Swallowing Problems: Chest Heart & Stroke Scotland

You are in: Home > Stroke Information > How Stroke Affects You > Swallowing Problems

Swallowing Problems

What is dysphagia?
Indications of swallowing problems
Immediate assessment
Adapting your diet
Tips for easier swallowing
Alternative methods of feeding
Useful websites

What is dysphagia?

You may find it difficult to eat and drink after your stroke: this is called dysphagia.

Your stroke may have caused weakness / uncoordinated action of your mouth and throat muscles involved in swallowing.

Most people recover their swallow within a few weeks. Some will take longer, and a few people find that their ability to swallow does not come back.

Indications of swallowing problems

Coughing and choking when you try to swallow food or fluids
Food sticking in your mouth or throat: difficulty 'getting food over'
Dribbling or drooling
Taking a long time to eat and drink
Your voice sounding wet and 'gurgly' after eating or drinking
Feeling food or drinks are going down the wrong way: you may develop a chest infection
Feeling anxious or embarrassed about eating or drinking, particularly in front of others
Losing weight

Immediate assessment

Everyone who has a stroke should be screened for dysphagia before being offered any food or drink.

A swallowing test simple water–swallow test is used to identify who needs to be referred to the speech and language therapist (SLT) for a full swallowing assessment.

If your doctors and SLT think you are at risk of inhaling food or drink into your lungs (aspiration), you will not be allowed to eat or drink: this is referred to as 'nil by mouth'. Your swallowing will be closely monitored during this time.

You will be started on fluids through a drip into a vein and the dietician will prescribe any nutritional supplements you need.
You will be able to get your medication in an alternative form to ensure that you can continue with any treatment you need.

Everyone involved in your care will help to make sure you get the food and drink your body needs.

Early recovery

If your swallowing improves you will be able to try soft food options with caution, then gradually you will be allowed to eat and drink normally.

A full nutritional assessment will be carried out within 48 hours after you have a stroke.

Your SLT will carry out a full swallowing assessment if you need it. Depending on the results you may need further tests to work out the best way to your manage your swallowing difficulties.

Adapting your diet

Your dietician will make sure you are getting enough nourishment and may recommend you have nutritional supplement drinks to provide you with some extra vitamins and calories.

Food and fluids can be adapted to allow safe swallowing and meet your nutrition needs.

You may be started on thickened drinks or a thickening powder can be added to almost any drink to provide the right consistency for you.
You may need a softer, moister diet such as pureed food: some hospitals are now putting pureed foods into shaped moulds to make it look more appetising.

Your appetite may be poor, particularly if you have not been eating for a while. So, it may be easier to have smaller, more frequent meals to begin with.

If your stroke has left you with a physical disability your occupational therapist can provide special cutlery, plate guards and non slip mats. You may find that you need help to feed yourself from nursing staff at first.

Tips for easier swallowing

Sit in a quiet place and keep distractions to a minimum. Don't try to talk and eat at the same time.
Sit in an upright position while you are eating and for half an hour afterwards to aid digestion.
Avoid tipping your head back when eating or drinking.
Take smaller mouthfuls, and don't mix food and drink in the same mouthful.
Chew your food well and make sure your mouth is empty before taking another mouthful.
Smaller, more frequent meals may be less tiring.
Avoid foods that you find difficult, such as hard, dry or stringy foods.
Avoid using straws unless an SLT has recommended these for you.
Avoid using spouted beakers or cups.
Ask your doctor to prescribe your drugs in syrup or liquid form. Check with your doctor or pharmacist before crushing any tablets.
Use different positions to help, e.g. tuck your chin down or turn your head to the side when swallowing.
Practise any swallowing exercises that your SLT recommends.

Alternative methods of feeding

To stay healthy, and to help in your general recovery from stroke, it is important that your body is kept well–nourished and hydrated.

If you have a swallowing problem, and you are unable to take food and fluids in normally, alternative (tube) feeding may be necessary. The two common forms of tube feeding are:

Nasogastic tube (NG) feeding
Percutaneous endoscopic gastrostomy (PEG)feeding

Nasogastric tube (NG)feeding

If you are still unable to swallow and take any food by mouth after a few days, you will need nasogastric (NG) tube feeding.

Your nurse will pass a narrow tube up through your nose, down the back of the throat and into your stomach. This can be a bit uncomfortable, but it is usually quite a quick procedure and should not be painful.The tube will be securely attached to your nose with medical tape to prevent it from falling out.

Your dietician will prescribe a balanced liquid diet specifically tailored to your needs, and this will be dripped slowly into your stomach through the NG tube.
Liquid supplements and medicines can also be given through the tube.

The NG tube is only suitable for short–term use. You may still have your NG tube in place while food and drink by mouth is reintroduced.

When you are able to eat and drink well enough to meet your nutritional needs, the NG tube can be removed.

Percutaneous endoscopic gastrostomy feeding

If you need artificial tube feeding for longer than 4 weeks, a PEG (Percutaneous Endoscopic Gastrostomy) tube may be needed.

A PEG tube is a flexible, thin tube which is inserted, under local anaesthetic, directly into your stomach through a small incision in the skin.

The PEG tube is held in place by a plastic disc (like a button) so you won't need any stitches.

An external tube can be attached to the opening of the PEG tube.

This allows liquid supplements, fluids, drugs and even pureed foods to be administered.

You will be advised to sit upright for 30–60 minutes during and after feeding. The 'button' can be covered up by clothing when not needed.

Before leaving hospital, your nurse will explain to you and / or your carer:

How to attach the external tube.
How to prevent it clogging by flushing it with water before and after use.
How to care for the skin around the tube.
How to recognise any sign that the area might be infected.
What to do if the tube blocks, or there is infection.
How to hide your tube under your clothes.
How to take a bath with a PEG tube.
When you will be able to get back to your normal daily activities.

It is important to remember that your ability to swallow can return even months after your stroke, so your speech and language therapist (or doctor) should continue to regularly reassess your swallowing.

Stroke Information