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It’s important to take dysphagia after a stroke seriously. While common during stroke recovery, dysphagia — the medical term for trouble swallowing — can be dangerous.

Dysphagia can cause choking, dehydration, poor nutrition, and social isolation. It can also lead to aspiration pneumonia, a bacterial infection in the lungs that’s sometimes fatal. Various treatments can help people with dysphagia avoid poor health outcomes and recover the ability to swallow.

What is Dysphagia?

Dysphagia refers to difficulty swallowing or the inability to swallow.

Swallowing requires the muscles in the mouth, throat, and esophagus to work together and move food down to the stomach. There are three different phases of swallowing:

• Oral Phase, where solid food, liquids, and medications enter the mouth and is manipulated by the lips, teeth, tongue, and palate before being transferred to the back of the mouth.
• Pharyngeal Phase, which involves the actual initiation of the swallow and passing of food/liquid.
• Esophageal Phase, where food enters the esophagus and travels to the stomach.

While dysphagia can occur for multiple reasons, it is a common result of a stroke. A stroke can damage the part of the brain that controls the nerves or weakens the muscles involved in swallowing. This makes it harder to not only move food to the back of the throat, but also down the throat, too.

Many people feel more tired and less alert after a stroke. This can also slow the reaction time of muscles.

Eating can be a very social activity, so the inability to participate as one normally would can result in social isolation for people with dysphagia.

What Percentage of People Have Dysphagia After a Stroke?

An analysis in 2022 found that the prevalence of dysphagia after a stroke can range from 42% to 72%, depending on the sensitivity of the assessment tools used.

Dysphagia can be mild (slight difficulty swallowing) to severe (extreme difficulty swallowing).

What are the Signs and Symptoms of Swallowing Problems After a Stroke?

It’s possible to have mild dysphagia and not know it.

But even mild forms can have severe health impacts, which is why screening for dysphagia after a stroke is so important.

Speech-language pathologists (SLPs) specialize in one’s ability to speak, swallow, and effectively communicate with others. They also help to improve cognitive communication skills following a stroke. They can help identify signs and symptoms of dysphagia.

For those who have noticeable dysphagia, symptoms may include:

• A gurgling sound to the voice after eating or drinking.
• Choking when eating.
• Coughing up food when eating or drinking.
• Dehydration.
• Drooling.
• Feeling like food gets stuck in the throat when swallowing.
• Food or liquid staying in the mouth after swallowing.
• Inability to keep the mouth closed when eating.
• Needing more time to chew or swallow.
• Pain when swallowing.
• Weight loss.

How Long Does Dysphagia Last After a Stroke?

Dysphagia after a stroke may improve or go away over time.

Many people who don’t recover in the first month can still consume food and drink by mouth. However, they may need to use techniques that make swallowing easier, such as diet modifications, thickening liquids, or speech therapy exercises.

In the study, about a quarter of the people with dysphagia swallowing problems after a stroke couldn’t get enough nutrients by eating. They required nutrients delivered through a tube placed either directly into the stomach or in the nose that travels to the stomach, or through an IV.

Fortunately, even in these severe cases, most people eventually regain their swallowing function. Only 6% of those diagnosed with dysphagia required tube feeding at six months post-stroke.

Dysphagia After a Stroke: The Dangers

People with dysphagia are more likely to choke when eating, which can be fatal. This is why it’s vital to monitor someone with dysphagia as they eat.

Another concern is aspiration pneumonia. When someone has trouble swallowing, the epiglottis — the flap that covers the airway — may not close tightly when swallowing. This can cause bits of food or liquid to enter the lungs, leading to a bacterial infection called aspiration pneumonia. This is most likely to occur in individuals with reduced mobility, lowered immune systems, more severe dysphagia, or poor oral hygiene.

Many people with dysphagia don’t know they’ve swallowed food, liquid, or saliva into the lungs. Symptoms of aspiration pneumonia may show up within hours or days among at-risk individuals, but can even appear weeks after something foreign enters the lungs.

Symptoms of aspiration pneumonia include:

• Coughing up mucus, which may have a foul odor.
• Fatigue.
• Fever or chills.
• Muscle aches.
• Pain in the chest.
• Shortness of breath, especially with exercise.

Dysphagia is also a danger because people may drink and eat less to avoid the effort of swallowing. Or they may choose less healthy foods because they’re easier to swallow, like gelatin. For these reasons, dysphagia can cause malnutrition and dehydration.

Diagnosing Dysphagia

If you or a loved one has had a stroke, a speech therapist can evaluate your swallowing and assess the strength and coordination of your muscles used in swallowing. Additional testing may also be ordered to more thoroughly assess what is happening internally when you swallow.

These tests include:

• Fiber-optic endoscopic evaluation of swallowing (FEES) — A doctor or SLP uses a scope with a video camera to see how your throat muscles move while swallowing.
• Modified barium swallow study (MCSS) — You swallow food containing barium, which shows up on a video x-ray. The doctor can then see whether food moves too slowly or gets obstructed. They can also ask you to move your head in different ways to see which postures improve swallowing.

How to Treat Dysphagia After a Stroke

It may take days, weeks, or months to recover the ability to swallow. For some people, swallowing never fully recovers.

Following an evaluation by a speech therapist, a treatment plan will be developed. This may include:

• Diet modifications for solids.
• Thickening liquids.
• Oral, laryngeal, and pharyngeal exercises.
• Various swallow strategies.
• Any additional referrals for further evaluation.

Treating dysphagia after a stroke can help ensure you get the hydration and nutrition your body needs. It can also improve your swallowing ability over time and prevent choking or aspiration pneumonia.

Examples of treatment for dysphagia include:

• Changing your diet, such as avoiding sticky foods (like peanut butter) or foods hard to chew.
• Cutting food into smaller pieces and chewing food more to avoid choking.
• Speech therapy exercises to improve your swallowing ability over time. An SLP can teach you how to strengthen your tongue and throat muscles.
• Providing hydration and nutrition through an IV or a tube in the throat or nose. (Often a temporary solution, but it can be permanent in severe dysphagia cases that don’t improve.)
• Thickening liquids to make them easier to swallow.
• Using safe swallowing techniques, such as tucking in the chin when swallowing to lower the risk of aspiration pneumonia or turning and tilting the head to one side if one side of the throat has stronger muscles.

Swallowing difficulties can have a significant impact on one’s quality of life. Our speech therapists work with you to improve your dysphagia symptoms and help you regain your ability to swallow safely and completely.

For more information about speech therapy at UPMC, call 1-888-723-4277.

Editor's Note: This article was originally published on April 4, 2025, and was last reviewed on April 10, 2025.