Overview
Dysphagia is the medical term for difficulty swallowing. It is a common complication following a stroke and can affect a person’s ability to eat, drink and take medication safely.
Swallowing difficulties can range from mild problems with certain foods or drinks to more significant impairment, where food, liquid or saliva may enter the airway rather than pass safely into the stomach. This is known as aspiration and can increase the risk of chest infections and other complications.
With appropriate assessment, treatment and rehabilitation, people experiencing dysphagia after a stroke can receive support to improve swallowing function, manage symptoms and maintain their nutrition and hydration.
At The Royal Buckinghamshire Hospital, our specialist inpatient rehabilitation service includes Speech and Language Therapy as part of a multidisciplinary approach to stroke recovery.
What is dysphagia?
Dysphagia means difficulty swallowing. Swallowing is a complex process involving muscles and nerves that work together to move food, drink and saliva from the mouth through the throat and into the oesophagus.
A stroke can damage the areas of the brain responsible for controlling and coordinating these movements. This can affect the timing, strength and coordination of the swallowing process.
Some people experience difficulty moving food around their mouth or initiating a swallow. Others may have problems with the movement of food or liquid through the throat, increasing the risk of it entering the airway.
Dysphagia can affect a person’s ability to manage different food and drink textures, and the severity can vary considerably.
What causes swallowing difficulties after a stroke?
A stroke occurs when the blood supply to part of the brain is interrupted or when bleeding damages brain tissue.
There are two main types:
The brain controls the muscles involved in swallowing. When a stroke damages the relevant areas or neurological pathways, the coordination of these muscles can be affected.
This may result in:
- Reduced control of the lips, tongue and mouth.
- Difficulty moving food or liquid towards the back of the mouth.
- Difficulty initiating a swallow.
- Reduced coordination between swallowing and breathing.
- Reduced sensation in the mouth or throat.
- Difficulty clearing food or liquid from the throat.
The nature and severity of dysphagia depend on the location and extent of the stroke and the impact on the swallowing mechanism.
Symptoms of dysphagia following stroke
Swallowing difficulties can present in different ways. Some symptoms are immediately noticeable, while others may be less obvious.
Common symptoms include:
- Coughing or choking when eating or drinking.
- Coughing shortly after swallowing.
- A wet, gurgling or bubbly voice after eating or drinking.
- Difficulty chewing or moving food around the mouth.
- Food remaining in the mouth after swallowing.
- Difficulty swallowing tablets or medication.
- Food or drink feeling as though it is stuck in the throat.
- Drooling or difficulty managing saliva.
- Taking significantly longer to finish meals.
- Avoiding certain foods or drinks.
- Repeated chest infections.
- Unexplained weight loss or dehydration.
Not everyone with dysphagia coughs or chokes when swallowing. Some people experience silent aspiration, where food or liquid enters the airway without an obvious coughing response.
This is why professional assessment is important, even when swallowing difficulties are not immediately apparent.
What are the risks of dysphagia after a stroke?
If swallowing is impaired, food, drink or saliva can enter the airway instead of passing safely into the stomach.
This can lead to several complications.
Aspiration pneumonia
Aspiration occurs when food, liquid or saliva enters the airway. This can introduce bacteria into the lungs and increase the risk of aspiration pneumonia, a potentially serious chest infection.
Dehydration
People with swallowing difficulties may drink less because swallowing is uncomfortable, difficult or unsafe. This can lead to dehydration and affect general health and recovery.
Malnutrition and weight loss
Difficulty eating enough food can result in inadequate nutrition, unintended weight loss and reduced energy.
Maintaining good nutrition is particularly important during stroke rehabilitation, when the body needs sufficient energy and nutrients to support recovery.
Reduced confidence and quality of life
Eating and drinking are important parts of everyday life and social interaction. Swallowing difficulties can make mealtimes stressful, reduce confidence and lead people to avoid eating with others.
Appropriate support can help address these difficulties and make eating and drinking safer and more manageable.
How is dysphagia diagnosed after a stroke?
Swallowing difficulties should be assessed by appropriately trained healthcare professionals.
Following a stroke, an initial swallowing screen should take place before a person is given food, drink or oral medication. If a person has difficulty swallowing, they should receive a more detailed assessment from a Speech and Language Therapist (SLT).
Assessment may include:
- Reviewing the person’s medical and stroke history.
- Examining the movement and control of the lips, tongue and mouth.
- Assessing swallowing ability and relevant symptoms.
- Considering the consistency of foods and drinks that can be managed safely.
- Reviewing coughing, choking or changes in voice associated with swallowing.
- Assessing the person’s nutritional and hydration needs.
Where clinically indicated, further investigations may be recommended. These can include:
Videofluoroscopic Swallowing Study (VFSS): An imaging assessment that uses X-rays to examine how food and liquid move through the mouth and throat during swallowing.
Fibreoptic Endoscopic Evaluation of Swallowing (FEES): An examination using a small flexible camera passed through the nose to assess structures involved in swallowing and observe signs of swallowing impairment.
These investigations help clinicians understand the nature of the swallowing difficulty and inform an appropriate management plan. Their availability and suitability depend on the clinical circumstances and referral pathway.
Treatment and rehabilitation for dysphagia following stroke
Treatment depends on the nature and severity of the swallowing impairment. The aim is to support safe swallowing, maintain nutrition and hydration, and improve function where possible.
Speech and Language Therapy plays an important role in the assessment and management of dysphagia.
Speech and Language Therapy
A Speech and Language Therapist assesses swallowing difficulties and develops an individualised management plan.
Depending on the person’s needs, this may involve:
- Exercises to improve the strength and coordination of swallowing muscles.
- Techniques to support safer swallowing.
- Advice on posture and positioning during meals.
- Guidance on appropriate food and drink consistencies.
- Strategies to manage difficulties with chewing and swallowing.
- Education for patients, families and carers.
- Monitoring progress and reviewing recommendations.
Therapy is adapted to the person’s abilities and should be guided by their clinical assessment.
Food and drink modification
Some people may need changes to the texture of their food or the consistency of their drinks to make swallowing safer.
This may involve softer or modified-texture foods and, where clinically indicated, thickened fluids.
Recommendations should be made following an appropriate swallowing assessment. Changes should not be made independently, as unsuitable food or drink consistencies can increase risks or unnecessarily restrict a person’s diet.
Nutrition and hydration support
Maintaining adequate nutrition and hydration is an important part of stroke recovery.
Where swallowing difficulties affect a person’s ability to eat or drink enough, the rehabilitation team may work with dietitians and other healthcare professionals to review nutritional requirements and consider appropriate support.
In some circumstances, alternative methods of providing nutrition and hydration may be required, such as a feeding tube. Decisions depend on individual clinical needs and should be discussed with the treating team.
Multidisciplinary rehabilitation
Dysphagia can occur alongside other effects of stroke, including weakness, impaired coordination, communication difficulties and cognitive changes.
A multidisciplinary rehabilitation approach helps address these wider needs and supports the person throughout their recovery.
Dysphagia rehabilitation at The Royal Buckinghamshire Hospital
At The Royal Buckinghamshire Hospital, Speech and Language Therapy forms part of our specialist inpatient neurological and stroke rehabilitation service.
Our multidisciplinary team works with patients to address the effects of stroke and support progress towards greater independence.
Depending on individual assessment and clinical requirements, rehabilitation may include:
- Speech and Language Therapy: Assessment and treatment for swallowing, eating and drinking difficulties, alongside communication and speech problems where required.
- Physiotherapy: Support with physical recovery, mobility, posture, balance and movement following stroke.
- Occupational Therapy: Help with everyday activities, including personal care, practical tasks and developing greater independence.
- Specialist nursing support: Ongoing support with daily care, monitoring, nutrition and hydration needs, and implementing recommendations from the wider rehabilitation team.
- Individual rehabilitation planning: Each person’s rehabilitation programme is developed around their clinical needs, abilities and personal goals. Progress is reviewed and the programme adjusted as appropriate.
Who may benefit from inpatient stroke rehabilitation?
Inpatient rehabilitation may be appropriate for people who have ongoing difficulties following a stroke and require a structured programme of specialist therapy and support.
This may include people who:
- Have swallowing difficulties following a stroke.
- Require ongoing Speech and Language Therapy.
- Have a combination of physical, communication and swallowing difficulties.
- Need support with nutrition, hydration and daily activities.
- Would benefit from coordinated rehabilitation involving different healthcare professionals.
Suitability depends on medical stability, swallowing and nutritional needs, rehabilitation requirements and the person’s ability to participate in a structured programme. An individual assessment is required to establish whether inpatient rehabilitation is appropriate.
Why choose The Royal Buckinghamshire Hospital?
The Royal Buckinghamshire Hospital provides specialist inpatient rehabilitation for adults recovering from stroke and other neurological conditions.
Our approach brings together different rehabilitation professionals to support the physical, communication and functional effects of neurological injury.
Speech and Language Therapy is an important part of this service, helping patients with swallowing and communication difficulties as part of their wider rehabilitation programme.
The team works with patients, families and referring professionals to develop individual rehabilitation goals and support planning for the next stage of care.
Discuss stroke rehabilitation with our team
Swallowing difficulties after a stroke can have a significant impact on health, nutrition and quality of life. Appropriate assessment and rehabilitation can help people manage these difficulties and work towards improved function.
If you or someone close to you is experiencing swallowing difficulties following a stroke, our team can discuss the inpatient rehabilitation options available at The Royal Buckinghamshire Hospital.
Call 01296 678800 to speak to the team, visit our Stroke Recovery and Rehabilitation page to find out more or enquire online below.
Frequently asked questions
Can dysphagia improve after a stroke?
Yes. Some people experience improvements in swallowing as they recover from a stroke. Speech and Language Therapy can help assess swallowing difficulties and provide appropriate exercises, techniques and strategies. The extent and timescale of improvement vary between individuals.
Is dysphagia common after a stroke?
Swallowing difficulties are a recognised complication of stroke. They can affect people to different degrees, from mild difficulties with certain foods or drinks to more significant problems requiring specialist support.
Can dysphagia cause pneumonia?
Yes. If food, drink or saliva enters the airway, it can increase the risk of aspiration pneumonia. Some people experience silent aspiration without coughing or choking, so a professional swallowing assessment is important.
What foods can someone eat if they have dysphagia?
This depends on the individual’s swallowing assessment. Some people may need softer or modified-texture foods, while others may be able to eat a more normal diet. A Speech and Language Therapist can provide recommendations based on swallowing safety.
Can someone with dysphagia drink water?
Not everyone with dysphagia can safely drink thin fluids such as water. Some people may require modified fluid consistency, while others can drink normally. Recommendations should follow an individual swallowing assessment.
What does a Speech and Language Therapist do for dysphagia?
A Speech and Language Therapist assesses swallowing ability, identifies potential risks and develops a management plan. This may include swallowing exercises, techniques, food and drink recommendations, and advice for patients and carers.
Can someone with dysphagia still eat normally?
Some people can continue eating a normal diet, while others may need changes to food texture, drink consistency or mealtime routines. The appropriate approach depends on the severity and nature of the swallowing difficulty.
When should someone seek emergency medical help?
Sudden difficulty swallowing, particularly when accompanied by facial weakness, arm weakness, speech difficulties or other new neurological symptoms, may indicate a stroke. Call 999 immediately. If someone is choking and unable to breathe, cough or speak, call 999 and follow emergency first-aid instructions.
Important: This page provides general information and is not a substitute for individual medical assessment. Swallowing recommendations must be based on a suitably qualified clinician’s assessment.
Review Date: 04/11/28
Published Date: 04/11/26
