Symptoms of Multiple Sclerosis

Multiple sclerosis (MS) is a disease with multiple symptoms, which range from fatigue to muscle weakness, vision issues to cognitive dysfunction, and beyond. In fact, there are so many possible symptoms of MS that it's rare for two people with this disease to have the exact same ones. On top of that, in most cases, the symptoms of MS come and go (relapse and remit), and their severity can vary greatly.

The reason for all of this stems from the nature of the autoimmune disease itself and depends on the location and extent of the damage to your myelin—the protective layer that allows your nerves to transmit the electrical impulses tied to movement, breathing, thinking, and more.

In spite of each case of MS being unique, a particular set of symptoms is really common. It includes:

• Fatigue
• Muscle-related symptoms
• Bowel and bladder symptoms
• Cognitive dysfunction
• Depression
• Sexual dysfunction
• Vision problems
• Vertigo
• Pain and other sensory symptoms

This fatigue goes beyond normal tiredness. It's physical and mental exhaustion that isn't relieved by sleep or rest. Fatigue is the most debilitating aspect of MS for many people.

It's a complex problem, though. Fatigue can result from any combination of the following factors:

• MS itself
• Medications for MS, both disease-modifying therapies and drugs for managing symptoms
• Symptoms that keep you awake or wake you up frequently, such as pain, heat sensitivity, and an overactive bladder
• Sleep disorders that are common in people with MS, including insomnia, sleep apnea, and restless legs syndrome
• Depression

Effective treatment for your fatigue relies on getting to the bottom of what's causing it, so it's important to work with your doctor to find out.

When communication to the nerves controlling your muscles is impaired, your muscles can behave in abnormal ways. Muscle-related symptoms of MS often include:

• Weakness severe enough to make even simple tasks, like walking or brushing your teeth, difficult or impossible
• Spasticity: Involuntary muscle tightness ranging from mild stiffness to intensely painful cramps that make it hard to move
• Tremor: Shaking that's out of control

In some, these symptoms are bad enough to require an assistive device, like a cane or wheelchair, or even keep them in bed.

As many as 80 percent of people with MS have bowel and/or bladder problems.

Common bladder symptoms include:

• Frequent urination
• Urgency while urinating
• Hesitancy when urinating
• Inability to control urination
• Frequent urinary tract infections, which can trigger the worsening of MS symptoms

Bowel problems may result from damage to the myelin around nerves that transmit signals from the brain to the bowels. Constipation is the most common one, but lack of bowel control can also be a problem.

Some MS medications may cause constipation as a side effect, so be sure to speak to your doctor about your current treatment if this symptom is a problem for you.

Around 50 percent of people with MS have some form of cognitive dysfunction. These can include:

• Short-term memory impairment (e.g., not remembering why you walked into a room)
• Difficulty paying attention or concentrating
• Word-finding problems
• Issues processing sensory information

While many people experience these things every now and then, they are far more pervasive problems in people with MS.

Depression is common in people with chronic disease. That's understandable, with the added stress and challenges associated with long-term illness. It's even more common in people with MS, though. It's believed that demyelination in the brain may play an added role in causing depression in those with the disease.

On top of that, some MS drugs may cause or contribute to depression, especially interferon drugs such as Avonex, Betaseron, or Rebif.

Clinical depression is more than just regular sadness. Symptoms may include:

• Losing interest in things you used to enjoy
• Being unable to experience pleasure
• Loss of appetite
• Loss of interest in sex
• Low energy
• Unexplained aches and pains
• Thoughts of suicide

When your desire or ability to have sex is impaired, it can be damaging psychologically and impact your intimate relationships.

Related issues common in MS include:

• Difficulty maintaining an erection
• Inability to achieve orgasm
• Loss of desire
• Reduced sensation or unpleasant sensation in the vaginal area
• Vaginal dryness

Help is available for these problems. It can be difficult to bring them up to a doctor, or even to your partner(s), but talking about it is the first step to getting better.

Damage to the optic nerve due to inflammation (optic neuritis) is common in MS, and that leads to myriad vision-related problems.

It is especially common in the early stages of the disease, and its symptoms may be among the first you experience with MS. It can affect one or both eyes and may include:

• A dull ache behind your eye
• Pain when moving your eye
• Vision impairment or loss
• Washing out or loss of color vision
• Blind spots
• Flashing or flickering lights

Another vision problem, which is often an early sign of MS, is mismatched pupils. This is called Marcus Gunn pupil or the relative afferent pupillary defect (RAPD). Basically, one pupil doesn't constrict (get smaller) like it should when light hits your eyes.

Vertigo, or dizziness, is the sensation that you are spinning. It can result from MS-related damage to the brainstem, which is a stalk at the base of your skull that connects the brain and spinal cord. It can also be caused by a lesion in the cerebellum.

It may also be associated with an abnormal eye movement called nystagmus and occur alongside gait imbalance, double vision, or slurred speech. Some MS medications may also cause vertigo.

Not everyone with MS has pain, but many do—and not just one type. Abnormal nerve sensations can include electrical nerve zings, numbness and tingling, prickling, stabbing, tearing, or feelings of pressure.

These sensations can happen anywhere in the body at any time and range from annoying to drop-you-to-your knees painful.

MS involves a couple of distinctive pains that are highly indicative of the disease. They are:

• Lhermitte's sign, which is a sudden electric zap down the spine that happens when you touch your chin to your chest
• The MS hug, which is a tightness that's usually felt around the chest or stomach

Some people with MS aren't aware that these uncommon symptoms are related to the disease. Rare symptoms include:

• Trigeminal neuralgia (tic douloureux): Shock-like or burning pains in the face
• Glossopharyngeal neuralgia: Pain in the tongue, throat, ear, or tonsils
• Paroxysmal symptoms: Momentary spasms in the limbs and sometimes in the muscles associated with speech or swallowing; sometimes mistaken for seizures
• Pseudobulbar affect: Uncontrollable laughing or crying that's not related to feelings or situations in which that response is normal
• Pruritis: A neurologically caused "itch" that doesn't respond to scratching or topical treatments
• Swallowing problems (dysphasia): This can cause choking or coughing while you eat or drink.
• Breathing difficulty due to muscle weakness
• Hearing loss: About 6 percent of people with MS experience temporary lessening or loss of hearing; actual deafness is exceedingly rare.
• Seizures: These can affect between 2 and 5 percent of people with MS

Complications aren't true symptoms, but things that can happen as a result of them. Not everyone will experience them, and they vary greatly in those who do.

Some possible complications of MS include:

• Aspiration pneumonia: A lung infection caused by inhaling food particles due to dysphagia or difficulties swallowing
• Malnutrition and dehydration: Also due to dysphagia
• Pressure sores: Due to lack of mobility
• Venous thromboembolism: Blockage to blood vessels due to blood clots; may be due to lack of mobility, spasticity, or as a side effect of steroid medications

If you have symptoms that could indicate MS, and especially if they come and go, be sure to talk to your doctor about it.

Early MS diagnosis and treatment have long-term benefits, so don't hesitate or wait to bring up what you're experiencing.

Looking over these lists can be overwhelming. Keep in mind that you probably won't experience most of the potential symptoms. With proper treatment and management, you may be able to avoid the bulk of them.