When you think of a swallowing problem, you may picture someone choking on their food.

But swallowing difficulties are not always this obvious.

You can have a swallowing problem without having a frightening choking episode.

Instead, you might notice small changes. Perhaps meals are taking longer. You might cough sometimes when drinking or feel that food is difficult to manage.

These changes can be easy to ignore.

You might think:

“I'm not choking, so surely my swallowing is fine?”

Not necessarily.

Recognising changes early can help you know when it is time to ask for professional advice.

What is a swallowing problem?

The medical word for difficulty swallowing is dysphagia.

Swallowing is something most of us do without thinking about it. But it involves a carefully timed sequence of movements to get food and drink safely from your mouth towards your stomach.

A swallowing difficulty can affect different parts of this process.

It can happen for many reasons.

For example, swallowing difficulties can occur in people who have had a stroke or brain injury. They can also affect people living with neurological conditions such as Parkinson's or Motor Neurone Disease (MND).

The clinic also supports people who experience communication and swallowing changes related to other neurological conditions.

What are the less obvious signs?

Choking is not the only reason to pay attention to your swallowing.

Possible signs that eating or drinking has become more difficult can include:

• Coughing during or after eating or drinking.

• Frequently clearing your throat during meals.

• Taking much longer to finish a meal.

• Finding some foods harder to manage than others.

• Feeling that food is sticking or not going down easily.

• Having difficulty chewing or controlling food in your mouth.

• Avoiding foods you previously enjoyed.

• Feeling anxious about eating or drinking.

• Becoming tired during meals.

• Changes in your voice around mealtimes.

You may only notice one change.

Or your family may notice something before you do.

The important point is that you do not need to wait for a choking episode before asking for advice.

“But I only cough when I drink water”

It can be tempting to dismiss an occasional cough.

Perhaps it happens when you drink quickly. Maybe it seems to happen more when you are tired.

But if coughing when drinking is becoming a pattern, it is worth discussing with a healthcare professional.

Water and other thin drinks can sometimes be more difficult for a person with swallowing problems to control.

This does not mean that everyone who coughs while drinking has dysphagia.

It does mean that repeated changes deserve attention.

A proper assessment can help you understand what is happening rather than guessing.

Swallowing problems can affect more than eating

Food and drink are a big part of everyday life.

Think about having coffee with a friend.

Going out for dinner.

Having Sunday lunch with your family.

Enjoying a cup of tea without thinking about every swallow.

When eating and drinking become difficult, people can start worrying about these situations.

You may choose softer or easier foods without telling anyone.

You might avoid restaurants because you are worried about coughing.

You may eat less because meals feel tiring or stressful.

Fear around coughing and choking, losing foods you enjoy and becoming more dependent on other people are concerns that can have a significant effect on everyday life.

That is why swallowing support is not only about the mechanics of swallowing.

It is also about helping you eat and drink as safely and comfortably as possible while maintaining your quality of life.

How can a Speech and Language Therapist help?

You might associate Speech and Language Therapists with speech and communication.

But they also work with swallowing difficulties.

A Speech and Language Therapist can assess how you are managing food and drinks and look at the difficulties you are experiencing.

They can then give advice based on your individual needs.

This may include strategies to make eating and drinking easier or safer.

The important thing is that swallowing advice should be personalised.

What is helpful for one person may not be suitable for another.

For that reason, it is best not to make major changes to food or drinks based only on something you have read online.

When should I ask for help?

If you have noticed an ongoing change in the way you eat or drink, it is worth asking for advice.

You do not have to wait until the problem becomes severe.

Speak to an appropriate healthcare professional if you are regularly coughing during meals, struggling with certain foods or drinks, taking much longer to eat, or becoming worried about swallowing.

If someone is choking and cannot breathe, this is an emergency and requires immediate help.

For ongoing or less obvious swallowing concerns, a swallowing assessment can help identify what is happening and what support may be appropriate.

You don't need to wait for choking

A swallowing problem does not always look dramatic.

Sometimes the first signs are small.

A cough.

A meal that takes longer than it used to.

A food you have quietly stopped eating.

Or a growing feeling that eating and drinking simply doesn't feel the same anymore.

Helen McLean is an experienced Speech and Language Therapist with over 15 years of experience supporting adults with acquired communication and swallowing difficulties. She provides personalised dysphagia and swallowing support, including strategies designed around each person's individual needs.

If you or someone you care for has noticed changes in swallowing, you don't need to wait for a choking episode to seek help. Get in touch to discuss your concerns and find out whether a swallowing assessment could help.