When you swallow, food in your mouth passes into your throat (pharynx) [1]. So that food can move into the esophagus, the upper esophageal sphincter [2] opens. In the esophagus, a process termed peristalsis occurs, where waves of muscular contractions push the food downwards [3]. When food reaches the bottom of the esophagus, it moves through the lower esophageal sphincter [4] into the stomach [5].

It Hurts When I Swallow, Why?

1. Viral Infections of the Saliva Glands

Viruses are the most likely cause of throat infection. The most common is the cold virus, but other types of virus can cause throat pain. A viral infection can develop in the salivary glands, making them swollen and tender. There is also mononucleosis/mono, which can continue for months.

Many people ask their doctor for antibiotics for a viral throat infection. However, these drugs will not work and may make the problem worse. Therefore, it’s important to get the correct diagnosis.

2. Bacterial Infections

These are less common than viral infections but are often more severe. Some, but not all patients may need antibiotics.

• One of the most common bacterial infections causing throat pain is Streptococcus bacteria. In this infection, termed strep throat, the patient’s throat and tonsils are red and swollen, so swallowing becomes difficult.
• STDs can also cause pain when you swallow, for example chlamydia and gonorrhea, often contracted during oral sex. Throat pain is also a symptom of syphilis infection.

3. Fungal Infection

It hurts when i swallow, why? You could have fungal infection. These are most often seen in patients with weakened immune systems. One common oral fungal infection occurs when the Candida fungus, part of the normal mouth flora, grows out of control, resulting in a condition called thrush. This is the same fungus that frequently causes yeast infections in the vagina. Oral thrush creates a number of small, painful sores around the mouth and throat, making swallowing painful.

4. Canker Sores

Sore throats can also occur from canker sores, otherwise known as mouth ulcers. These can develop around the teeth and gums, or at the back or top of the throat. Canker sores can last anywhere between a couple of days and a few weeks, with those in the throat usually lasting longer. This is because when food and fluids pass over the sore, it makes healing over difficult.

5. Medications & Cancer Therapy

A sore throat is a common drug side-effect due to a decrease in saliva production. This is especially strong at nighttime, when the mouth and throat lining becomes dry and irritated. Drugs used for depression and allergies often have these effects.

Cancer treatment can also lead to throat pain. Both radiation and chemotherapy may cause mucositis, where the soft tissues throughout the digestive tract, including in the mouth and throat, develop sores and become inflamed. Up to 15% cancer patients get mucositis.

6. Stomach Acid in the Throat

People who have heartburn or acid reflex may find swallowing difficult, particularly if they are not controlling their condition. Acid passing up from the stomach to the mouth irritates and damages the throat and vocal chords, even if you don’t feel heartburn.

The resultant inflammation can mean that the patient finds it painful and difficult to swallow. Untreated acid reflux can result in painful burns to the throat lining. This can take a long time to heal, so the pain may persist.

7. Cold & Flu

The most common cause of sore throat is upper respiratory viral infection, for example common cold or flu. The cold virus can directly affect the throat, creating a persistent burning feeling, plus coughing and constant throat clearing can be irritating, making swallowing painful.

Sore throat is less common in influenza virus infection, but you may find that “it hurts when I swallow”. One difference between cold and flu is that flu tends to come on much quicker and the symptoms are more serious.

8. Dry Air

Your throat is easily damaged with dry air, for example from forced-air heating or air conditioning. These processes remove much of the moisture in air, so it’s more irritating when you inhale.

People who breathe through their mouth, perhaps because of a stuffy nose, or if the mouth is open when sleeping, are more likely to suffer. This is because your nose humidifies air before it passes down your throat. In mouth-breathing, the dry air comes into direct contact with the throat, irritating it.

9. Allergies

Allergies from pollen, dust, or dander, collectively termed hay fever, can cause throat discomfort, along with watery eyes, runny nose, and sneezing. The symptoms will generally be worse during hay fever season. However, you’re more likely to feel itching than pain.

Your condition may worsen after eating particular foods, with symptoms including stomach cramps, diarrhea, itchy mouth, and throat irritation. If you notice this, particularly after eating citrus fruit, grains, dairy, or nuts, ask your doctor to test you for allergies.

What You Can Do to Soothe the Pain

When you feel that “it hurts when I swallow”, the best strategy is to get plenty of rest, as long as your symptoms do not suggest a cold, sinusitis, laryngitis, or allergies. You may also want to try one of the following home remedies:

• Make sure you drink lots of fluids, particularly if you have an infection, for example tonsillitis or the common cold.
• Mix some salt into warm water and gargle with this mixture. However, be careful not to use too much salt, as this may make your throat worse. The water should be just salty enough to ease your pain. Alternatively, try gargling with apple cider vinegar. This has natural anti-bacterial effects, so is effective for sore throat.
• For some short-term pain relief, try sucking on some hard candy or a throat lozenge. These are not recommended for children, as they are a choking risk.
• You may find your symptoms ease if you use a humidifier, particularly if you breathe through your mouth or have been exposed to dry air.
• If you have strep throat, you’ll need to see a healthcare professional straight away. Your doctor can then prescribe anti-inflammatory drugs or antibiotics, if necessary. If you do receive antibiotics, you need to complete the course to prevent antibiotic resistance developing.
• Eat lots of vitamin C-rich fruit and vegetables. Vitamin C boosts your immune system, helping you fight bacterial and viral infections.

When to See a Doctor

If you have any of the following symptoms in addition to painful swallowing, speak to a healthcare professional:

• Bloody or black-colored stools
• Weight loss
• Breathlessness or lightheadedness
• Chills
• Fever
• Heartburn
• Coughing
• Wheezing
• Abdominal pain
• Nausea and/or vomiting
• A sour taste in your mouth