When It's Hard to Swallow: Understanding Dysphagia and Its Connection to Parkinson's Disease

Estimated reading time: 6 minutes

Difficulty swallowing, known in the medical world as dysphagia, is more than an inconvenience, it can be a sign of an underlying condition like Parkinson’s disease.  For those living with Parkinson’s, recognizing and addressing dysphagia is critical for maintaining nutrition, hydration, and quality of life. 

What Causes Difficulty Swallowing?

Swallowing is a complex process that involves the coordination of muscles and nerves in your mouth, throat, and esophagus. Sometimes we are very conscious of when we swallow, like when we are eating a meal. Other times it is a natural process, like when you swallow your saliva throughout the night as you rest. When this process is disrupted, swallowing becomes hard and, in some cases, dangerous. Dysphagia can be caused by a wide range of issues, including neurological conditions, structural abnormalities, or muscle dysfunction.

Dysphagia is common but may be underreported because it is oftentimes a subtle symptom that people more often attribute to heartburn or reflux. In fact a recent global survey showed that some people don’t seek medical advice because they are too embarrassed to share that they have trouble eating. You have probably experienced dysphagia, if you’ve eaten your food too fast or it felt like it “went down the wrong pipe” or if you’ve ever had to clear your throat because something felt stuck. It’s an uncomfortable feeling but it’s usually not something to worry about. 

In Parkinson’s disease, dysphagia often develops as the disease progresses, affecting the muscles responsible for swallowing. Changes in movement and coordination caused by Parkinson’s can make even routine tasks like eating or drinking feel overwhelming. PatientLikeMe members who experience swallowing difficulties have shared experiences like:

 “...I have lost 15 pounds and are now obliged to eat soft food. It takes me really long to eat, and I even have difficulty to swallow my saliva.”

- PatientsLikeMe member since 2010

“... tonight I swallowed dinner poorly and having first experience with something really stuck (coughing, etc.). … What becomes of this? … Felt for the first time, it might be the beginning of a demise (and I am a really positive, proactive person).”

- PatientsLikeMe member since 2015

“Swallowing problems was one of my first symptoms and continues to be one of my most annoying problems.” 

- PatientsLikeMe member since 2013

Are you experiencing problems with swallowing? Join the discussion on PatientsLikeMe to hear from others who share those experiences.

What Makes It Hard to Swallow?

The experience of difficulty swallowing can vary widely. Some people feel like food gets stuck in their throat, while others have trouble chewing or with the act of swallowing. Symptoms of dysphagia in Parkinson’s disease can include:

• Delayed swallowing reflexes: Parkinson’s slows down the signals between the brain and muscles, making it harder to start the swallowing process. This could include drooling and a hoarse voice. 
• Weak throat muscles: As muscle strength diminishes, food or liquid may not pass through the esophagus efficiently, increasing the risk of choking. This could be a result of Parkinson’s progressing or the natural aging process. This symptom may cause you to avoid eating, skip meals, or lose your appetite. If this occurs there will be signs like unexpected weight loss and difficulty chewing solid foods. 
• Silent aspiration: Some individuals may unintentionally inhale small amounts of food or liquid into their lungs without realizing it, which can lead to aspiration pneumonia. 

These issues stem from Parkinson’s other symptoms: bradykinesia (slowness of movement), rigidity, and impaired motor control. Together, these all disrupt the act of swallowing.

Types of Dysphagia

There are three types of dysphagia and they are all based on where the problem lies in the swallowing journey from your mouth to your stomach. 

• Oral dysphagia: Oral dysphagia affects the jaw, teeth, and tongue efforts when you chew your food. Symptoms associated with oral dysphagia are difficulty chewing solid food, avoiding eating, skipping meals, and losing an appetite.
• Oropharyngeal dysphagia: Oropharyngeal dysphagia involves difficulty moving food or liquid from your mouth to your throat. It’s primarily linked to neurological conditions like Parkinson’s. Common symptoms associated with oropharyngeal dysphagia are coughing, choking, or that uncomfortable feeling that food is stuck. 
• Esophageal dysphagia: Esophageal dysphagia occurs when food has trouble moving down the esophagus into the stomach. This type is less commonly associated with Parkinson’s but can still occur.

In Parkinson’s, dysphagia falls under oropharyngeal dysphagia because Parkinson’s affects the central nervous system which controls the initial phases of swallowing. According to a review of an international expert meeting on oropharyngeal dysphagia (OD), OD is highly prevalent in the older population. The physicians highlighted that older patients should be aware that malnutrition, dehydration, and pneumonia are frequently caused by undiagnosed dysphagia. These conditions are associated with some of the symptoms we talked about earlier because skipping meals, losing an appetite, and avoiding meals or drinking causes the domino effect. 

Treating Dysphagia

Treatment for dysphagia focuses on making swallowing safer and more effective. While dysphagia related to Parkinson’s cannot always be fully reversed, interventions can significantly improve quality of life.

1. Swallowing rehabilitation: Speech and language therapists are vital in helping manage Parkinson’s dysphagia. They will teach you exercises to strengthen your swallowing muscles and recommend techniques to reduce choking risks. These techniques will also help you safely clear your throat when food or liquids get stuck. 
2. Diet modification: As one of our members noted above, in some cases you need to change your diet to include soft foods, thickened liquids, and smaller bites to help reduce the effort needed to swallow. A last resort option would be a feeding tube to deliver nutrients directly to your stomach. This option is only necessary if you aren’t getting enough to eat or drink and suffer from dehydration or malnutrition. 
3. Postural adjustments: Changes like tilting your head forward during swallowing can help prevent food or liquid from entering the airway. During your swallowing rehabilitation you will learn more about these sitting techniques. 

Addressing dysphagia early is essential for preventing complications, including dehydration and malnutrition. Using a health tracking app, like PatientsLikeMe, can help paint a clear pattern for you and your doctor. For people living with Parkinson’s, proactively discussing swallowing difficulties with your doctor can lead to earlier interventions. 

Share Your Story and Connect with Others

When swallowing becomes hard it’s more than an annoyance, it could be a sign of something more serious like Parkinson’s disease. Whether you're starting to experience difficulty swallowing and worried it may be a symptom of Parkinson’s disease or you have a confirmed diagnosis from your doctor, having a support network makes a difference in your health.  Join PatientsLikeMe to connect with others who share similar experiences and gain access to valuable insights and support tailored to your health needs. If you’re managing both Parkinson’s and difficulty swallowing, how do you cope? Let us and others know in the discussions!