Physical symptoms

Because of the damage to the protective layer of the nerve and the nerve itself that can occur, MS affects the ability of your nerves and muscles to communicate, and symptoms depend on what part of your central nervous system (CNS) is involved. Many of the physical symptoms of MS are related to nerve function.

Mobility icon

Mobility

MS symptoms are often interrelated, and they can affect different parts of your body. One MS symptom is trouble with your mobility. This means you can have difficulty walking or moving parts of your body, or you can have movements that are not something you control.

Mobility Symptom #1

Walking difficulties

MS affects the way your muscles and nerves communicate, so it can affect how you walk (your gait). This is one of the most common MS symptoms, and is related to several factors like muscle weakness, spasticity, numbness, balance and fatigue.

MS can cause you to fall more often (studies from several countries report that 50-70% of people with MS say they have fallen in the past 2-6 months), which can cause injuries. You can be more at risk of falling for a few reasons like poor balance, walking slower than usual, a reduced ability to sense where your body parts are in space, using the wrong canes or walkers or using them incorrectly, and using certain medicines that affect your nervous system.

You can be more at risk of falling for a few reasons like poor balance, walking slower than usual, a reduced ability to sense where your body parts are in space, using the wrong canes or walkers or using them incorrectly, and using certain medicines that affect your nervous system.

If you have trouble walking, you may have to walk more consciously to avoid falls, avoid slippery or cluttered surfaces and wear safe, stable shoes.

Other things you can do to manage walking issues are:

  • Physical therapy
  • Stretch
  • Use the right assistive devices
  • Talk to your doctor

Mobility Symptom #2

Spasticity

Spasticity is a word for feelings of stiffness and muscle spasms (muscle contractions that don’t stop, or sudden movements). It can range from mild (muscle tightness or stiffness) to severe (painful, uncontrollable spasms of muscles or pain in the joints). It can occur in any of your limbs, but it’s the most common in the legs. Spasms can be bothersome, especially at night, and they can add to feelings of fatigue.

Common spasticity treatments may involve physical or occupational therapy.

Mobility Symptom #3

Tremor

Tremor is a movement disorder that involves rhythmic, involuntary movements. In MS, tremor happens during or can be triggered by voluntary movements (“intention tremor”), and they can affect any muscle group in the body, such as the arms, legs, trunk, head, vocal cords, jaws, lips and tongue. Sometimes, people with tremor can also have difficulty swallowing or speaking. Tremor often contributes to feelings of fatigue and overall disability, since it can make regular things like dressing or eating more difficult. For this reason tremor can have an impact on your emotions and social life as well.

Addressing tremor can involve occupational or physical therapy.

Strength icon

Strength

MS can make your muscles weaker and can cause feelings of extreme tiredness (fatigue). Overall, these symptoms can affect your physical and mental strength.

Strength symptoms:

  1. Weakness
  2. Fatigue

Strength symptoms #1

Weakness

Muscle weakness is a very common symptom of MS, and it can happen in any part of the body. It can be caused by several things, like your muscles being out of shape because you are not using your body as much or inflammation or damage of the nerve pathways in your brain or spinal cord. People with MS can face many physical challenges (pain, balance and coordination problems, tiredness) that make it harder to be active, and MS nerve damage sometimes means your muscles aren’t receiving the messages from your nerves as well as before.

Muscle weakness can affect your daily activities (like walking), and can be treated with physiotherapy, occupational therapy, assistive devices and/or other approaches.

Strength symptoms #2

Fatigue

Fatigue is another MS symptom that can affect your ability to function at home or at work. Fatigue, or tiredness, is very common: Up to 90% of people with MS have feelings of fatigue. It can also interfere a lot in your ability to function in daily life. And is one of the top symptoms that make people stop working.

Fatigue can be a primary physical symptom related to MS, or it can be secondary (related to the effects other MS symptoms have on your life, like muscle weakness, depression or trouble getting enough sleep). Treating fatigue can also mean looking at causes other than your MS, like vitamin deficiency.

There is a specific kind of fatigue related to MS, called “lassitude”. It’s different from other types of fatigue in that it:

  • Generally happens every day
  • Happens in the morning, even after a good sleep
  • Gets worse as the day goes on
  • Gets worse with heat and humidity
  • Can be sudden
  • Is worse than “regular” fatigue
  • Interferes with daily responsibilities

There are many factors that can affect fatigue, so treating this symptom can involve occupational therapy, physical therapy, sleep therapy, psychological treatment, energy conservation counseling, mobility aids, temperature regulation or other approaches.

Balance / Dizziness icon

Balance / Dizziness

Symptoms related to balance and dizziness can affect your stability.

It is common for people with MS to feel off-balance, lightheaded or dizzy and sometimes even have a sensation that the room is spinning (vertigo). This is because of MS damage to the parts of your nervous system that coordinate visual, spatial and other input to maintain equilibrium.

These symptoms can impair your reflexes. They can also put you at risk of injuries from falls.

Dizziness can also be related to other non-MS conditions like an inner-ear infection, so it’s important to figure out whether MS is really the cause.

Treating dizziness and issues with balance can involve walking aids or other therapies.

Bladder / Bowel icon

Bladder / Bowel

MS can have an effect on your bladder and/or bowel function.

Bladder/Bowel Symptom:

  1. Bladder problems
  2. Bowel problems

Bladder/Bowel Symptom #1

Bladder problems

About 80% of people with MS can have bladder problems. These problems include needing to go more often, suddenly, or having to get up a lot at night to go to the bathroom; having trouble starting to urinate; not being able to control when you go (incontinence); or being unable to empty your bladder completely. This is because of nerve damage to the part of the nervous system that controls these things.

Bladder problems can have secondary effects on your urinary health (getting infections or kidney stones), and can cause other difficulties in your work or social life.

Treatment for bladder issues may include things like lifestyle modifications, physical therapy and/or nerve stimulation procedures.

Bladder/Bowel Symptom #2

Bowel problems

MS can also affect your bowels. Bowel dysfunction in MS most often involves constipation, but it can also be associated with diarrhea and incontinence. Getting more active, getting enough fiber and staying hydrated can help with constipation, and medications will sometimes be recommended for constipation and other bowel issues, but only as somewhat of a last resort. A bowel management plan created with your healthcare providers can often make a big difference.

Vision icon

Vision

Your vision can also be affected by MS, and changes in eyesight can be one of the first symptoms of MS that people notice. Vision problems in MS can include the following:

  • Optic neuritis (inflammation of the optic nerve)
  • Nystagmus (involuntary eye movements)
  • Diplopia (double vision)

Vision Symptom #1

Optic neuritis

Inflammation of the optic nerve is common in MS patients. For about 16% of people with MS this is the their first MS symptom. It usually happens in one eye and can cause aching pain when you move the eye, blurry vision, or dimness and loss of colour in your eyesight. Sometimes you can temporarily lose vision in the affected eye or see a dark spot in the middle of your vision while at the edge (periphery) things look normal. Mostly these changes usually aren’t permanent. Regulating your temperature (cooling down) can sometimes help with this symptom.

Vision Symptom #2

Nystagmus

This is when you have rapid, involuntary eye movements that interfere with your vision. Sometimes called “dancing eyes”, the eyes move quickly up and down or from side to side. It may make you feel like the world is moving, and you may notice that you can hold your head at an angle to reduce this symptom.

Vision Symptom #3

Diplopia

Diplopia, or double vision, happens in MS when the nerves controlling your eye movements are inflamed or get damaged. It happens when the muscles for one eye are weaker, due to nerve damage, than the ones for the other eye. This can be temporary or persistent, and sometimes goes away on its own. It can be part of a relapse and you may need special eyeglasses or an eye patch.

Pain icon

Pain

About 50% of people with MS will deal with MS-related pain, which results from damage to nerves in the central nervous system or changes in your body because of MS. Along with pain, MS can cause other less specific nerve sensations, like itching.
There are two main types of MS pain:

  • Neuropathic pain that is either sudden or chronic
  • Musculoskeletal pain

Pain can be treated in numerous ways and depends on your situation. Good pain management involves careful identification of the type of pain and persistence to find the right treatment plan. Talk to your doctor to find a plan that works for you.

Pain Symptom #1

Neuropathic pain

Neuropathic pain is caused by “short circuits” of the nerves that carry messages from the brain to the body. It can be acute (with a rapid onset and short duration, usually associated with a relapse) or chronic, (where the pain can be an unpredictable, almost daily occurrence). These types of pain can include the following:

Acute

  • Trigeminal neuralgia (TN): A sharp, stabbing pain in the face or jaw area. This is caused by damage to the trigeminal nerve. This pain often comes and goes, and can be an initial MS symptom or happen during a relapse.

  • Lhermitte’s sign: A quick, electric-shock-like sensation running from the back of your head down your spine and into your arms and legs. It can be brought on by bending your neck forward and is caused by damage to nerves in your neck. This can also be an initial MS symptom or part of a relapse.

  • MS hug: This is an uncomfortable squeezing sensation around your trunk. It feels like a blood pressure cuff as it tightens. Like the previous two types, this can be an initial MS symptom or part of a relapse.

  • Paroxysmal spasm: A type of spasticity that involves the off-and-on painful tightening of muscles.

Chronic

  • Dysesthesias (abnormal sensations): Typically not associated with a relapse, this is a type of chronic pain that can feel like burning, prickling, “pins and needles”, stabbing, or ice-cold or electrical sensations.

  • Pruritus (itching): This is a form of dysesthesia that can happen in MS.

Pain Symptom #2

Musculoskeletal pain

This type of pain is the kind you have when you pull a muscle or sprain something. It can happen due to falls related to your MS, but it can also happen because you are moving differently and putting different pressure on your joints and muscles. Spasticity (tight, stiff muscles) is caused directly by MS and can change the way you move, which can contribute to musculoskeletal pain in your ankles, knees, hips or back.

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Relapse

“Paroxysmal symptoms” are when a cluster of sudden neurological symptoms happens they can happen at any time with MS, and can last a few seconds or minutes or happen many times a day. When these cluster continue for several days, it’s called an “MS relapse”. They can happen with or without pain and involve a host of MS symptoms. It’s important to report these occurrences to your doctor.

Sensory processing icon

Sensory processing

With MS, you can also have sensory changes, some of which can be painful (see “Pain”). The most common sensory symptom in MS patients is numbness. You can also have “dysesthesias” (abnormal sensations) like tingling, electric-shock feelings or itching. Some medications can help with these symptoms.

Sexuality icon

Sexuality

MS can also affect your sexual function. There can be an emotional component to this (see “Emotional symptoms”), but there are often underlying physical effects that MS can have. MS-related damage to the nerves that coordinate sexual arousal can impair your sexual feelings or responses.

There may be help with these symptoms, so although it can be hard, it can also be good to talk to your healthcare providers if you would like help with sexual symptoms.

Body temperature sensitivity icon

Body temperature sensitivity

MS can cause your body to be extra sensitive to increases in your body temperature (called “Uhthoff’s phenomena”). MS damages the protective coating of your nerves (demyelination), which usually protects nerves from temperature changes, which means your nerves are less protected and temperature changes can affect them more. When your body temperature goes up even a little bit, any of your MS symptoms can present/flare up. Activities (hot baths, sunbathing, exercise, etc.) or certain emotions (e.g., getting angry) can increase your body’s temperature, so it is good to try and prevent getting heated when possible and to cool down quickly. Generally, these heat fluctuations don’t cause permanent damage but get better as your body cools down.

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