Why Do I Keep Swallowing Down the Wrong Pipe?

Have you ever taken a sip of water and suddenly started coughing hard? That feeling, when something seems to “go down the wrong pipe,” is your body’s way of protecting your airway. It can also be a sign of a swallowing problem called dysphagia.

When you swallow – be it a sip of water, a sandwich, or a chunk of king cake – many muscles and nerves work in unison to get what’s in your mouth to your stomach safely. Normally, this happens so smoothly that you don’t even notice. But when something goes wrong in this process, swallowing can become difficult or even painful.

According to the National Institutes of Health, about 1 in 6 people will experience this condition at some point in their lives.

What does dysphagia feel like?

Most people have had a brief episode of dysphagia at some point. It can cause:
•    Pain or discomfort when swallowing
•    The feeling that food is “stuck” in your throat or chest
•    Coughing or choking while eating or drinking
•    Hiccups after swallowing

These symptoms can be mild and short-lived, or they can be more serious and long-lasting.

When people say food “went down the wrong pipe,” they’re often describing a moment when food or liquid accidentally entered the windpipe, instead of the esophagus (the food pipe that leads to your stomach).

The right pipe versus the wrong pipe

When you swallow the right way, food and liquid travel down your esophagus — the tube that carries food to your stomach. Your body has built-in reflexes that protect your trachea (windpipe), which is only meant for air to move in and out of your lungs.

If something other than air — like food, saliva, or liquid — gets into the trachea, that’s called aspiration. Most of the time, your body quickly responds with a strong cough to clear it out.

But if you have severe coughing that doesn’t stop, trouble breathing, or notice blood when you cough, you should see a doctor right away.

If aspiration happens often, that’s another reason to get checked. Frequent aspiration can lead to infections in the lungs.

What happens if food gets in your lungs?

Sometimes, a person can’t cough out the food or drink that went down the wrong pipe. When that happens, bacteria can grow in the lungs and cause an infection called aspiration pneumonia.

Some people don’t realize this has happened — that’s called silent aspiration. The infection might show up days or even weeks later, with symptoms such as:
•    Fever
•    Shortness of breath
•    Chest pain
•    Feeling very tired or weak

People who are over 65, have nerve or muscle conditions like Parkinson’s disease or multiple sclerosis, or who live in nursing or assisted living facilities are at higher risk.

Aspiration, dysphagia and odynophagia: What’s the difference?

Dysphagia, aspiration and odynophagia are sometimes mistaken for one another. The three are related in that they all affect swallowing, but they are distinct conditions.

•    Aspiration is when something other than air, such as food or liquid, gets into the airways.
•    Dysphagia is trouble swallowing or the feeling that food doesn’t go down properly.
•    Odynophagia is painful swallowing, which can be caused by irritation or inflammation from acid reflux, infections or allergies.

What are the four types of dysphagia?

The categories of dysphagia are based on the location of the problem.

1.    Oral dysphagia – Difficulty chewing or moving food to the back of the mouth.
2.    Oropharyngeal dysphagia – The throat muscles don’t coordinate properly to push food into the esophagus.
3.    Esophageal dysphagia – Food gets stuck or moves slowly through the esophagus.
4.    Functional dysphagia – Swallowing feels difficult, but no physical cause can be found. Stress or anxiety can play a role.

What causes dysphagia?

Many factors may cause dysphagia, and most are temporary and non-life-threatening, according to the American Academy of Otolaryngology – Head and Neck Surgery. They include:

•    Acid reflux or GERD (stomach acid backing up into the throat)
•    Throat infections, such as tonsillitis 
•    Muscle weakness from aging
•    Food stuck in the throat
•    Narrowing or scarring of the esophagus
•    Vocal fold paralysis or weakness
•    Side effect of medications
•    Tumors
•    Prolonged illness needling long stays at the hospital
•    Past surgery or radiation to the neck, back or chest
•    Nerve disease such as Parkinson’s disease or multiple scoliosis

How is dysphagia treated?

Treatment depends on what’s causing the swallowing problem.
For mild cases, you may find relief by:
•    Eating slowly
•    Taking smaller bites
•    Chewing food thoroughly
•    Avoiding very hot or very cold foods

If acid reflux is the cause, your doctor may prescribe medications that reduce stomach acid.

A speech-language pathologist (a specialist in swallowing and communication) can teach you exercises and techniques to make swallowing easier and safer.

In some cases, muscle relaxants or surgery may be needed to correct a structural or nerve-related problem.

The bottom line

Occasional coughing while eating or drinking is normal. But if swallowing feels painful, food seems to get stuck often, or you’re coughing or choking regularly, it’s important to see a doctor.

Early evaluation can help prevent complications like aspiration pneumonia and ensure you get back to eating and drinking comfortably.

Learn more about primary care physician Mona Jodari-Karimi, MD