If you have MS, you may have several different symptoms, which can vary in severity. There are treatments that can relieve each specific symptom, although some symptoms are more easily treated than others.
If your visual problems are mild – such as having trouble reading – see your optician for an eye test. The problem may not be due to MS. However, if your visual problems are more severe or you have difficulty focusing (nystagmus), you may be prescribed medication called gabapentin.
Muscle spasms and spasticity
Muscle spasms and spasticity can be improved with physiotherapy. Stretching movements can help prevent spasticity (stiffness). You may be referred to a physiotherapist trained in MS treatment if muscle spasms and spasticity are restricting your movements.
If your muscular spasms are more severe, you may be prescribed a medicine that can relax your muscles and reduce spasms. This will usually be either baclofen or gabapentin, although there are alternative medicines, such as tizanidine, diazepam, clonazepam and dantrolene.
These medicines all have side effects, such as dizziness, weakness, nausea and diarrhoea, so discuss which would be best for you with your GP or MS specialist nurse.
In rare cases, medicines may not be enough to control muscle spasms and spasticity. If this is the case, you may be referred for specialist treatment. This may involve wearing special splints or weights on your legs, or having medication injected into the fluid surrounding your spinal cord.
Neuropathic pain is caused by damage to your nerves and is usually sharp and stabbing. It can also occur as extreme skin sensitivity, or a burning sensation. This type of pain can be treated using the medicines gabapentin or carbamazepine, or with an antidepressant called amitriptyline.
You will probably have musculoskeletal pain if you have muscle spasms and spasticity, as it is caused by excess pressure and stiffness in your joints.
A physiotherapist may be able to help with musculoskeletal pain by suggesting exercise techniques or better seating positions. If your pain is more severe, you may be prescribed painkillers (analgesics) or antidepressants (which can also help with pain). Alternatively, you may have a procedure that stimulates your nerve endings, known as transcutaneous electrical nerve stimulation (TENS).
As with musculoskeletal pain, mobility problems are usually the result of muscle spasms and spasticity or muscle weakness. Your joints may tighten, making it hard to move around.
If you have mobility problems, it's best to try to prevent muscle spasms and spasticity in the first place with physiotherapy or medication (see above). Your muscles can tighten to the point where it's painful and difficult to move at all, which is known as a contracture.
If this occurs, you may need to do special stretching exercises with plaster casts and removable splints. You may also be prescribed injections of botulinum toxin, which can help relax your muscles.
Muscle weakness can be helped by strengthening exercises or learning to compensate for weakness by using other muscles.
There are medicines, exercises and equipment that can relieve a tremor (ataxia) or dizziness caused by MS. These are available from your neurological rehabilitation team.
Cognitive problems (difficulty with thought, memory and speech)
If you experience cognitive problems, any treatment you receive will be fully explained and recorded so that it's clear to you.
You should be referred to a clinical psychologist, who will assess your problems and suggest ways to manage them. You may receive treatment from a speech therapist if necessary.
If you experience emotional outbursts, such as laughing or crying for no apparent reason, you should be assessed by a healthcare professional trained in MS symptoms. This could be a clinical psychologist. They may suggest treatment with an antidepressant. If you do not want antidepressants, learning techniques to control your emotions can help.
People with MS who have depression can be treated with antidepressants. If you often feel anxious or worried, your GP or neurologist may prescribe antidepressants or benzodiazepines, which are a type of tranquilliser that have a calming effect. Clinical psychologists can help you with depression by using psychotherapy, such as cognitive behavioural therapy (CBT). If you have severe or persistent depression, you may be referred to a psychiatrist for further advice.
Fatigue and tiredness
Many people with MS experience extreme tiredness. Your GP or MS specialist nurse should assess this to see if there's another reason for your fatigue other than MS, such as medication or poor diet.
If your fatigue is due to MS, you may be prescribed medication called amantadine, although it may only have a limited effect. You should also be given general advice on ways to prevent fatigue, such as exercise and energy-saving techniques.
If you have an overactive bladder, you may be prescribed an anti-cholinergic medicine, such as oxybutynin or tolterodine. This will help make the need to pass urine more predictable. The need to pass urine frequently at night can be treated with a medicine called desmopressin.
If you have an underactive bladder which is not emptying properly, you may undertake intermittent catheterisation or be fitted with a catheter. This is a small tube inserted into your urinary opening that drains away any excess urine.
You may be referred to a continence adviser or urologist, who can offer specialist treatment and advice, such as bladder exercises or electrical treatment for your bladder muscles.
It may be possible to treat mild to moderate constipation by changing your diet or taking laxatives.
More severe constipation may need to be treated with suppositories, which are inserted into your rectum, or an enema. An enema involves having a liquid medication rinsed through your rectum and colon, which softens and flushes out your stools.
Bowel incontinence can be treated with anti-diarrhoea medication or by doing pelvic floor exercises to strengthen your rectal muscles.