Whether it’s a dainty baby aspirin or a bulky horse pill, trying to swallow an object without chewing can make for a frustrating experience. The body naturally wants to break something down before it ingests it, so introducing a solid, not to mention ill-tasting, object has the tendency to make medicating more difficult. But swallowing pills doesn’t have to come with such side effects.
Mental Block or Physical Dysfunction?
The problem of swallowing pills is compounded, in many cases, by feelings of immaturity. The resulting gagging or crying may be involuntary, but it’s hardly the reaction that many people would like to produce when facing an object the size of a breath mint. Stephen Cassivi, a thoracic surgeon at Mayo Clinic, says that his patients face the problem constantly.
"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 told the Wall Street Journal. The majority of people simply face mental barrier, which they could easily overcome if taking pills weren’t made into a grand performance.
Often, the greatest difficulties come from a fear of gagging. People may have had a particularly traumatizing episode where the pill slid too far back on the tongue without actually falling down the esophagus, so now they relive that moment on each future occasion. Overcoming that fear is a matter of concentrating effort on relaxing the muscles of the throat, Cassivi says.
"We have an unconscious ability to know when food is moistened and masticated enough to be delivered to the back of the throat," he added, highlighting a complication that many people face. Gnawing off a large bite of food and swallowing it nearly whole is, for most people, not a worry — or at least not a trigger for the fear response. Some foods, like yogurt or applesauce, require no chewing at all. The chalky texture of many pills — gel capsules are generally easier to swallow, Cassivi says — creates a disconnect between the body and mind, as the brain realizes the pill isn’t food but is asked to treat it that way.
Cassivi notes that there are three stages to swallowing: oral, pharyngeal, and esophageal. The oral phase involves wetting the food and chewing it in preparation for swallowing. The pharyngeal phase includes closing the larynx, which prevents food from traveling down your windpipe. Finally, the esophageal phase pushes the food through the esophagus in order to reach the stomach for digestion. Problems most commonly arise in the oral phase, as it is the only stage of the process controlled by the pill swallower.
Given that it takes about 50 pairs of muscles and nerves just to swallow a tiny pill, difficulties swallowing can arise from a number of factors. Dysphagia, a severe difficulty moving food from the mouth to the throat, can stem from neurological disorders (multiple sclerosis, Parkinson’s disease), neurological damage (from a stroke or spinal cord injury), pharyngeal diverticula (a small pouch that forms in the throat and collects obstructive food particles), or cancer.
In many cases, these serious complications won’t explain why people can’t withstand the foreign feeling of a baby aspirin falling down their throat.
“While it may seem as if you have an extraordinarily strong gag reflex or odd throat mannerisms, consider that it may actually be the power of your mind, not the power of your throat,” writes Alice of Go Ask Alice, Columbia University’s health Q&A service. “Try to psych yourself out with this pill swallowing mantra — ‘I can swallow this. I can see the pill going down.’"
People who have a hard time with pills should also stand or sit upright while taking it, ensuring the pill’s path won’t be a crooked one. Looking to the side may also be helpful, as Cassivi suggests the esophageal sphincter opens up more in that position. What he, and other experts, caution people against — despite its attractiveness — is cutting pills down to more manageable sizes.
"An extended-release pill has layers to delay the release," he told the Wall Street Journal. "If you chew, dissolve or cut it, you're not delivering the medication as it was intended."
Leading Up To Success
Tricking the body, or at least preparing it when the stakes are low, has also seen success. In his own children, Cassivi has cut up gummy bears for them to practice on. When the time came for them to swallow a real pill, their mouth and throat were already accustomed to swallowing a solid object. If this still presents a problem, consider stashing the pill covertly in some applesauce or yogurt — anything to mitigate the pill’s texture or taste.
Cassivi reassures people that pills travelling down the “wrong pipe” are very uncommon. "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,” he added, “it’s not a concern.”
For many people, overcoming the fear of taking pills — like the act itself — comes in stages. First, the pills start out small. Perhaps they’re lodged in easily ingestible food. Next, they’re taken with disproportionately large gulps of water, rendering them unnoticed as they go down the hatch. Finally, they’re taken on their own, with minimal water, and before the pill swallower has noticed it, both the pill, and the fear of taking it, have vanished.
"Over time we realize that it's what we need to do,” Cassivi told the Wall Street Journal, “and it becomes like riding a bike."