Difficulty swallowing

Difficulty swallowing, also known as dysphagia, refers to having problem moving food or fluids from the mouth into the food pipe. While some may feel like there is something being stuck in their throat, others may cough, choke, vomit or feel pain when trying to swallow food or fluids.

Causes of difficulty swallowing

Cancers in the mouth, throat or food pipe may narrow the spaces by which food and fluid passes, making swallowing difficult
Surgical treatments to the mouth, jaw, throat or food pipe can cause physical changes that makes swallowing difficult
Radiation therapy can cause scarring (also known as fibrosis), as well as swelling or narrowing in the area
Chemotherapy and radiation therapy can also cause dry mouth and mouth ulcers, which lead to pain that makes swallowing difficult
Infections in the mouth and throat can also cause painful swallowing

What you need to look out for

While difficulty swallowing may be a short-term side effect in some people with cancer, it can also be a longer-term problem for others. Having difficulty in swallowing will interfere with eating and drinking, and in turn cause problems with nutrition, hydration, and your overall wellbeing. It can also cause foods and fluids to go down your windpipe by accident, and this can lead to chest infection. It is thus important to inform your doctor or nurse early if you develop any of the following:

Difficulty swallowing foods or fluids
Coughing, vomiting or choking when trying to swallow foods or fluids
Sensation of food being stuck in throat
Pain in your mouth, lips or throat
Dry mouth
An unexpected decrease in your weight
Fever

How it can be treated

The treatment for swallowing problems depends on its cause. For instance, if pain in your throat is causing difficulty in swallowing, your doctor or nurse will prescribe you with mouth gels or medications to help relieve the pain. Your doctor may also refer you to a speech therapist, who will assess your ability to safely swallow and recommend any food modifications if needed. To ensure your nutrition, your doctor may sometimes advise to place a feeding tube to deliver liquid nutrition, and/or refer you to a dietician who can work out a nutrition care plan for you.

What you can do

If you have difficulty swallowing, your doctor or speech therapist will be able to advise you on the type of food that will be safe for you to take. Below are some tips that you may find helpful in coping with your condition:

Whether temporary or permanent, it will take some time to adjust to a modified diet. Be patient and give yourself time to get used to the change

Sit upright to eat and drink. It is helpful to remain upright for at least 30 minutes after you finish eating, to prevent food or fluids from entering your windpipe by accident

Take small bites, and swallow each mouthful of food or fluid completely before taking another

If you are unable to swallow your pills or tablets, check with your nurse or pharmacist before crushing them. Some medications can cause serious side effects if crushed or broken

Use a food thickener as recommended by your doctor or speech therapist. This will help to reduce the risk of food or fluids entering your windpipe by accident

Avoid rushing through your meal. When swallowing is difficult, you need more time for food and fluids to pass through to the food pipe

For painful swallowing:

Take cool or cold foods and liquids. If the pain gets worse with cold foods, try food at room temperature

Use mouth gel or pain medicine before eating as prescribed

Avoid hot and spicy foods and drinks

Avoid acidic foods, such as citrus fruits

Avoid fizzy soft drinks

To ensure nutrition:

Eat small, frequent meals or snacks

Eat foods that are high in calories and protein (e.g. cream-based soups, pudding, ice-cream, yogurt, milkshakes)

Drink meal replacement or nutritional supplement beverages (E.g. Ensure, Resource)

Freeze nutritional supplements. The texture and taste will be similar to ice-cream but it is more nutritious

If you are able to take soft foods:

Try putting bread in milk or milo to soften it before eating

Use sauces and gravies over foods to moisten and soften them before eating

Avoid hard, dry or coarse foods (e.g. crackers, nuts)

Avoid foods that require a lot of chewing (e.g. squid, thick cuts of meat)

If you are able to take pureed foods:

Use a blender to mash your favourite foods (e.g. meats, potatoes, fresh fruits, vegetables)

Add calories and flavour by using milk or cream instead of water when blending your food

When to call your cancer care team

To prevent complications, please inform your doctor or nurse as soon as you notice any symptoms as mentioned above, or if they worsen.

If you have any questions regarding the above, please call Cancer Helpline at +65 6225 5655 or approach your doctor or nurse for further details.

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The above contents are made available as part of TEMASEK FOUNDATION-ACCESS (Accessible Cancer Care to Enable Support for Survivors) PROGRAMME, a holistic care programme to support cancer patients during their care and recovery journey.

The contents have been approved by the Cancer Education Information Service, National Cancer Centre Singapore (NCCS), for people with cancer and their families and caregivers. However, this information serves only as a guide and should not be used as a substitute for medical diagnosis, treatment or advice. For specific medical conditions, please seek expert medical advice from your healthcare team.

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Difficulty swallowing (Dysphagia)