“Lately I wake up at night with the corner of my pillow soaked because of drooling. Is this just life and getting older, or is this MS?” asked one member of MyMSTeam. MS can cause drooling if it affects the muscles in your face or makes it harder to swallow.

Aging, other health conditions, and some medications can also cause or worsen drooling.

We’ll cover ways MS can cause drooling, how this symptom affects people, and some options for how to manage it.

🗳️ Have you noticed drooling as a symptom of MS?

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What Causes Drooling in MS?

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

Swallowing Problems

Anything that makes it harder to swallow can result in drooling. Saliva pools in your mouth and can spill out.

“I’ve noticed I’ve been drooling. Also, it’s become harder to swallow.”

— A MyMSTeam member

Problems with swallowing are referred to as dysphagia. In MS, inflammation and damage to myelin can interfere with the muscles involved in swallowing.

Drooling and difficulty swallowing can be a dangerous combination if you breathe saliva into your airway. Breathing anything other than air into your lungs can raise your risk for aspiration pneumonia if you don’t cough it out.

People with MS are at a higher risk for developing aspiration pneumonia.

Facial Weakness

Drooling may also be caused by facial muscle weakness in people with MS. Drooling can develop when MS damages brain nerve cells (neurons) that control the muscles that move the cheeks and the lips.

Facial weakness on one side may be connected to Bell’s palsy, which occurs in 0.2 percent of people living with MS. “I suddenly find myself drooling,” said one MyMSTeam member. “I blame it on my dropped mouth, as that’s the only side that does it.”

Other Causes of Drooling

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

Conditions including chronic acid reflux, allergies, and Parkinson’s disease can all lead to drooling. Certain medications can also cause drooling.

How Does Drooling Affect Life With MS?

Drooling can affect people with MS in different ways. For some MyMSTeam members, it occurs only at night.

One member wrote, “About a year ago, I started drooling a lot at night. It’s starting to get worse.” Another stated, “I have a lot of drooling in my sleep.”

“I suddenly find myself drooling. I blame it on my dropped mouth, as that’s the only side that does it.”

— A MyMSTeam member

For other people, drooling is a nonstop problem that gets in the way of socializing. “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,” they continued.

Another shared, “Lately, I find myself drooling when I’m drinking, as if there’s a hole in my mouth. It’s embarrassing.”

For many people, it’s possible to manage drooling and improve quality of life with the help of your neurology team.

Managing Drooling Associated With MS

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

When Drooling Needs Immediate Medical Care

Starting to drool suddenly may be a sign of a stroke, especially if it happens with other symptoms like:

• Weakness in their face or arms
• Changes to how they speak
• Sudden and severe balance problems
• Sudden swallowing problems

If you notice drooling along with any of these signs, get emergency care as soon as possible.

Conservative Measures

Keeping an upright posture with your head raised might help reduce excessive drooling by encouraging automatic swallowing in people with MS.

For those with nerve damage to the face, oral devices can create a better seal. You may also consider a portable suction machine to remove extra saliva.

“Lately, I find myself drooling when I’m drinking, as if there’s a hole in my mouth. It’s embarrassing.”

— A MyMSTeam member

Swallowing therapy offers another conservative option.

A speech and language pathologist can evaluate your swallowing problem. Then, they can recommend exercises to help you improve your lip seal, strengthen and coordinate your swallowing muscles, and get rid of excess saliva in your mouth.

Medication Options

If conservative steps don’t help, your doctor may recommend trying medication.

Injecting botulinum toxin (sold as Botox and other brand names) may help reduce saliva production and drooling. Note that botulinum toxin isn’t approved by the U.S. Food and Drug Administration (FDA) to treat drooling, and it may not be an appropriate treatment for everyone with MS.

Drugs called anticholinergics cause dry mouth and can help reduce drooling associated with MS. The most commonly prescribed medication for drooling is glycopyrrolate. Glycopyrrolate isn’t FDA-approved for drooling, either.

All medications can cause side effects. Talk treatment options over with your doctor to better understand the potential benefits and risks.

Surgery

If drooling is severe and isn’t controlled by other measures, your doctor may mention surgery of the salivary glands. At least one study shows that drooling improved long-term after a surgical procedure.

However, this study involved adults with neurodevelopmental disabilities, rather than people living with MS. Surgery isn’t a common treatment for drooling.