Dysphagia after Stroke: 10 Things You Should Know

Dysphagia after Stroke: 10 Things You Should Know - MalaysiaAcute Conditions

Dysphagia after Stroke: 10 Things You Should Know

According to studies, dysphagia affects 50% of acute stroke patients. If untreated, it could lead to serious health complications and even death. Find out more here!

What is Dysphagia?

If you or your loved one is recovering from astroke, you’ll need to be careful with swallowing issues. In medical terms, this is known asdysphagia. Those with dysphagia will have difficulties swallowing certain foods or liquids; in more severe cases, some people are unable to do so.

The swallowing process is a complex one that involves as many as 50 pairs of muscles, as well as various nerves that work in tandem. As we chew food, it’s eventually turned into a soft ball, a bolus, that is easy to swallow. When we swallow, the movement causes the structures at the back of our mouth and throat to cover the entrance to the windpipe and allow food to only enter the oesophagus, the tube which passes food and drinks to the stomach.

The swallowing action triggers a natural wave of movement called peristalsis through the oesophagus, which propels the food and fluids down into our stomach. There is a tight band of muscle at the point where the oesophagus meets the stomach – this should open enough to allow food to pass into the stomach, but also be able to close tightly so that stomach acid and contents don’t regurgitate into the oesophagus and cause pain and inflammation.

Having dysphagia makes it difficult or painful (sometimes both) for someone to properly eat or drink and swallow it. This could compromise you or your loved one’s health: food or drink could go down the windpipe instead of the oesophagus (aspiration), or it might not be able to move any of the food or drink down into the stomach.

This article will help you learn more about dysphagia and what you can do to help yourself or your loved ones to recover from this complication.

Things You Should Know About Dysphagia

Stroke and Dysphagia

A stroke occurs when the blood supply to parts of our brain is reduced or interrupted. When this happens, blood flow to parts of the brain is impaired, which can cause brain damage and even lead to possible disability. A stroke either occurs due to a blood vessel blockage, or when a blood vessel in our brain leaks or ruptures.

Because of the nature of a stroke, it can significantly impair our ability to chew and swallow food properly. The after effects of a stroke can also lead to other complications:

  • If your arms are also affected by the stroke, it could make it harder to use cutlery or hold items in your hands
  • If your facial muscles are affected, you or your loved one might not be able to move your mouth or drool very easily
  • If your balance is affected, that can have an impact on your swallowing as well
  • Aspiration occurs when food or drink (or even saliva) goes down “the wrong way” – as in, it goes down your windpipe and into the lungs, or even from the stomach back up to the throat. Aspiration causes you to cough, but a stroke can “reduce sensation” and you won’t realize that you’re aspirating (silent aspiration)BE FAST when stroke strikes– Click to learn how to identify and respond to the signs of a stroke and help, in the fastest way possible, when it strikes.

Who’s At Risk?

Anyone recovering from a stroke is at risk of having dysphagia, but elderly persons fall in the higher risk category. In some cases, some people may recover quickly after a stroke, either due to early intervention when the stroke first occurred or due to other circumstances (e.g., responding well to treatment).

In most cases, it might take a lot longer than usual – more so for elderly persons. You may need to feed your loved ones yourself as they may be unable to care for themselves. Even if they’ve recovered and have regained most (or all) of their mobility, frequent monitoring is still required to prevent dysphagia-related complications from happening.

Follow-up checks and treatment may be needed to help you or your loved one to make a full recovery. Taking care of someone with stroke can take up a big portion of your day-to-day. The good news is help is always available! Learn more about how ourpart-time caregiversat can assist withstroke carein the comfort of your home based on your schedule.

When Can Dysphagia Occur?

Dysphagia can occur during any of the three main phases of swallowing.

  • Oral: this pertains to the mouth, or when food is being chewed up into a bolus before it’s moved to the oesophagus. Complications may affect the tongue or even the muscles that allow you to chew food
  • Oropharyngeal: this pertains to the throat; a stroke can potentially weaken the throat muscles, which thus complicates the swallowing process. You or your loved one could potentially choke, gag, or cough; the food or drink could also go down the windpipe and cause (silent) aspiration
  • Oesophageal: this pertains to the oesophagus; it could refer to food that gets caught or stuck at the base of your throat or in your chest once you’ve started to swallow

Whenever dysphagia occurs at any stage, seek immediate medical attention.

Signs and Symptoms of Dysphagia

Sometimes, signs of dysphagia may not readily be apparent. Nevertheless, pay attention to the following warning signs or symptoms:

  • Coughing or choking when eating or drinking
  • Pain during swallowing
  • Feeling like something is stuck in your throat
  • Inability to swallow (in some cases, it might not be immediately apparent)
  • Infrequent gurgling when eating or drinking
  • Regurgitation (food coming back out of the body)
  • Uncontrollable/random drooling
  • Hoarse voice when talking
  • Unexpected heartburn
  • Unexplained weight loss

Note that this is not an exhaustive list of signs and symptoms. If something seems off, be sure to notify medical professionals immediately.

Complications and Implications

If you or your loved one are recovering from a stroke, the medical team will make a point of screening your ability to swallow food or drink. Depending on the results, they may need to consult a speech/language therapist or otolaryngologist (ear, nose, and throat [ENT] doctors) for the next step in the treatment plan.

It’s still possible that dysphagia may occur outside of the hospital setting, such as if you opted to go with home treatment, or even after you or your loved one has had improvements to your overall health during the recovery process. However, the possibility of this happening is very, very slim, especially if you or your loved one are constantly monitored to see how well you’re doing.

If left untreated, though, its impact can be severe: you or your loved one could end up choking on food or drink without realising it, or silent aspiration could also potentially occur; either way, this will lead to further health complications, such as pneumonia. Unless treated with haste, it could ultimately lead to death.

When is a Feeding Tube Needed?

For severe cases where dysphagia prevents swallowing, a feeding tube may be needed. You or your loved one will need to undergo a percutaneous endoscopic gastrostomy (PEG) procedure to place a feeding tube. This way, you or your loved one can receive nutrition directly through the stomach.

PEG usually involves the use of endoscopes: small incisions will be made to allow these tube-like devices to enter your body and into the stomach to place the feeding tube. You’ll be put under local anaesthesia throughout the process, so you won’t feel a thing. It takes between 20 to 30 minutes to complete the procedure.

A dietitian will be arranged to help you out with your diet while using the feeding tube (also called the G tube); you’ll receive specialized nutrition and hydration for the duration you have the tube in your body. The G tube itself is about the size of a pen or pencil. On one end, an external bumper prevents the tube from going further into your stomach; on the other end is a cap or plug, which prevents stomach fluids from leaking out onto your skin or clothes.

Your doctors will advise you on what you need to do or avoid, and what signs to look out for; be sure to notify them of any complications you may experience during this time. If your condition does improve, the tube will be removed and you may be able to eat and drink normally after some time. Consult your doctor on the follow-up procedures once the tube is removed. Elderly people and those living with dysphagia may be recommended to follow a soft diet. Here are10 easy-to-swallow recipes for those with swallowing difficulties or dysphagia.

Nasogastric (NG) Feeding Tube

In other cases, an NG tube might be prescribed instead. This passes through the nose, down the throat and into the stomach. These are mainly used as short-term feeding tubes and medication administering, usually for a period of up to six weeks. These tubes will need to be checked on from time to time to make sure they did not shift.

The procedure to place an NG tube can be uncomfortable or even painful, but the process doesn’t take too long and is nowhere as invasive as the PEG process. You may be given an anaesthetic lozenge to help numb your upper gastrointestinal tract during the process.

Who Treats Dysphagia?

A specialised multi-disciplinary team of medical professionals will usually be needed to help you or your loved one in treating dysphagia. We’ve mentioned a few in the earlier sections, but it’s worth bringing it up again.

  • Speech/language/swallowing therapistsmay be needed to help with managing the dysphagia; they may also recommend therapies to help you or your loved one to be able to swallow food and drink again
  • Adietitianwill help advise you or your loved one on the recommended diet for the recovery process. If a feeding tube is needed, they’ll also advise you on how to feed yourself or your loved one using the tube
  • Anotolaryngologistmay be consulted as they are experts in ear, nose, and throat-related complications
  • Agastroenterologist, who specializes in diagnosing and treating disorders of the digestive system, may also be needed in some cases
  • Depending on the severity of the stroke, aneurologistmay be consulted to help with addressing any lingering stroke-related complications that may still impair you or your loved one’s swallowing

The Screening Process

Screening for dysphagia usually involves an assessment, as previously mentioned, to check how you swallow and if where the dysphagia might be happening. You or your loved one may be asked to swallow a very small amount of different types of food or water to determine if you’re able to swallow them without problems. You may need to swallow solid food or even a pill coated with barium, allowing doctors to see its movement via X-ray and make an accurate assessment.

There may be other screening procedures that may be conducted to determine the cause of the dysphagia.

  • Endoscopy: an endoscope is passed down your throat to check the condition of your oesophagus; it may be used to take samples for further testing
  • Fiber-optic endoscopic evaluation of swallowing (FEES): this is similar to an endoscopy, but it’s meant to see what happens when you swallow
  • Imaging scans: you are scanned with a CT or MRI scanner to create detailed images of your throat/oesophagus

The Treatment Process

Treating dysphagia depends on the type or cause of swallowing issues you or your loved one faces. In mild cases, learning exercises – such as swallowing techniques – might only be needed to get you on the right track. It might mean learning how to place food in your mouth or position your body and head to allow you to swallow easily. It might require a significant amount of modification to your eating habits.

Other treatment methods include:

  • Medicationsto help prevent acid reflux or control oesophageal spasms, among other things
  • Oesophageal dilation, where an endoscope with a special balloon is carefully placed into your throat, and the balloon is used to gently stretch the oesophagus open. In some cases, a flexible tube may be used instead of a balloon
  • InjectingonabotulinumtoxinA, which relaxes the muscles at the end of the oesophagus. This may require repeat injections, however, and may only be used as a temporary measure
  • Surgerymay be needed in severe cases, followed by speech and swallowing therapy during the recovery process. Surgical processes may require an incision to be made to allow food and drink to pass into the stomach

Of course, the medical team will speak to you about your options beforehand. Make sure to ask as many questions as you can to understand how treatment will affect you, what the outcome is, and so on. Have a list of questions prepared beforehand in case you’re anxious when you go and see the doctor(s).

The Recovery Process

Dysphagia is normally a temporary affliction and most people with dysphagia will improve after some time.Stroke rehabilitationmay be recommended to help with speeding up the recovery process, allowing you or your loved one to strengthen swallowing muscles. It may involve learning how to chew food thoroughly before swallowing, sitting upright when eating, and other useful techniques. A therapist will help you through the rehabilitation process.

You might also need to make some modifications to your diet, such as making food soft or in a puree to make it easier to swallow. Your dietitian will make food and drink recommendations to ensure you or your loved one are getting the nutrients your body needs, as well as food and drink you’ll need to avoid to prevent complications. For example, sticky foods might be cut out from your diet as they can complicate the swallowing process.

There are many other things you can do to help with the recovery process:

  • Take care of your oral hygiene: bacteria in your mouth could potentially cause problems, so be sure to take good care of your oral and dental health
  • Take your time when eating or drinking: rushing the process could cause serious complications, such as food getting stuck in your throat
  • Avoid eating or drinking if you feel sleepy or weak: you could end up having food or drink going down your windpipe
  • Have someone around to make sure you’re OK: they can keep an eye on you, or help you with eating and drinking
  • Ask questions: if you have any doubts or concerns, speak to your therapist or doctor for advice

Recovery will take some time, and it varies from person to person. Be sure to have someone by your side at all times, and don’t hesitate to discuss your worries frankly with them. If need be, speak to a professional counselor to help you put your mind at ease. You don’t have to do this alone.

Getting Help

Are you looking after someone recovering from a stroke? It can be challenging to look after them and make sure they’re not having any difficulties swallowing, and when work calls, you’d inevitably worry about their wellbeing. can help you through our well-trainedCare Professionals. They can look after your loved one while you’re away at work, make sure they receive adequate nutrition, and even keep track of their medication timings.

We offer flexible care plans that can be tailored to meet your needs.Download our appto book for care today! References

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