Coughing after eating or drinking: causes and when to get help

Everyone coughs now and then when a crumb or sip of water goes down the wrong way. The pattern that deserves attention is a cough that follows eating or drinking again and again, or that comes with a wet, gurgly voice, a feeling of food sticking, or repeated chest infections.

The two main explanations are acid reflux and a swallowing problem. The NHS describes dysphagia as being where you have problems swallowing, usually caused by certain medicines or another condition. It describes acid reflux as stomach acid travelling up towards the throat, which can cause a cough that keeps coming back.

It is not possible to tell the two apart from the cough alone, which is why a GP assessment is advised when the cough keeps happening around meals.

The NHS lists the signs of dysphagia as coughing or choking when eating or drinking, bringing food back up, sometimes through the nose, a feeling that food is stuck in the throat or chest, and a gurgly, wet-sounding voice when eating or drinking. You may also drool and have problems chewing. Over time, it says, dysphagia can cause weight loss, dehydration and repeated chest infections.

It names a range of factors that make dysphagia more likely: certain medicines such as antipsychotics, a learning disability, heartburn and acid reflux, breathing problems caused by conditions such as COPD, conditions affecting the nervous system or brain such as cerebral palsy, stroke, dementia or multiple sclerosis, and cancers such as mouth cancer or oesophageal cancer. Babies with a cleft lip and palate can also have dysphagia.

The NHS includes shortness of breath after eating or drinking and getting lots of chest infections among the signs that should prompt urgent advice, so a cough around meals together with breathing symptoms or recurrent chest infections is worth mentioning to the GP.

According to the NHS, the main symptoms of acid reflux are heartburn, a burning sensation in the middle of the chest, and an unpleasant sour taste in the mouth. It may also cause a cough or hiccups that keep coming back, a hoarse voice, bad breath, bloating and feeling sick. Symptoms are often worse after eating, when lying down and when bending over.

The NHS cough page names heartburn (acid reflux) among the causes of a cough, alongside smoking, allergies, infections like bronchitis or COVID-19 and mucus dripping down the throat from the back of the nose. It also advises seeing a GP if a cough has lasted more than 3 weeks.

For reflux the NHS suggests smaller, more frequent meals, avoiding trigger foods, not eating within 3 or 4 hours of bedtime, stopping smoking and moderating alcohol. A pharmacist can suggest antacids or alginates, and a GP may prescribe a proton pump inhibitor and consider a gastroscopy if symptoms are severe or other symptoms such as food sticking, frequent vomiting or weight loss are present.

The NHS dysphagia page says to ask for an urgent GP appointment or get help from NHS 111 if you, your child or someone you care for has difficulty swallowing, coughs or chokes while eating or drinking, feels like something is stuck in the throat after eating, keeps bringing food or milk back up, has a wet, gurgly voice after eating or drinking, is short of breath after eating or drinking, or gets lots of chest infections. For babies it adds crying a lot or arching the back when feeding.

The NHS cough page advises an urgent appointment or NHS 111 if the cough is very bad or quickly getting worse, if you feel very unwell, have chest pain, find it hard to breathe or are coughing up blood. It advises seeing a GP for a cough lasting more than 3 weeks, for unexplained weight loss, or if you have a weakened immune system. The NHS heartburn page lists food getting stuck in the throat, frequent vomiting and losing weight for no reason as reasons to see a GP.

Any case of choking that blocks the airway or leaves someone struggling to breathe is an emergency. Call 999.

The NHS says the GP will examine you and may refer you to a specialist for further tests, and also to a speech and language therapist or a dietitian for advice about swallowing and diet. Treatment depends on what is causing the problem and how severe it is. If reflux is the cause, the swallowing problem may get better on its own, but longer-term causes may need specialist treatment to make eating and drinking as safe as possible.

The treatments listed include medicines to treat acid reflux, swallowing therapy with a speech and language therapist, changes to what you eat and drink such as softer foods and thickener in drinks, special spoons, plates and cups, feeding tubes through the nose or into the stomach, surgery to widen the oesophagus, and injections to relax the muscles of the oesophagus.

If you are caring for someone with swallowing difficulty, avoid changing food textures or adding thickener without guidance, because the right consistency is individual to the person and is decided after assessment.