Multiple sclerosis (MS) - common symptoms

What is multiple sclerosis (MS)?

Multiple sclerosis (MS) is an autoimmune disease of the central nervous system that can affect the brain, spinal cord and optic nerves. It can result in a range of symptoms and functional impairments.

MS symptoms are varied and unpredictable, depending on which part of the central nervous system is affected, and to what degree. It is important to remember that some people may not have many symptoms at all. Symptoms may last for a short time or only occur during the short period of a relapse, depending on the affected areas and the degree of inflammation present.

Symptoms can be a combination of changes in:

• levels of fatigue
• sensory function (such as pins and needles or burning pain)
• vision (such as blurred or double vision)
• bladder function (such as urgency, frequency or difficulty in emptying the bladder)
• bowel function (such as constipation or incontinence)
• sexual function
• motor function (such as problems with weakness, balance, spasms or functioning of the legs and arms)
• mood (such as depression or anxiety)
• cognition (such as problems with memory and information processing)
• pain (such as acute pain with a relapse or chronic with spasticity).

The symptoms of MS can be both visible and invisible to others. They can also be unpredictable and vary from person to person and from time to time. Symptoms can also interact with each other and other co-occurring conditions or diagnoses.

The key goals in managing MS are to:

• minimise relapses
• eliminate inflammation
• prevent new lesions
• slow down brain atrophy at all stages of the disease
• restore function
• minimise the impact of symptoms on your day-to-day life.

See your doctor or specialist MS healthcare team for investigation and diagnosis of any new symptoms, as some symptoms can be caused by other illnesses or may be indicative of a relapse.

Watch this MS Australia animation about the invisible symptoms of MS.

Fatigue and MS

Fatigue is a side effect of nervous system damage and is one of the most common symptoms of MS, affecting up to 90% of people.

Unlike ordinary fatigue, MS fatigue usually occurs more rapidly, lasts longer and takes longer to recover from. It can be temporary such as during a relapse, an infection or unrelated illness, or when starting some MS medications. Or it can be ongoing (chronic), even after rest.

MS fatigue may occur when you wake, in some cases every day, even if you have had a good night's sleep and:

• tends to worsen as the day progresses
• appears more easily and suddenly than ordinary fatigue
• is generally more severe than ordinary fatigue
• tends to be aggravated by heat and humidity
• is more likely to interfere with daily activities.

Fatigue in MS is thought to be partly caused by MS itself (known as primary fatigue) and partly by other factors (secondary fatigue) that affect people with MS, more than those without the condition.

How to manage MS fatigue

It can be useful to learn to recognise the early signs of fatigue and how it affects you. Likewise, talking with family, friends and/or colleagues may help them understand any limitations.

MS fatigue often results from secondary factors, such as co-existing medical conditions, poor diet, lack of fitness or sleep, medication side effects, stress, depression, hormonal changes or heat sensitivity. Identifying any contributing factors, should help you to develop a tailored management plan.

Fatigue management strategies include:

• Maintain a well-balanced diet and stay hydrated.
• Stay active – exercises to increase your stamina and strength may be useful.
• Monitor sleep patterns and address any issues.
• Manage other contributing MS symptoms, such as depression.
• Rest/take breaks.
• Vary heavy with lighter tasks – for example, if you have more fatigue in the afternoon, do harder jobs in the morning.

Vision and MS

Visual problems are often the first symptoms associated with MS.

The optic (eye) nerve can become inflamed (optic neuritis) as the optic nerve is a common area where damage to the protective covering of nerves (demyelination) occurs.

More than half of people with MS will experience at least one issue with vision. Talk to your GP, MS nurse or neurologist as soon as possible if you:

• feel eye pain
• think colours appear to have faded (especially red)
• experience double or blurred vision or visual field defects (part of your vision is missing in different areas of your visual field)
• seem to have ‘blind spots’.

An eye assessment can determine how much inflammation is present and inform your doctor whether special treatment is needed.

Sensory symptoms and MS

Changes in sensations such as numbness, pins and needles and tingling are common MS symptoms, related to damage to nerve covering in certain areas. These sensations can occur anywhere on the body such as the arms, legs and face. They can be mild or could interfere with your ability to use the affected part of your body, such as difficulty in writing with a pen.

The new onset of sensory symptoms may be associated with a relapse and should be reported to your MS healthcare team.

Pain and MS

Pain in MS can be primarily due to demyelination or may be due to secondary conditions, such as musculoskeletal problems resulting from altered posture or spasticity. Weakened leg muscles commonly trigger aches and pains in the back or knees, but people with MS may experience pain anywhere. Sensory pain may also feel like ’burning’ pain.

As pain can significantly affect quality of life, it should be reported to your healthcare professional for assessment.

Changes to bladder and bowel function with MS

Issues with bladder and bowel function can be a common problem for people with MS at some stage in their life. These issues may be related to other conditions, so it is important to report any changes, so the right assessments can be made.

Issues with bladder and bowel function may include:

• Incontinence – an accidental or involuntary loss of urine from the bladder (urinary incontinence) or bowel motion, faeces or wind from the bowel (faecal or bowel incontinence). It is a widespread condition affecting many Australians, so you should not feel alone.
• Bladder dysfunction symptoms – including greater or less frequency of passing of urine, urgency, incontinence, urinary tract infections and the need to urinate frequently overnight.
• Bowel issues – including severe constipation, faecal incontinence and diarrhoea.

With the right advice, you can manage these symptoms and prevent complications or associated illnesses.

You can also make small changes that could make a big difference, including:

• Treatment and medication – if you have bladder or bowel concerns talk to your GP, MS nurse or neurologist about medication, aids, diet and lifestyle adjustments. Tell your neurologist about new and/or persistent symptoms. For serious concerns, you may be referred to a urologist (bladder) or gastroenterologist (bowel) for further assessment of the problem and management.
• Continence aids – aids such as disposable pads are available at supermarkets and pharmacists.
• Plan ahead – peace of mind about toilet facilities and their locations can make a big difference (check out the National Toilet Map). Consider calling ahead to your destination to ensure there are adequate, accessible facilities.
• Drink enough fluids – for anyone with bladder problems, it is still important to drink plenty of water to avoid complications such as urinary tract infections or constipation. Not enough water makes urine concentrated and irritates the bladder, causing more frequent urinating. Do not try to manage bladder symptoms by rationing your fluid intake.
• Maintain a healthy diet – a healthy bowel pattern benefits from a well-balanced, high-fibre diet.
• Limit caffeine and alcohol – caffeinated or alcoholic drinks can exacerbate frequency of urination.
• Exercises – exercises such as those to strengthen the pelvic floor (the muscles that support the organs inside the pelvis) can help, as well as keeping as fit and exercising in general.

Sexual function and MS

Sexual dysfunction is common in MS. It can be directly related to MS from brain or spinal cord lesions, or more indirectly related due to other MS symptoms such as depression and fatigue, or from wider relationship and social issues stemming from MS.

Although a difficult area to talk to your health professional about, it is an important area to maintain your quality of life and self-confidence. There are many avenues of help available from physical to psychological and your GP, MS nurse or neurologist can point you in the right direction for the most appropriate assessment and assistance.

Motor symptoms and MS

Difficulty with walking or a change in walking style (gait) can be one of the first MS symptoms noticeable to others, for example beginning to stumble or trip.

Nerve demyelination can cause damage to the nerves that direct the affected muscles, causing incoordination. In some people, balance may also be affected, if special areas of the brain are demyelinated, and can lead to feeling off-balanced and leaning to one side, or difficulties in perception of where the body is in space (ataxia).

Balance and walking problems vary considerably from one person with MS to another and may include:

• tripping, stumbling or falling
• unsteadiness when walking or turning
• needing support from walls, furniture or other people
• a heavy feeling in the legs when stepping forward
• leg weakness when weight bearing
• difficulty placing the foot squarely on the ground
• taking slower, shorter steps
• loss of confidence when walking.

Spasticity is a symptom of MS that causes your muscles to feel stiff, heavy and difficult to move. A spasm is a sudden stiffening of a muscle which may cause a limb to kick out or jerk towards your body and can also cause pain.

Not all motor problems are caused by MS, so it is important to seek professional advice. A health professional, such as a neurologist, an MS nurse, GP or physiotherapist can work with you to determine the cause of your walking and balance problems and advise on management.

Other MS symptoms can impact on walking and balance and increase the risk of falling. These include pain, tremor, dizziness, vertigo and visual problems.

Speech and swallowing changes with MS

Speech and swallowing changes can occur due to affected nerves being damaged. This may present as changes to the voice tone and quality, or coughing when eating.

These symptoms should be reported to your MS healthcare team for assistance from a speech therapist, who can advise on appropriate management.

Psychological aspects of MS

Mood issues can be very common in MS, not just around the time of diagnosis, but at various stages of life. The most common mood disturbances are depression and anxiety which can be short or long term.

The most important thing to remember is to talk to your MS healthcare team as soon as you start to notice symptoms, so that you can access appropriate help, to improve your quality of life.

Depression

Depression can be a symptom of MS or develop due to diagnosis or a change in your condition. Inflammation because of MS can affect the areas in the brain which regulate mood. Around half of people diagnosed with MS will have a depressive episode – 3 times higher than for the general population.

Depression can range from feeling down or having negative thoughts, to the more severe form of clinical depression that can last for months and impact your day-to-day life.

Depression does not discriminate or indicate weakness, nor is it something to hide. Often out of your control, depression can come and go, occur once, build up slowly or fast.

Help is never far away. Talk to a professional and family and/or friends. It can be hard to discuss mental health, but family and friends can also play a key role in helping you identify, recognise, or even manage and prevent depression.

Prevention strategies for depression and ways to manage your mental and physical health may include:

• regular exercise
• sunshine, warmth, light and fresh air
• positive thoughts, avoid being hard on or comparing yourself to others
• recognising risk factors can be important, so keeping a diary can be valuable.

Without the right help early on, depression can spiral out of control and may also affect your MS management, and other MS symptoms.

If you have mood or motivation issues, it may be helpful to review your MS management and medications with your GP and neurologist. There are also many avenues for help and therapy with allied healthcare professionals, such as psychologists.

Anxiety

Anxiety issues can also play havoc in MS, often at the start of the MS journey around the time of diagnosis but can also occur with relapses or other changes in your condition.

Working with a healthcare professional such as a psychologist, can be an effective way to cope with the emotional demands of a complex and unpredictable disease such as MS. Learning coping and behaviour strategies can be a life-long investment when dealing with chronic disease.

Talk to your GP, MS nurse or neurologist about any anxiety issues that you have noticed and get the right help early on.

Cognitive changes and MS

About half of all people with MS will experience issues with aspects of cognition, memory, attention span, planning, decision-making, understanding or concentration. These symptoms may be mild and not noticed by others or can be more serious, and begin impacting on employment, social interactions and relationships.

Reporting cognitive changes early to your GP, MS nurse or neurologist, can lead to a formal assessment to identify specific areas of concern and interventions to better manage your cognitive function and quality of life.

Brain health lifestyle strategies and MS

There is increasing evidence to support the importance of general good health and wellbeing when living with MS, with a particular focus on brain health. To keep your brain as healthy as possible, you can make these positive lifestyle choices:

• Keep active – high levels of aerobic fitness are associated with faster information processing and preserving brain tissue volume. Many MS-related symptoms can be reduced through physical exercise, including bladder and bowel issues.
• Keep your mind active – education, reading, hobbies and artistic or creative pastimes, can help protect against cognitive problems in MS, when pursued over the long term.
• Keep your weight under control – there is strong evidence that increased body weight and obesity is associated with a higher number of MS lesions. Numerous studies have shown that being overweight/obese, particularly during adolescence, is associated with a 2–3-fold increase in the risk of developing MS.
• Avoid smoking – smoking is associated with decreased brain volume in people with MS. It has also been associated with higher relapse rates, increased disability progression, more cognitive problems and reduced survival compared to not smoking at all. Smoking is known to cause an increase in inflammation, and chemicals in cigarettes and smoke can also directly alter the function of some immune cells, potentially contributing to the development of MS.
• Watch how much you drink – higher levels of alcohol use are associated with disability progression and reduced survival in people with MS.
• Avoid stress – MS by itself can be stressful. However, studies have linked severe stress with an increase in MS relapses. Find strategies that work for you to reduce your overall stress levels.
• Reorganise your life and priorities – recognise your strengths and build on those. Work toward achieving your goals for your life, family and health by being flexible, thinking creatively about solutions and delegating where possible.
• Find your support team – be the CEO of your life and support plan. Where possible, seek support from healthcare professionals who specialise in MS.
• Continue taking other medicines that your doctor prescribed – if you have other diagnoses or health conditions, be responsible for monitoring and managing them, including taking your prescribed medication.
• Continue to attend regular check-ups and screening appointments – conditions such as high blood pressure, high cholesterol, heart disease and diabetes can worsen your MS symptoms.

Where to get help

• Your GP (doctor)
• Your neurologist
• Your MS nurse
• Your MS healthcare team
• Allied health professionals
• MS Australia Tel. 1300 010 158
  • Symptom resources
  • Support and services
• MS Limited (Victoria, NSW, ACT, Tasmania) Tel. 1800 042 138