Why Can’t I Swallow? Common Causes and a Pro Tip That Makes Taking Pills Easier
A top doctor explains why the problem becomes more common with age
Swallowing is so fundamental to everyday life that when the proverbial frog in your throat rears its head, it can feel anything from mildly annoying to downright disconcerting. So if you’re wondering, “Why can’t I swallow?” keep reading for a few common causes and the doctor-approved strategies that will help open your throat and restore peace of mind.
Why can’t I swallow? The two main culprits
While trouble swallowing (medically known as dysphagia) can have many causes, it generally falls into two main categories, reveals Anish Sheth, MD, AGAF, Chief of Gastroenterology, Director of the Center for Digestive Health and President of the Medical Staff at Penn Medicine Princeton Health.
The first involves mechanical issues, “specifically narrowing of the food pipe, or esophagus, which causes a physical constriction,” he explains. “The second category includes motility disorders, meaning the muscles of the esophagus aren’t functioning properly—they may be too weak or squeeze incorrectly.”
Woman's World Answers
Of the two potential culprits, mechanical issues are more common. “Rings or scar tissue sometimes form in the esophagus,” Dr. Sheth explains. “These are generally benign, fibrous changes that may result from various factors. For example, people with long-standing acid reflux or GERD can develop scarring over time, which may progressively narrow the esophagus.”
When it comes to motility issues, various conditions such as autoimmune disorders like lupus or Sjögren’s disease can affect the esophagus, he adds.
Does swallowing become more difficult as we get older?
Sometimes. “As we grow older, there’s a natural weakening of the esophageal muscles,” confirms Dr. Sheth. “When we’re young, the esophagus is usually a tight, efficient conduit. But as we age, it can become a bit stretched, floppy and less effective at moving food.
“We see this change slightly more often in women than men, and it generally becomes noticeable only in our 70s and 80s. It’s a normal physiological change with no known cause other than aging.” The result: trouble swallowing food or liquids when you eat or drink and difficulty taking pills (more on that below).
Can’t swallow pills?
Beyond age-related changes, there’s another swallowing challenge many people face—and it has nothing to do with food. “Some people, with certain-sized pills, get a sensation that they’re going to choke and can’t initiate the swallow,” says Dr. Sheth.
“The larger the pill, the more likely this is to happen—but there’s no underlying gastrointestinal cause, and no medical intervention can ‘fix’ it. Sometimes it develops into a behavioral aversion, and people just have to find ways to work around it.”
You already know the most logical workaround when it comes to how to swallow a pill, and it’s doctor-approved: “The simplest solution is often to crush the pills and mix them into applesauce or something with a similar consistency, if that’s safe for the kind of medication you’re taking.”
Other than that, there’s not much else to do about this type of swallowing problem because it’s not a mechanical blockage in the esophagus, adds Dr. Sheth. “It’s simply a difficulty some people experience, whether it’s a mental block or something else.”
When to see your doctor for difficulty swallowing
One of the most important factors to consider is the frequency of your symptoms, notes Dr. Sheth. “Progressive symptoms are key. Is this something that happens with every meal and keeps getting worse? For example, it started with steak and now it’s even with mashed potatoes. That’s very different from someone who, once every couple of months, doesn’t chew their food well and feels it getting [momentarily] stuck in their throat.”
Dr. Sheth notes two other signs that warrant a trip to your doctor:
- Loss of appetite
- Unexplained weight loss
What to do if you have trouble swallowing
“If someone is having trouble swallowing because of scar tissue [often due to years of acid reflux or GERD), we usually start with endoscopy,” says Dr. Sheth. “During the procedure, we can stretch the esophagus and use various tools to open up narrowed areas. We also use medications to treat acid reflux and prevent further inflammation. Essentially, widening the esophagus through endoscopy is the main intervention.”
The bottom line on trouble swallowing
While there may be several reasons you’re having trouble swallowing—from age-related weakening of throat muscles to prolonged acid reflux—there are effective ways to manage it, depending on the severity of your condition. That can range from over-the-counter heartburn medications to surgical options. As Dr. Sheth notes, consult your doctor if your symptoms worsen or become more frequent so that you can get the treatment that’s right for you.
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