Symptoms of MS

These symptoms might show up during a relapse or become more long-term. Dizziness often feels like being lightheaded or off-balance, while vertigo is more intense—like the room is spinning. MS causes these issues by affecting parts of the brain involved in balance and coordination.

Treatment usually includes medications that help ease dizziness or discomfort, along with physical therapy to strengthen balance and coordination. Since these symptoms can increase the chance of falling, it’s important to take steps to stay safe—like using mobility aids if needed and making adjustment around the home.

Bladder problems may occur in up to 80% of people with MS at some time. There are many treatment options for bladder problems, including medication and rehabilitation approaches.

The most common urinary problem involves an over activity of the bladder’s emptying muscle. This can cause trouble holding urine or emptying the bladder, or a combination of both. Urgency (sudden need to urinate), frequency, and incontinence (inability to control the time and place of urination) can also happen. People with MS may be at an increased risk of urinary tract infections (UTI’s) because of leftover urine in the bladder (urinary retention). Sometimes UTI’s can cause worsening of old MS symptoms.

Symptoms of a UTI may include frequent urination, burning with urination, strong smell, and discolouration of the urine. Talk to your healthcare provider about changes in urinary function and treatment recommendations.

The most common bowel issue for people with MS is constipation. Less common bowel problems include urgency, and involuntary bowel movements. While it’s not necessary to have a bowel movement every day, if irregularity is a problem, there are several steps you can follow. Timing of bowel movements, adequate fluid intake, a high-fibre diet, and physical activity are some treatment strategies that can help promote good bowel health.

Your healthcare provider can discuss medications or measures appropriate for the management of your constipation. Any changes in bowel function should be investigated by your healthcare provider to rule out other causes not related to MS.

Cognition refers to how we think, remember, communicate, and learn. Changes in cognition occur in over 50% of adults and 30% of children living with MS. Current research suggests that these changes can happen early, even before the diagnosis is made.

MS lesions in the brain can interrupt connections, leading to slower information processing speed and disruption of normal cognitive functioning. Cognitive symptoms may or may not be obvious to the person living with MS or to others. They often happen slowly, over years or decades, and may worsen during an MS relapse. Fatigue can affect cognition. Early identification of cognitive change, with appropriate treatments like cognitive rehabilitation, medication adjustment, and self-help options (Smartphone apps, note-taking) may be helpful. People with cognitive change are encouraged to speak with their healthcare providers if these changes are concerning.

Read Cognition and MS for more information

Fatigue is one of the most common symptoms of MS, affecting approximately 90% of people living with the disease. MS fatigue is more than the usual being tired after a busy day. It’s there all the time and doesn’t depend on how active a person is. It’s often there after waking up after a good night’s sleep.

Many things contribute to fatigue in MS. Fatigue can result from damage that happens in the CNS. It can also be the result of other conditions or factors related to MS, including urinary problems, pain, spasticity, and sleep problems. Depression, another common symptom of MS, can also contribute to fatigue. Poor diet, lack of physical activity, dehydration, and certain medications can also play a role.

Managing fatigue can be complex and needs a team approach. A healthcare provider can help determine if there are general health problems that need to be treated. Making lifestyle changes is another good place to start, working on nutrition and overall healthy behaviours. An occupational therapist can help identify energy-saving strategies. Your neurologist may also suggest some medications you can try.

It’s normal to experience a range of emotions when you receive a diagnosis of MS, including sadness, anxiety, and grief. As you come to terms with having MS, you may also feel irritable, angry, or depressed. If this goes on for more than a few months or starts to interfere with being able to live your life in a healthy way, contact your healthcare provider to discuss things that might help.

Mood might get worse with:

• An MS relapse
• Normal life stresses
• Hormonal changes

Mood problems in MS may be due to damage in areas of the brain that control response to emotion. The lesions caused by MS affect the brain signals for emotion. This causes a disruption, like it can with signals for movement of an arm or a leg. Mood disturbance can also happen in other neurological conditions, including traumatic brain injury, stroke, epilepsy, and several others.

Many people feel uncomfortable discussing changes in their moods. However, it’s important to talk about this with your healthcare team. Mood changes in MS can be improved with treatment and support. Other contributing factors like family history, previous medical history, and life circumstances should be considered when making a treatment plan.

About 50 to 90% of people with MS will experience pain because of their MS at some point. Pain from MS is classified as neurogenic (nerve pain) or musculoskeletal. Neurogenic pain can be related to MS lesions in the CNS. Musculoskeletal pain affects muscles and joints and comes from the physical strain that living with MS can place on a body. Difficulty with balance, fatigue, or muscle weakness may lead to problems with walking, posture, or other movements. This can result in strain on the joints, ligaments, or other muscles.

Dysesthesias are the most common types of neurogenic pain in MS, and may be described as burning, prickling, bandlike, or tingling sensations. Allodynia is pain that results from a stimulus that does not normally cause pain, like changes in temperature or clothing touching the skin. Not all pain is associated with MS, so people need to discuss their pain with their healthcare provider to make a proper diagnosis and get the right treatment plan in place.

Abnormal skin sensations may happen like burning, tingling, numbing, prickling, or “pins and needles.” Numbness of the face, body, or arms and legs may be the first symptom experienced, and while annoying, numbness is not harmful. Lhermitte’s sign is an “electrical” sensation that runs through the back and into the limbs when the head is bent forward.

MS can affect sexual feelings and functions. Sexual arousal and function involve complex pathways of awareness, sensation, and cognition in the CNS. MS-related damage in these pathways can interfere with sexual function. Sexual problems may also happen because of other MS-related symptoms like fatigue, mood changes, spasticity, bladder or bowel problems, and pain. Medications can impact sexual function.

Treatment can involve many strategies, including physiotherapy, individual or couples counseling, and sometimes, medication. Although it may be an uncomfortable topic to discuss, people are encouraged to discuss any sexual problems with their healthcare team.

The nerves that control movement get mixed signals due to damage in the brain or spinal cord, causing muscles to either suddenly tighten (spasms) or stay stiff for a long time. You may be referred to a physiotherapist for a personalized stretching program. If it’s affecting your walking, an assistive device may help.

Involuntary shaking movements of the body, head, and limbs may be experienced by some people and can interfere with daily activities. Medications, physiotherapy, and occupational therapy may help manage tremor.

Many people with MS may experience sensitivity to increased body temperature. Damaged nerves due to MS lesions in the CNS can be very sensitive to even small changes in body temperature. Many normal activities can increase body temperature. Sunbathing, exercise, hot baths, emotion, fatigue, fever, and viral infections like the flu can all cause an increase in body core temperature. This may trigger a pseudo-relapse, a temporary worsening of MS symptoms that have occurred before. This is not related to new inflammation and does not require treatment. Symptoms will improve as the body temperature returns to normal.

Vision problems are often one of the first symptoms that people with MS notice and can include optic neuritis, double vision and involuntary eye movements. Optic neuritis is inflammation of the optic nerve and can cause blurry vision, temporary loss of vision, and pain with eye movements.

Treatment with corticosteroids can help speed recovery of optic neuritis especially in more severe cases, but a lot of people recover without them.

Walking can change with MS, sometimes becoming more difficult or less steady. Muscle weakness, stiffness, poor balance, fatigue, and pain can all play a role. These shifts might make walking slower or more tiring and can affect confidence or independence.

Physiotherapy and occupational therapy can help improve strength, coordination, and safety. Movement exercises may ease stiffness, and mobility aids like canes or walkers can offer extra stability.

Weakness happens when the nerves that send signals to the muscles aren’t working properly because of inflammation or damage in the brain or spinal cord, that can make movements feel harder or slower.

Things like fatigue, heat, or even the time of day can make weakness feel worse. Staying active and working with a care team—like a physiotherapist—can help improve strength and make everyday tasks easier.

Inappropriate affect is a symptom of MS when someone laughs or cries suddenly without meaning to. It happens because MS can affect parts of the brain that control emotions, and this can feel confusing or upsetting. Treatment might include behavioural therapy or medications like antidepressants.

Coordination problems in MS often happen when the cerebellum—the part of the brain that controls balance and movement—is affected. This can be a challenging symptom for people with MS, but there are ways to help manage it. Using walking aids, making changes around the home to prevent falls, and working with therapists to improve movement and balance can all make a big difference in daily activities.

Speech problems can happen in MS when the nerves that control muscles in the face, mouth, and throat are affected. This can make speech sound slurred, slow, or unclear—like talking with marbles in your mouth. Speech changes can range from mild difficulty speaking clearly to more noticeable changes in how someone sounds. Speech therapy can help improve communication and confidence.

Trouble swallowing can happen, but it’s more common in advanced MS and does not happen to everyone. When it does occur, it often starts as mild choking, especially with liquids. Swallowing involves complex muscle coordination, and MS can affect those muscles if certain areas of the brain that control swallowing are damaged or disrupted.

To help with this, people might sit up straight while eating, take smaller bites or sips, and focus on each swallow without distractions. If it continues, a speech therapist can suggest simple changes that make eating and drinking feel safer and more comfortable.