopic dilatation: This procedure involves using an endoscope (a thin tube with a light and camera) to widen a narrowed oesophagus by passing a small balloon or a thin, flexible medical instrument through the narrowed area.
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How can family and friends help?
Family and friends can play a crucial role in helping a stroke patient recover their swallowing reflex and adjust to life after a stroke. Here are some ways they can help:
- Understand the condition and its implications: Educate yourself about dysphagia and its impact on the patient's ability to eat, drink, and swallow. Be aware of the signs of aspiration, which can be life-threatening, and know how to respond in such situations.
- Follow the advice of medical professionals: Ensure that the patient follows the recommendations of their speech pathologist or therapist, such as specific exercises to strengthen swallowing muscles, positioning of the head and body during swallowing, and the consistency of food and drinks.
- Provide safe eating and drinking assistance: Help the patient during mealtimes by ensuring they are sitting up straight, allowing them plenty of time to eat, and presenting food in an appetising manner. Avoid rushing them or offering too much at once. Be mindful of the types of food and drinks that are challenging for the patient to consume, such as thin liquids and high-fibre foods.
- Monitor their condition: Keep an eye out for any adverse conditions, such as weight loss, and report them to the patient's recovery team. Also, be mindful of any changes in the patient's swallowing ability and inform the relevant medical professionals.
- Encourage and provide emotional support: The road to recovery can be long and challenging. Provide encouragement and emotional support to the patient, helping them stay motivated to reach their long-term goals. Be understanding of any psychological or cognitive changes they may be experiencing and offer reassurance.
- Assist with rehabilitation exercises: Help the patient practice their physiotherapy, occupational therapy, and speech and language therapy exercises between their sessions with the therapist. This can aid in their overall recovery and improve their swallowing function.
- Promote a healthy lifestyle: Encourage the patient to adopt healthy lifestyle changes, such as stopping smoking, eating healthier, and engaging in suitable physical activities. This can positively impact their overall health and may also aid in their recovery.
- Facilitate social connections: Help the patient enjoy social interactions and meet new people. Social engagement is essential for their cognitive and mental health and can provide a sense of support and community during their recovery journey.
- Offer practical support: Assist the patient with everyday tasks and adaptations, such as helping them access the necessary support services, accompanying them to support sessions, and making changes to their home environment to accommodate their needs.
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Frequently asked questions
Dysphagia is a common condition after a stroke that affects the way you move food around in your mouth and how well you can swallow.
Signs of dysphagia include coughing during or after eating or drinking, having a wet or gurgly voice, needing extra time to chew or swallow, having food or liquid leak from your mouth, and difficulty breathing after meals.
Dysphagia can lead to aspiration, where food or liquid enters the lungs instead of the stomach. This can cause life-threatening chest infections such as aspiration pneumonia. Dysphagia can also result in dehydration, weight loss, malnutrition, and difficulty taking medications.