Multiple sclerosis - common problems

The nerves of the central nervous system are sheathed in myelin, a substance that assists in nerve function. Multiple sclerosis (MS) is an incurable disease of the central nervous system that inflames the myelin and causes plaques or lesions to appear. The brain, spinal cord and optic nerves can be affected.

The disease most commonly affects young white females living in temperate regions of the world. The cause of MS is not known – it is thought that a virus may be the trigger. There is also evidence of genetic susceptibility. The two major forms of MS include relapsing–remitting and progressive.

Symptoms depend on which part of the nervous system is targeted. Common symptoms may include fatigue, continence problems, constipation, pain, cognitive (thought-related) changes, altered sensation, and muscular and visual changes. These symptoms can be eased with appropriate medications, therapies and self-help strategies. Always discuss your concerns with your doctor or specialist.

Fatigue
Fatigue is a side effect of nervous system damage and is one of the most common symptoms of MS. Management strategies include:

• Pace yourself – be aware of your limits and try not to exceed them.
• Conserve energy – make changes around the home and to your daily schedule to avoid wasting energy. For example, put a tall chair in your kitchen so that you can sit down while cooking and try to perform your more difficult tasks when you know you’ll be fresh, such as first thing in the morning. Enlist the help of relatives and friends for any physical work around the house.
• Medications – some studies have found that medications used in the treatment of the sleep disorder narcolepsy are helpful in relieving MS-related fatigue. Other medications are also available. See your doctor for information and advice.
• Occupational therapy – an occupational therapist can advise on labour-saving devices and energy-saving skills.
• Understand the causes – ensure the fatigue is due to the MS and not secondary to other causes such as poor sleep patterns, lack of fitness or depression.

• Drink enough fluids – your kidneys need at least two litres of water each day to flush out waste products. Don’t try to manage bladder symptoms by rationing your fluid intake. This can increase the risk of infection.
• Time your drinks – for example, don’t have too many drinks just before bed. Plan your fluid intake so that it is spread evenly over the course of the day.
• Limit caffeine and alcohol – caffeinated or alcoholic drinks can exacerbate frequency of urination.
• Special exercises – exercises such as those to strengthen the pelvic floor (the muscles that support the organs inside the pelvis) can help.
• Continence aids – aids such as disposable pads are available at supermarkets and pharmacists.
• Medications – can help to reduce the urge to urinate or help the bladder to empty itself.

• High fibre diet – fibre is the indigestible parts of plant foods that pass through the gastrointestinal tract unchanged. Fibre adds bulk to stools. High fibre foods include bran cereals, fruit and vegetables.
• Drink enough fluids – stools need sufficient water if they are to be soft and easy to pass. You may be constipated if you are deliberately limiting your fluid intake to cope with bladder incontinence. Drink at least two litres of fluid each day.
• Physical activity – regular exercise helps to keep your bowels regular too.
• Medical treatments – if these lifestyle changes don’t help, your doctor can offer medical treatments such as laxatives, suppositories, certain medications or enemas.

• Medications – such as over-the-counter painkillers. Pain and aching brought on by muscle stiffness and cramping can also be eased with appropriate medications.
• Physical therapies – including stretching exercises and massage.
• Relaxation techniques – such as meditation and yoga to reduce stress levels and help you better cope with pain.

• Medications – prescribed drugs to treat spasticity and tremors.
• Exercises – such as stretching and flexibility exercises to ease stiffness.
• Physiotherapy – including exercises tailored to the individual and strategies to improve mobility.
• Aids – such as walking sticks.
• Physical therapies – including massage.

• Symptom relief – medications, physical therapies and self-help strategies can minimise the symptoms of MS and improve quality of life.
• Counselling – from a professional counsellor of your choice, including psychologists and psychiatrists.
• Neuropsychology assessment – to assess cognitive changes.
• Self-help groups – to enable you and your family to discuss and share problems with others who are experiencing similar challenges.
• Medication – including antidepressants.

• Your doctor
• Neurologist
• Allied health professionals including physiotherapists, occupational therapists, nurses (particularly for bladder and bowel issues), neuropsychologists, psychologists and social workers
• The MS Society of NSW/Vic Tel. (03) 9845 2700 or Tel. 1800 042 138

• Multiple sclerosis (MS) is an incurable disease of the central nervous system that can affect the brain, spinal cord and optic nerves.
• Common symptoms include fatigue, bladder and bowel problems, pain, cognitive and mood changes such as depression, muscular and visual changes.
• See your doctor for investigation and diagnosis of symptoms, since some symptoms can be caused by other illnesses.

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