The presence, severity and duration of all symptoms of MS vary considerably from person to person. The unpredictable nature of the condition can sometimes make it harder to manage. However, many people notice patterns and triggers to their symptoms and with appropriate treatment and intervention many symptoms can be managed quite successfully.
Some of the symptoms of MS are immediately obvious. Reduced mobility is often the most visual symptoms to onlookers. Other symptoms such as fatigue, changes in sensation, memory and concentration problems are often ‘hidden’ symptoms and can be difficult to explain to others. No matter what the symptoms are, it is important to alert your GP or neurologist when a new symptom appears or an existing symptom changes.
Managing symptoms is not just about drug treatments. Many people find a healthy lifestyle helps to alleviate symptoms. A balanced diet, appropriate exercise and the reduction of stress can give your body and mind the best chance to cope with symptoms. Some people with MS also find complementary or alternative therapies useful. Many of these promote a greater sense of wellness.
Managing symptoms is part of the overall management of the affects of MS. Symptoms not only affect the functioning of the body physically, emotionally and cognitively, they can also affect your work, social life and family. It is important that you look at your everyday life and look at what changes you can make that will help manage your MS as successfully as possible.
Bladder and bowel problems can be all too familiar for people with MS. However, people do not have to cope alone, as these problems can almost always be managed effectively and help is available.
Until there are problems, bladder control is something we all tend to take for granted. In health, we have the ability to inhibit the bladder (‘hold on’) and to activate it at will. There are two main types of bladder disorder that can occur in MS. The most common is a failure with storage and the other is a failure with emptying. It is not known why some people get one and not the other, or why some people are unlucky and get a bit of both. Bladder problems are not unusual, and may occur or worsen during a relapse, particularly if a person’s mobility is affected. Perhaps as many as three quarters of people with MS experience bladder symptoms. People with MS may also have similar
symptoms as a result of a urinary tract infection, which might be due to bladder problems or be unrelated to MS.
Some people with MS will never experience bowel problems, but problems can occur. There are two main bowel problems that can occur with MS. Constipation is the more common one, but some people also experience bowel incontinence. The two can be linked, but people who have constipation will not necessarily go on to develop a problem with incontinence, or vice versa. It can sometimes be difficult to approach the subject with your doctor or nurse. But discussing the issue and getting the right support from health care professionals can help many people manage bowel problems more effectively.
Muscle spasms or stiffness are common symptoms, affecting at least 20 per cent of people with MS at some time. Spasms and stiffness affect people differently and can vary over time. Mild stiffness in the muscles can aid balance and mobility for some, but more severe stiffness or spasms can be tiring, frustrating and, for some, painful.
There are a number of treatments available, and health care professionals can help you find the best approach to treat or manage your symptoms. Many people find relief by identifying and avoiding things that trigger spasms. Working with health care professionals to plan stretching exercises, physiotherapy or drug treatments can also be important when tackling these difficult symptoms.
MS can affect your emotions as well as your body. Although this has been recognised since MS was first described in the 19th century, it is only more recently that we have begun to understand more about how MS can cause changes in mood and feelings. There are now many treatments available to help manage these often upsetting and difficult aspects of MS. Medication, talking therapies and self-help techniques can all make it easier to cope.
Even so, mood, emotional and behavioural symptoms of MS – which can include depression – are sometimes overlooked, not fully acknowledged, or even dismissed as an understandable emotional reaction to the condition.
If you experience any changes in mood, emotions or behaviour, do seek medical advice. Your health care team can provide help and support.
Emotional and behavioural symptoms are different from ‘cognitive’ symptoms, which affect how your mind processes information, although they can affect each other.
Not everyone who has multiple sclerosis (MS) will experience problems with memory and thinking but mild difficulties are common.
For example, many people with MS can find it harder to recall information, follow conversations or think things through. These are examples of cognitive skills – and there are many ways to cope if you are having problems.
As a shortcut, you can picture cognition as something that refers to memory and thinking. More accurately, cognition describes the way we:
These skills vary naturally in different people – we all have different strengths and weaknesses. Our cognitive powers are considered to be normal if our skills allow us to cope adequately with everyday life.
Balance problems are common in MS, but the causes and effects can vary from person to person and from one day to another. Problems can include ‘vertigo’ – a feeling of dizziness where the world appears to be spinning, though not everyone experiences this. For some people, balance problems mean they are wobbly on their feet from time to time, or they find they need to move with more care than before to avoid losing balance.
Finding the best way to manage any balance problems will be an individual thing – there is no single solution for everyone. But many people do find effective ways to improve their balance and feel more confident about getting about.
Keeping the body balanced involves many messages going to and from the brain. Even standing still, the body is constantly adjusting to the environment and making tiny changes. When MS causes damage to the brain or spinal cord, this can distort messages and cause balance problems. However, there can be other causes, quite separate from MS, and balance problems are common in the general population too.
A whole range of health and social care professionals can help, including physiotherapists, occupational therapists, rehabilitation specialists, MS specialist nurses and ear, nose and throat specialists.
For many people with MS, one of the early symptoms is a problem with vision. This may be in the form of temporary loss or blurring of vision, or double vision. Most people with MS who experience visual symptoms recover well. A small number of people may develop a persistent problem.Problem with vision could be caused by a number of factors; it is important not to assume that all difficulties are due to MS. If you develop problems with your vision, ask your GP for a referral to an ophthalmologist (eye specialist) or neurologist. Seek advice on what might be causing it and what might be done.
Speech difficulties of some kind affect between 40 and 50 per cent of people with MS. But for most people, changes in speech are mild and do not prevent them from being understood. Speech difficulties can come and go through the day, perhaps lasting only a few minutes at a time, and may be a symptom that appears during a relapse. Many people find practical ways to manage these changes, often working with a speech and language therapist to find techniques that help.
If problems last longer and affect communication more strongly, there may be gadgets and equipment suggested by a speech and language therapist that can help, as well as strategies to help you adapt to the changes. Any changes in speech can be frustrating and tiring and it is often helpful if others understand the issue.
MS can cause swallowing difficulties – also known as ‘dysphagia’. Between 30 and 40 per cent of people with MS experience difficulties with swallowing at some time, though for some people changes are so small that they are hardly aware of them. Picking up these small changes to swallowing can help avoid possible complications.
Just like any other symptom of MS, swallowing difficulties may come and go. For example, temporary changes in swallowing can happen during a relapse and improve, or disappear completely, over time. For others, swallowing can become more difficult in the long term. But however long symptoms last, there are practical things that can help you manage the changes effectively and make swallowing as comfortable and easy as possible.
Health care professionals including speech and language therapists can help diagnose problems and find the best treatments with you, but there are also techniques that you, your family or carers can learn to help with swallowing.
Until the mid-1980s, many people, including doctors, considered MS to be a painless condition. It is now widely recognised that MS can cause pain and that at least a third of all people with MS will feel some level of pain at some time. No two people will experience exactly the same pain. MS pain can come and go in short bursts, or may last longer. It can be a daily nuisance, a distressing but occasional shock, or an ongoing ache that makes it hard to think about anything else. Even mild changes in sensations can have an impact on daily life, so it is important that pain is acknowledged and managed.
Describing and explaining MS pain to health care professionals helps the causes to be found, and knowing the cause of pain can help find the most appropriate ways to manage it. This may include a combination of physiotherapy, drug treatments, complementary therapies and making adjustments to the way that daily activities are approached. It is best to determine which combination of treatments will suit you by looking at your individual circumstances with a doctor. With recognition and support, it is possible to find relief or gain some control over pain, making it easier to cope with this difficult symptom.
Sensory problems relate to the altered feelings some people with MS can experience. These may include numbness, tingling or pins and needles. While these may not necessarily be painful they can be uncomfortable.
Fatigue is one of the most common symptoms experienced by people with MS and, for some, it is the symptom that affects them most. Different people have different experiences of fatigue and it can impact on all aspects of life. It can come and go, or change over time and could be one of the first symptoms you experience, or something that appears years later.
Fatigue is difficult to explain. In MS, it is not just an ordinary tiredness that people might experience after a hard day’s work or strenuous exercise. Many describe it as an overwhelming sense of tiredness with no apparent reason. Some people become tired after very little activity, or rarely wake up feeling refreshed in the morning. While there is still much to learn about the exact causes of fatigue in MS, many people have found ways to minimise its effects.
Health and social care professionals can help with managing fatigue, but because fatigue in MS may have a variety of causes, and affects each person differently, there is no ‘one size fits all’ treatment. Some people may be prescribed drugs that help, though, for many, a combination of self-management strategies, physiotherapy and exercise helps reduce the impact of their fatigue.
Up to 75 per cent of people with MS experience tremor at some time. Tremor can affect people in very different ways. For some, tremor may be so mild it is not obvious to anyone else. For others, tremor may be more pronounced, causing a drink to spill when the cup is full, for example, or affecting handwriting. For a small percentage of people, it is more severe, causing limbs to shake so that it becomes difficult or even impossible to eat, drink or get dressed without help. Tremor can be frustrating, embarrassing and exhausting to live with.
While tremor is one of the most difficult symptoms of MS to manage, there are things that may be worth exploring to try to alleviate problems. Rehabilitation and drug treatments, and in some cases even surgery, have helped some people with MS tremor. There is no single ‘best’ approach, so it is likely to take both time and perseverance to work out what will be of most benefit.