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MS and Drooling: Causes and Management

Posted on May 19, 2022
Medically reviewed by
Joseph V. Campellone, M.D.
Article written by
Sarah Winfrey

Some people with multiple sclerosis (MS) experience drooling (also known as sialorrhea). This symptom can be frustrating and may leave you wondering what is to blame. One MyMSTeam member expressed this kind of dismay when they asked, “Has anyone experienced drooling? Is it a little-known symptom of MS?”

If you’re experiencing excessive drooling, here’s what you need to know, including how it may be connected to MS and what you can do to manage it.

How Does Drooling Affect Life With MS?

Drooling can affect people with MS in different ways. It occurs only sporadically for some people, like one member who said, “About a year ago, I started drooling a lot at night. It is starting to get worse.” Another added, “Lately, I’ve experienced occasional drooling and wondered if anyone else has this problem.”

For other people, drooling is a much more significant concern. “I can’t get out a full sentence without having to stop, swallow, resume,” one member said. “It’s absolutely infuriating. Between confused thoughts, struggling to keep up with conversation, and then having to worry about drooling, I usually find it much easier and less frustrating to remain silent.”

Another member finds that drooling can make it hard to consume fluids, especially in public. “So, lately, I find myself drooling when I’m drinking as if it’s a hole in my mouth,” they explained. “Is this normal? Nonetheless, it’s embarrassing.”

Clearly, drooling can affect your quality of life when you have MS. However, it is possible to manage the symptom with the help of your neurologist or neurology team.

What Causes Drooling in MS?

There are several causes of drooling in people with MS. You can work with your neurologist or health care professional to pinpoint the cause in your case and find the best treatments for your needs.

Swallowing Problems

Many people, including MyMSTeam members, wonder if hypersalivation (too much saliva being produced) causes their drooling. This is sometimes the case, as some medications can increase saliva production.

More frequently, however, the problem involves weakness in the muscles that control drooling (in the tongue, lips, and cheeks). Not swallowing often enough also can cause drooling.

Some people experience difficulty swallowing alongside drooling. For example, one member explained, “I have noticed I’ve been drooling. Also, it’s become harder to swallow.” Other times, swallowing problems may be mild, with drooling the only symptom.

Problems with swallowing are called dysphagia. The condition occurs when the nerves that control the muscles for swallowing are damaged due to demyelination from MS. Demyelination is when MS attacks the myelin coating on nerves throughout your central nervous system, causing lesions to form on the nerves. Electrical signals struggle to get through these lesions, and the signals do not reach the muscles properly. This can cause problems with movement and bodily functions such as swallowing. Dysphagia can also occur in other neurological disorders, including Parkinson’s disease, cerebral palsy, and amyotrophic lateral sclerosis.

People with dysphagia might choke on food, have trouble swallowing medications, inhale food or beverages into the lungs, and have other related problems.

Facial Weakness

Less frequently, drooling may be caused by facial muscle weakness or palsy in people with MS. This occurs when the nerves that control the facial muscles are damaged. Specifically, problems with the cheeks and the lips can result in drooling.

One member who experiences this wrote, “I suddenly find myself drooling. I blame it on my dropped mouth, as that is the only side that does it.”

Other Causes of Drooling in MS

Although nerve damage is the most frequent cause of drooling in MS, the symptom also can occur for other reasons.

Drooling can result from eating foods with a high sugar or acid content. It can also be related to illnesses that affect the throat and mouth, such as strep throat, tonsillitis, and sinus infections. Other causes include chronic acid reflux, allergies, and exposure to certain toxins. Taking certain medications can also lead to drooling.

If drooling starts suddenly or begins to happen more often, you should seek medical advice right away. Finding the cause of your drooling will help you address it as quickly as possible.

Managing Drooling Associated With MS

Quite a few treatment and management options address drooling associated with MS. You can work with your doctor or health care provider to find the treatment plan that best controls your symptoms without interfering with your MS care.

Conservative Measures

Positioning can help reduce drooling in people with MS. For those with nerve damage to the face, devices can create a better lip seal. Some people also use portable suction machines to help get rid of excess saliva. Swallowing therapy offers another conservative option.

Swallowing Therapy

Your doctor may recommend swallowing therapy. This is best for people who are not severely affected by drooling and have enough time and energy to do the exercises. A speech and language pathologist can work with you to help you improve your lip seal, strengthen and coordinate your swallowing muscles, and get rid of excess saliva in your mouth.

One member recommends this approach. “Try to see a speech therapist,” they wrote. “They will check the strength of your throat and swallow muscles. … A speech therapist may be able to help you strengthen these muscles or give you exercises to work on coordination.”

Injections

Injecting botulinum toxin, or Botox, may help reduce saliva production and drooling. Even if you don’t overproduce saliva, this treatment can help keep drooling under control.

Injected botulinum toxin may not be an appropriate treatment for everyone with MS. If the saliva glands are already malfunctioning because of nerve damage, reducing saliva production more may not be the best option. If this is the case, you may want to ask your doctor about other potential treatments.

Medications

Drugs called anticholinergics cause dry mouth and can help reduce drooling associated with MS. The most commonly prescribed medication to help with drooling is glycopyrrolate, which reduces the symptom in about 95 percent of people who give it a try.

Glycopyrrolate is usually taken in tablet or liquid form, but it can also be given as an injection. A similar medication, scopolamine, is also available in a patch. Glycopyrrolate can cause side effects such as constipation, blurry vision, and urinary retention and can cause confusion in older adults. Your body may develop a tolerance to the drug over time and thus require more and more of it to control drooling. It is also important to check in with your doctor to make sure your mouth does not get too dry, which can cause additional problems.

Radiation Therapy

Targeted radiotherapy may work in a way similar to botulinum toxin. A beam of radiation is aimed at the salivary glands to lower saliva production. This treatment is usually recommended after people have tried medications and botulinum toxin injections without success. Once again, this treatment is not recommended for people whose salivary glands are not working properly. In addition, this therapy can cause an excessively dry mouth, and the radiation exposure may increase the risk of cancer.

Surgery

Surgery of the salivary glands can also help reduce drooling. Although many people are happy with the results, these procedures are quite invasive, and there’s no consensus on which type is best.

If less invasive strategies will not control your drooling, consider working with a surgeon to determine which procedure might be best for you. Make sure your surgeon knows that you have MS, because this may influence their choice of procedure.

Find Your Team

Are you or a loved one living with multiple sclerosis? Consider joining MyMSTeam. Reach out today to meet people from around the world who live with MS. You can share your story, ask questions, or answer questions others pose. You’ll find a team of people who will always be on your side!

Are you frustrated by MS-related drooling, or are you concerned about swallowing? Share your story or thoughts in the comments below or by posting on MyMSTeam.

All updates must be accompanied by text or a picture.
Joseph V. Campellone, M.D. is board-certified in neurology, neuromuscular disease, and electrodiagnostic medicine. Review provided by VeriMed Healthcare Network. Learn more about him here.
Sarah Winfrey is a writer at MyHealthTeam. Learn more about her here.

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