The problems that many people have with swallowing pills can be primarily explained by psychological factors, although there are some physical aspects that can make the pill-taking process more difficult than swallowing normal food.
Although many of us would rather this not be the case, taking pills is often a necessary part of life. The sensation of a rough, chalky pill sliding down your throat is unpleasant, to say the least. However, between daily vitamins and prescription medications for an endless list of potential health concerns, most people have to deal with swallowing pills at some point—sometimes every single day! While swallowing large chunks of chewed-up food is rarely a problem, swallowing comparatively small pills can cause people to cough, gag, choke, or even vomit.
This leads to an obvious question… Why do so many people struggle to swallow pills, and why does it feel like pills are harder to swallow than food?
The Physics of Swallowing
The reason that the difficulty of swallowing pills is so baffling to people is that everyone practices swallowing every day of their life—it’s one of the first actions we take as infants, alongside breathing, blinking and crying. Whether we are swallowing a sizable and savory chunk of steak, a clump of popcorn, a piece of bread or a diced up salad, most throats can smoothly swallow food on instinct, and people barely give it a second thought. Before we can understand why pills are particularly hard to swallow, we need to understand what the process of swallowing actually entails. To begin with, there are three phases of swallowing, only one of which we consciously control.
Oral Phase – This is the part of swallowing that we control, the parts that involve opening our lips to allow food or drink to enter the mouth (oral cavity). We begin by moistening the food with saliva, and then chewing with our teeth, moving the bolus of food from side to side with the help of the tongue. A nerve in the tongue (lingual nerve) senses when food is appropriately moistened and compacted into a bolus, enough to swallow. A trough then forms at the back of the tongue, and the tip of the tongue moves to the front top of the mouth, forming a downward slide for the bolus. As the apex of the tongue presses against the roof of the mouth, the bolus moves to the oropharynx.
Pharyngeal Phase – All other entrances to the pharynx are closed once the bolus moves into the pharynx, preventing vomiting, breathing, chewing or coughing. The soft palate tenses and the folds of the pharynx rise to meet the incoming bolus, which must not be too large. The auditory tube then opens and the oropharynx closes, followed by the opening to the vocal cords (larynx). This part of the swallowing process is automatic, and is passively controlled by specialized cranial nerves. As the pharynx undergoes peristalsis, the bolus is moved down towards the esophagus. The cricopharyngeus opens and the final phase begins.
Esophageal Phase – Another phase that is passively controlled by the brain, this final phase sees the food bolus moving slower than it did in the pharynx, propelled by smooth muscle movement. The esophageal sphincter contracts and relaxes, moving the bolus down towards the stomach. When the bolus passes out of the esophagus, both the larynx and pharynx relax, returning to their normal states.
Problems With Swallowing Pills
Perhaps the brief explanation above shows you how complex the swallowing process is, even if we’re not directly in control of it. Clearly, there are a number of things that could go wrong in the process, which could result in aspiration, discomfort, and the very visceral feeling that you’re about to die. Factors that result in difficulty swallowing pills include psychological causes, pill dimensions, improper technique, or physical issues, such as dysphagia.
Yes, of all the problems that people have with swallowing pills, the memory of times choking in the past are likely the most common. The inability to breathe, or the sensation of having something large stuck in your throat, is a terrifying experience that sticks with you. If you have gagged on a pill in the past, or even a piece of food that wasn’t properly moistened, your brain will remember that feeling; some part of your mind doesn’t want to repeat it, and you end up psyching yourself out in the middle of swallowing a pill.
Our minds are also programmed to swallow masticated food and liquid, which we recognize unconsciously, right before swallowing huge chunks of steak or whole spoonfuls of mashed potatoes. However, a pill is very different from a sensory angle, with chalky consistency and a firm, solid shape; we are asking our brains to treat it the same as food, but some part of our unconscious defense mechanism can be triggered, particularly if we are psychologically predisposed to hating pills!
Although swallowing may seem like second nature, there are “better” ways to do it, based on the shape and alignment of our pharynx and esophagus when swallowing takes place. For those who struggle with swallowing pills, you may have a slightly smaller pharynx or a narrower passage for your food bolus. You can try various techniques, such as the pop-bottle method, which consists of placing the tablet on your tongue and then squeezing a bottle of water into your mouth, effectively flushing the pill right down your throat. Leaning forward as you swallow may also help, despite seeming counterintuitive, it can open up your pharynx and make the swallowing process much easier.
If you have ever been prescribed a “horse pill”, you know that some medications are intimidatingly large, which can make it very hard to swallow. Studies have found that gelcaps are much easier to swallow than tablets, and round shapes are easier to get down than cylindrical or rectangular pills. If you consistently struggle to swallow pills, or feel them lodged uncomfortably in your chest, like a bolus, perhaps ask your doctor for a different brand, a liquid form, or some other variation that fits your comfort level. On the other extreme, for very small pills in a large mouthful of water, people will lose track of the pill, which might cause it to lodge behind a tooth or stick to the gums, rather than moving down the throat.
Aside from all these other factors, there are many people who suffer from dysphagia, which some consider a symptom of other conditions, and others consider to be a health condition itself! At its most basic definition, it means difficulty swallowing, and may relate to trouble manipulating food with the tongue, maintaining proper saliva levels, moving the bolus into the pharynx, or completing the swallowing process, with the food getting “stuck” before moving into the stomach. Dysphagia can affect one or more of the steps of swallowing, and may make it difficult to consume medication and pills.
A Final Word
In a perfect world, everyone would be healthy and we would have no reason to ever swallow pills. However, billions of people around the world have to swallow pills every single day, and millions struggle with this process! Fortunately, understanding some of the factors behind this difficulty may help you develop strategies to avoid gagging, while still getting all the meds and vitamins your body needs!