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POTS and Feeling of Choking, Straining, or Pain in the Throat?

Updated: Jun 5

Feel like your throat is tightening and you don't know what to do about it?

It might feel like you're choking, have a lump, or pain in the throat, or that your voice is strained.

This can make you feel anxious, which can cause you to be in a cycle of fight or flight thus bringing on more symptoms.

Why does this happen? What can help? (see images and article below)

Let's examine this symptom through each of the pillars of the POTS Possibilitation Program: pacing, nervous system regulation, dietary changes, and movement.

Pacing & Nervous System Regulation

Fight or Flight and Adrenaline Dumps

Having POTS and dysautonomia often means that your body goes into a state of fight or flight.

This causes several things to happen to the body that can contribute to these symptoms:

  • Muscle tension: Muscles become tense in fight or flight.

  • Dysfunctional breathing: People might find that their breathing is more shallow than usual, which can lead to a feeling of tightness in the throat.

  • Swallowing difficulties: Being in fight or flight can also make it more difficult to swallow, thus leading to the feeling that something is stuck in the throat. There might also be less saliva being produced, which helps with swallowing and lubricating the mouth and throat.

  • Increased sensitivity: The flood of hormones in the body can make one more sensitive to all kinds of sensations, including those in the throat.

What Can Help: People who struggle with POTS often report having this symptom, so the good news is that it's not uncommon. I've worked with people who were barely able to swallow and thus were losing a lot of weight, and doing the nervous system work is what helped them the most in getting rid of this symptom and being able to eat again.

As an example, you can see Rita's story HERE.

The nervous system work is working on what puts your body in a rest and digest mode. Of course, as with anything, what puts your body in rest and digest mode is very different from person to person. One person found visualization very useful, another person enjoyed meditation, one did breathing exercises, and another person did yoga, some quit their job, or said no in other ways, etc.

Some have also been helped by taking beta blockers and/or anti-anxiety medications.

Reflection Point for you: What do you think can help in maintaining your body in a state of rest and digest? For some ideas, you can also take a look at the images above.

Bradycardia - Slow Heart Rate

The opposite is also true. Some people report this symptom when their heart rate is low. They notice that when they start working with the nervous system, the body tends to swing between extremes. So they might transition from tachycardia to bradycardia, and thus, this symptom will pop up.

As they continue working with the nervous system and experience fewer swings in heart rate, this symptom tends to disappear. (Sometimes, bradycardia can also be caused by medications such as beta blockers that slow down the heart rate.)

As a personal example, I used to struggle a lot with this symptom too. In hindsight, I think there were a few triggers. Positional changes were a big one, as were adrenaline dumps and bradycardia. Heat was always a significant trigger for me, and it tended to cause the lump in the throat feeling most often.

The Gut, the Enteric Nervous System, and Dietary Changes

There are a few conditions that are found alongside POTS that can also cause these throat symptoms.

Gastroesophageal Reflux Disease (GERD) and Laryngopharyngeal Reflux (LPR)

  • GERD is a condition where stomach acid frequently flows back into the esophagus, causing heartburn, regurgitation, and sometimes chest pain or cough.

  • LPR occurs when stomach acid flows back into the voice box and throat. It typically doesn't cause heartburn like GERD but leads to symptoms like chronic cough, throat clearing, and a sensation of a lump in the throat.

Mast Cell Activation Syndrome (MCAS)

  • MCAS is a condition where mast cells (a type of white blood cell involved in the body's immune response) become overly reactive and release excessive amounts of chemical mediators (such as histamine) in response to triggers that are normally harmless.

  • This excessive activation leads to a wide range of symptoms throughout the body, including skin symptoms (itching, hives), GI symptoms, respiratory symptoms (nasal congestion, throat tightness), cardiovascular symptoms, neurological symptoms, etc.

What Can Help: Since everything is interconnected, our nervous system health also influences mast cell activity, inflammation, and our immune response, as well as affecting gut health by modulating the digestive system. Therefore, by continuing the nervous system work, we can make a positive difference in managing conditions such as GERD, LPR, and MCAS.

At the same time, we can (and should) address our health from a different angle by considering dietary changes known to have a significant impact on GERD, LPR, and MCAS.

Some clients have benefited from specific GERD diets and low histamine diets, while others have found relief through anti-inflammatory diets. Additionally, some have identified triggers for their symptoms by trialing an elimination diet. Similar to nervous system work, dietary adjustments are highly customized.

Also, don't forget to stay hydrated to keep the throat moist.

When discussing what enters our body, it's important to consider not only food but also what we are inhaling. I've had a few clients who have alleviated their throat symptoms by removing carpets, curtains, or moving out of a moldy home.

Some clients have also been placed on medications (antihistamines, PPIs, etc.) to help with these conditions.

Reflection point for you: What's the first dietary baby step you can take in this area? Is it making minor diet changes or examining your home environment more closely?

Movement and the Body

Postural Changes

If you find yourself lying down on your back more than usual, this can also cause increased blood flow to the head and neck, thus resulting in these symptoms.

Laying down can also trigger acid reflux, where stomach acid flows back into the esophagus, leading to throat irritation and tightness.

If your neck is strained (maybe you've been lying or sitting in a specific position more than usual lately), this can also contribute to these symptoms.

What Can Help: I had a client who started using a wedge pillow when they laid down and slept, and that helped them. Someone else elevated the foot of their bed so that when they slept, they were not lying completely flat. (This also helps with dehydration and general POTS symptoms.) Another person found relief by lying down in a zero-gravity chair throughout the day.

Reflection Point for You: What changes in position can you make to ease some of the strain off your neck? There are also some exercises in the images above that you can try.

Final Thoughts

By working with the nervous system, making dietary adjustments, and paying attention to the body's positioning, it is possible manage and alleviate these symptoms effectively.

The interconnected nature of our body means that working on one aspect can influence others.

Implementing these strategies may alleviate more than just throat tightness :)

It's important to personalize your approach and I hope that the reflection points helped you figure out your next step.

If you have any questions, don't hesitate to reach out.

If you're seeking support and a structured plan while navigating these changes, have a look at the POTS Possibilitation Program and see if it might be a fit for you.


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