Swallowing and speech difficulties

About a third of people with multiple sclerosis (MS) experience swallowing difficulties (dysphagia), which are more common in advanced MS. Weakness or poor coordination in the neck, mouth, cheek and throat muscles can interrupt the complex swallowing process, causing symptoms such as coughing or choking when eating or drinking, hoarseness, pain while swallowing, food feeling 'stuck,' or food and liquids entering the airway, which can lead to chest infections or pneumonia.

Damage in different parts of the brain can also affect speech and word-finding.

Does MS cause trouble swallowing?

MS can damage myelin – the protective layer around nerves in the brain and spine – making it harder for the brain to send signals to the muscles used to chew and swallow. As a result, multiple sclerosis swallowing difficulties (dysphagia) can occur.

How common is dysphagia in MS?

Dysphagia is more frequent in advanced cases of MS. You may notice:

• Chewing feels harder or more tiring
• Needing multiple swallows per mouthful
• Food feeling stuck in your throat
• Coughing or choking when eating or drinking
• Fluid or food entering the airway
• Weaker coughing muscles
• Drooling due to reduced swallowing frequency

If you’re having difficulty swallowing, talk to your GP, MS nurse or neurologist, who may refer you to an allied health specialist, such as a speech pathologist.

How to swallow safely

• Take your time eating and take smaller bites
• Sip drinks slowly
• Eat smaller, more frequent meals
• Sit upright with good posture
• Avoid dry, crumbly foods or thin liquids if they cause issues
• Relax and avoid talking while eating
• Stay upright for 20 minutes after meals
• Check your mouth is clear before taking the next bite or sip
• If you’re prone to choking, eat with someone who can assist, the Australian Governmentopens in new tab has advice on what to do if someone is choking

MS and dysarthria (speech difficulties)

Speaking involves coordinated movement of the lungs, diaphragm, vocal cords, lips, tongue and nasal cavity. MS-related nerve damage, fatigue or weakness can affect this process.

Common speech problems include:

• Slurred speech
• Reduced volume or clarity
• Difficulty controlling breath for speech
• Word-finding problems
• Trouble following long or complex conversations

For most people with MS, speech problems are mild and manageable.

What should you do if you experience speech problems?

If you’re having difficulty speaking, see your GP, MS nurse or neurologist. They can give you advice and may refer you to an allied health specialist, such as a speech pathologist or physiotherapist.

Tips for easier communication

• Speak slowly and keep sentences short
• Have important conversations when you're less tired
• Use written notes for key points
• Use tools like texts, emails, photos, images or gestures
• Check that others understand what you're saying