Why Is It Hard for Some People to Swallow Pills? by Heidi Mitchell

Commonly a problem with the ladies. The sweet tooth they developed over time usually frustrates the efforts of a doctor to effectively carry out his duty of making them well. A drug is prescribed for the benefit of the lady and she comes back later with the same complaint, and you discover she did not take the prescribed medication, usually because it is bitter.

For some healthy adults, getting sick enough to require medication is only half of the problem. The other is getting that pill to go down. Stephen Cassivi, a thoracic surgeon at the Mayo Clinic in Rochester, Minn., who specializes in esophageal disorders, offers one explanation for why some people find it difficult to swallow pills.

—Heidi Mitchell

Fear Factor

Dr. Cassivi says the reasons some people can't even get a baby aspirin to go down the esophagus are varied. "People who have underlying swallowing difficulties, called dysphagia, may have trouble swallowing pills, but that is generally the result of other problems, such as stroke or surgery or gastroesophageal reflux," he says.

For the rest of the population, Dr. Cassivi notes, pill-swallowing difficulty is usually related to a fear of gagging, which might come from a bad experience with taking a pill. "Fear of gagging is pretty prominent" and a bad experience can cause one to think a pill is harmful and thus cause the throat muscles to tighten, he says. To swallow pills without worry, one has to "get over the mental hump" and relax the muscles.

It's Just a Phase

There are three phases to swallowing: oral (chewing, moistening and delivering food to the back of the mouth); pharyngeal (which includes the closure of the larynx by the epiglottis and vocal cords, and the temporary inhibition of breathing as the food passes); and esophageal (the rhythmic contractions of the esophagus to deliver food to the stomach, among other actions).

"We have an unconscious ability to know when food is moistened and masticated enough to be delivered to the back of the throat," Dr. Cassivi says. For instance, no one chews yogurt—typically one just swallows it—but not being able to chew a hard substance like a pill can throw the mind-body connection in swallowing off, he says.

The oral phase is the voluntary phase and may be the key to helping many people overcome pill-swallowing difficulties.

Down the Hatch

Many pill-phobes will dissolve medication in water or cut it into small pieces to get it down, but Dr. Cassivi doesn't advise this. "An extended-release pill has layers to delay the release," he says. "If you chew, dissolve or cut it, you're not delivering the medication as it was intended."

A pill with a scored line, intended as a guide for cutting it in half, he says, may sometimes be bitten or split before ingesting, but in general, "it's always better to swallow a pill whole." For some people, gel capsules are easier to swallow than chalky pills, but for other fearful swallowers, a pill is a pill.

Practice Run

Practicing while not in distress is the best way to get over difficulty swallowing pills, says Dr. Cassivi. He used to cut up gummy bears to teach his children.

Another strategy: Sit up so gravity can help the process. Drink a sip of water, then put the pill in your mouth. Take another sip of water and swallow. Positive reinforcement is often a good motivator. "Tell yourself, 'This is a small pill, it's smaller than the last piece of steak I ate,' " he says.

Looking to the side can be helpful. "A team of scientists in Canada found that by turning the neck, the upper esophageal sphincter seems to open slightly more, which may allow for more accommodation of swallowed material," he says.

Distraction is often a good technique. If you place the pill in apple sauce or yogurt, your body may get used to accepting it without feeling the need to chew it, he says.

One thing most people shouldn't worry about is having the pill go down the wrong way. "The vocal cords and epiglottis serve a purpose in coordinating the temporary closing off of the airway and avoiding what we call aspirating," he says. "Unless your wiring is off due to nerve or muscle disorders, it's not a concern."

Dr. Cassivi says there is no perfect solution to overcoming an inability to swallow pills. "But over time we realize that it's what we need to do, and it becomes like riding a bike."

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