Dealing with swallowing problems after stroke

Why can't I swallow?

Swallowing is a complicated task that needs your brain to coordinate many different muscles. If your stroke damages the parts of your brain that do this, then this will affect your ability to swallow.

Other effects of stroke can cause problems too. If your muscles are weak, or you can’t control them very well, you may not be able to use a spoon or a cup properly. This can affect the way you swallow. If your face or lip muscles are affected, this can make you dribble.

If your balance has been affected, then you may not be able to sit up straight, which can make swallowing more difficult. If you’re drowsy or not able to concentrate very well, then you may not swallow your food in the right way.

What kinds of problems can this cause?

If you can’t swallow safely, you are more likely to cough or choke if your food ‘goes down the wrong way’. You may also breathe in small amounts of food and drink, which can get into your airway and lungs. This can lead to infections and pneumonia, which can be very serious.

However, aspiration isn't always noticeable. Some people can seem to swallow well, but food and drink may still be getting into their lungs. This is called silent aspiration. So you’ll need an assessment with a trained professional to confirm whether or not you are swallowing safely.

Will it get better?

Swallowing problems can get better and most people are able to swallow safely again within the first few weeks after a stroke. Only a small number of people have problems that last longer than this.

Even if you are left with long-term swallowing problems, they don’t have to stop you from doing what you want to do. Most people find that they’re still able to live full lives despite them. But it may take some time to get used to the changes that you need to make.

1. What can I do about swallowing problems?

Listen to your therapist

If you have swallowing problems, you’ll be referred to a speech and language therapist. They will explain to you and your family exactly what foods are safe for you to eat and suggest any other changes that they think you should make.

Changing your diet

To help you swallow safely your speech and language therapist may suggest that you:

• Thicken your drinks.
• Eat soft or pureed food.
• Change the temperature.
• Change how and when you eat.

2. What kinds of problems can this cause?

Learn how to swallow safely

Although your speech and language therapist will show you, our swallowing dos and don’ts can remind you what you need to do to swallow safely.

Do

• Give yourself the time and space to concentrate on what you’re doing. So turn off the TV or draw the curtain around your hospital bed.
• Sit up with a straight back, your arms and hands forwards. If you are in a chair, keep your feet flat on the floor.
• Take small amounts. Cut food up into small pieces and just take small sips when you drink.
• Swallow twice after each mouthful, to make sure nothing is left in your mouth.
• Take your time.

Don't

• Try to eat lying down.
• Talk while you’re trying to swallow.
• Use straws or cups with spouts unless your speech and language therapist has told you that it’s safe.
• Eat foods with a variety of textures, such as soup that has large chunks in it, or cornflakes and milk.

3. Ask questions

It’s important that you understand the instructions and advice you’re given. So ask your speech and language therapist to explain things again if you need them to. They would much rather you ask questions than doing something that may put you at risk. If you think your swallowing has improved, ask for another assessment.

4. Get the information you need before you go home

If your overall recovery is good, then your stroke team may suggest that you go home, even if you’re still having some problems with swallowing. It’s up to your stroke team to make sure that you and your family have all the information, support and equipment you need.

You’re likely to have lots of questions, and the earlier you get the answers, the more confident you’ll feel about going home. So ask your speech and language therapist to go through it all with you as soon as they can.

Make sure you know:

• What products you’ll need to use at home.
• How you can get more when you need them.
• Who to contact if you have a question.

5. Tube feeding

If your stroke team are worried that you’re not getting enough food because of your swallowing problems, then they may talk to you about tube feeding. This means putting liquid food directly into your digestive system through a tube.

Some people don’t like the idea of tube feeding. So it’s important that you discuss it properly with your doctor, dietitian and speech and language therapist. Food can go through a tube in your nose, or one that goes straight into your stomach. You’ll need to talk about both options to decide which one is best for you.

6. Look after your mouth and teeth

If you don't clean your teeth and mouth, then bacteria will build up. This can make your mouth sore and lead to infections.

• Ideally, you should clean your teeth or dentures after every meal, but this may not be possible. Try to aim for at least twice a day if you can.
• If you have swallowing problems, ask your nurse or speech and language therapist to show you the safest way to clean your teeth, tongue and mouth.
• Make sure your toothbrush is dry before you start to use it. When you’ve finished brushing spit out the toothpaste but don’t rinse your mouth. That way, more fluoride from the toothpaste stays in your mouth and protects your teeth.
• If you wear dentures, it’s still important to clean your mouth and tongue. You can do this with a soft brush or using some gauze wrapped around your finger.
• It’s important to keep your mouth moist. Even if you can’t drink, you may be able to use a saliva spray to stop your mouth from getting dry. Ask your speech and language therapist.
• Use lip balm to stop your lips from getting dry or cracked.
• Make sure you know what you need to do before you go home and that you have any special equipment or products you need before you leave the hospital.
• See your dentist regularly. They can make sure that your teeth and mouth are healthy and give you any other advice you need. You may also need new dentures, or have them adapted to make them easier for you to put in.

7. Find support

Swallowing problems can be especially difficult to cope with at home. A large part of our family and social lives is about eating and drinking, so it can have a big impact when you’re not able to enjoy these things anymore.

Speak to your dietitian

Your dietitian will be able to suggest different foods or recipes to try if you’re feeling bored with your diet. They can also give you any advice you need about eating out or going on holiday

Contact a support group

There are support groups especially for people with swallowing problems, who may also be able to give you advice. We’ve listed some later in this guide.

Talk to your pharmacist

If you’re finding it hard to swallow your tablets, speak to your pharmacist. Your medication may come in a different form, such as a liquid or a patch, which could be easier for you to take. Always check with your pharmacist first before crushing tablets, as this can change the way some medications work and can even be dangerous.

Information guides

• Download A complete guide to swallowing problems after stroke (PDF)
• Download Dealing with swallowing problems (PDF)

Where to get help and information from the Stroke Association

Helpline
Call us on 0303 3033 100,from a textphone 1800 0303 3033 100
Email: helpline@stroke.org.uk
Our Helpline offers information and support for anyone affected by stroke, including family, friends and carers.

Read our information
Call the Helpline to ask for printed copies of our guides.

Other sources of help and information

NHS
More information about swallowing problems and how they are diagnosed and treated.

NHS Inform (Scotland)
More information about swallowing problems and how they are diagnosed and treated.

Patients on Intravenous and Nasogastric Nutrition Treatment (PINNT)
Address: PO Box 3126, Christchurch, Dorset BH23 2XS
A support group for people who are being fed by tube. By becoming a member, you can receive information, regular newsletters and invitations to local meetings. Full membership normally costs £5 a year.

Apps from MyTherappy
App recommendations from the NHS for survivors and carers ranging from communication, eating and drinking, healthy lifestyle, vision and more.

Disclaimer: The Stroke Association provides the details of other organisations and apps for information only. Inclusion on My Stroke Guide does not constitute a recommendation or endorsement.