How You Swallow

People normally swallow hundreds of times a day to eat solids, drink liquids, and swallow the normal saliva and mucus that the body produces. The process of swallowing has four stages:

1. The first is oral preparation, where food or liquid is manipulated and chewed in preparation for swallowing.
   
2. During the oral stage, the tongue propels the food or liquid to the back of the mouth, starting the swallowing response.
3. The pharyngeal stage begins as food or liquid is quickly passed through the pharynx, the canal that connects the mouth with the esophagus, into the esophagus or swallowing tube.
4. In the final, esophageal stage, the food or liquid passes through the esophagus into the stomach.

Although the first and second stages have some voluntary control, stages three and four occur by themselves, without conscious input.

Symptoms of swallowing disorders may include:

• drooling;
• a feeling that food or liquid is sticking in the throat;
• discomfort in the throat or chest (when gastroesophageal reflux is present);
• a sensation of a foreign body or "lump" in the throat;
• weight loss and inadequate nutrition due to prolonged or more significant problems with swallowing; and
• coughing or choking caused by bits of food, liquid, or saliva not passing easily during swallowing, and being sucked into the lungs.

Possible Treatments For Swallowing Disorders

Many of these disorders can be treated with medication. Drugs that slow stomach acid production, muscle relaxants, and antacids are a few of the many medicines available. Treatment is tailored to the particular cause of the swallowing disorder.

Gastroesophageal reflux can often be treated by changing eating and living habits, for example:

• eat a bland diet with smaller, more frequent meals;
• eliminate alcohol and caffeine;
• reduce weight and stress;
• avoid food within three hours of bedtime; and
• elevate the head of the bed at night.

If these don't help, antacids between meals and at bedtime may provide relief.

Many swallowing disorders may be helped by direct swallowing therapy. A speech pathologist can provide special exercises for coordinating the swallowing muscles or restimulating the nerves that trigger the swallow reflex. Patients may also be taught simple ways to place food in the mouth or position the body and head to help the swallow occur successfully.

Some patients with swallowing disorders have difficulty feeding themselves. An occupational therapist can aid the patient and family in feeding techniques. These techniques make the patient as independent as possible. A dietician or nutritional expert can determine the amount of food or liquid necessary to sustain an individual and whether supplements are necessary.

Once the cause is determined, swallowing disorders may be treated with:

• medication
• swallowing therapy
• surgery