Multiple sclerosis (MS) can cause a wide range of symptoms and affect any part of the body. Each person with the condition is affected differently.

The symptoms are unpredictable. Some people's symptoms develop and worsen steadily over time, while for others they come and go.

Periods when symptoms get worse are known as relapses. Periods when symptoms improve or disappear are known as remissions.

Some of the most common symptoms include:

• fatigue
• vision problems
• numbness and tingling
• muscle spasms, stiffness and weakness
• mobility problems
• pain
• problems with thinking, learning and planning
• depression and anxiety
• sexual problems
• bladder problems
• bowel problems
• speech and swallowing difficulties

Most people with MS only have a few of these symptoms.

See your GP if you're worried you might have early signs of MS. The symptoms can be similar to several other conditions, so they're not necessarily caused by MS. 

Read more about diagnosing MS.

Fatigue

Feeling fatigued is one of the most common and troublesome symptoms of MS.

It's often described as an overwhelming sense of exhaustion that means it's a struggle to carry out even the simplest activities.

Fatigue can significantly interfere with your daily activities and tends to get worse towards the end of each day, in hot weather, after exercising, or during illness.

Vision problems

In around 1 in 4 cases of MS, the first noticeable symptom is a problem with one of your eyes (optic neuritis).

You may experience:

• some temporary loss of vision in the affected eye, usually lasting for days to weeks
• colour blindness
• eye pain, which is usually worse when moving the eye
• flashes of light when moving the eye

Other problems that can occur in the eyes include:

• double vision
• involuntary eye movements, which can make it seem as though stationary objects are jumping around

Occasionally, both of your eyes may be affected.

Abnormal sensations

Abnormal sensations can be a common initial symptom of MS.

This often takes the form of numbness or tingling in different parts of your body, such as the arms, legs or trunk, which typically spreads out over a few days.

Muscle spasms, stiffness and weakness

MS can cause your muscles to:

• contract tightly and painfully (spasm)
• become stiff and resistant to movement (spasticity)
• feel weak

Mobility problems

MS can make walking and moving around difficult, particularly if you also have muscle weakness and spasticity.

You may experience:

• clumsiness
• difficulty with balance and co-ordination (ataxia)
• shaking of the limbs (tremor)
• dizziness and vertigo, which can make it feel as though everything around you is spinning

Pain

Some people with MS experience pain, which can take 2 forms.

Pain caused by MS itself (neuropathic pain)

This is pain caused by damage to the nervous system.

It may include:

• stabbing pains in the face
• a variety of sensations in the trunk and limbs, including feelings of burning, pins and needles, hugging or squeezing

Muscle spasms can sometimes be painful.

Musculoskeletal pain

Back, neck and joint pain can be indirectly caused by MS, particularly for people who have problems walking or moving around that puts pressure on their lower back or hips.

Problems with thinking, learning and planning

Some people with MS have problems with thinking, learning and planning, known as cognitive dysfunction.

This can include:

• problems learning and remembering new things – long-term memory is usually unaffected
• slowness in processing lots of information or multitasking
• a shortened attention span
• getting stuck on words
• problems with understanding and processing visual information, such as reading a map
• difficulty with planning and problem solving – people often report that they know what they want to do, but can't grasp how to do it
• problems with reasoning, such as mathematical laws or solving puzzles

But many of these problems aren't specific to MS and can be caused by a wide range of other conditions, including depression and anxiety, or even some medicines.

Mental health issues

Many people with MS experience periods of depression. It's unclear whether this is directly caused by MS or the result of the stress of having to live with a long-term condition, or both.

Anxiety can also be a problem for people with MS, possibly because of the unpredictable nature of the condition.

In rare cases, people with MS can experience rapid and severe mood swings, suddenly bursting into tears, laughing, or shouting angrily for no apparent reason.

Sexual problems

MS can have an effect on sexual function.

Men with MS often find it hard to obtain or maintain an erection (erectile dysfunction).

They may also find it takes a lot longer to ejaculate when having sex or masturbating, and may even lose the ability to ejaculate altogether.

For women, problems include difficulty reaching orgasm, as well as decreased vaginal lubrication and sensation.

Both men and women with MS may find they're less interested in sex than they were before.

This could be directly related to MS, or it could be the result of living with the condition.

Bladder problems

Bladder problems are common in MS.

They may include:

• having to pee more frequently
• having a sudden, urgent need to pee, which can lead to unintentionally passing urine (urge incontinence)
• difficulty emptying the bladder completely
• having to get up frequently during the night to pee
• recurrent urinary tract infections (UTIs)

These problems can also have a range of causes other than MS.

Bowel problems

Many people with MS also have problems with their bowel function.

Constipation is the most common problem. You may find passing stools difficult and pass them much less frequently than normal.

Bowel incontinence is less common, but is often linked to constipation.

If a stool becomes stuck, it can irritate the wall of the bowel, causing it to produce more fluid and mucus that can leak out of your bottom.

Again, some of these problems aren't specific to MS and can even be the result of medicines, such as medicines prescribed for pain.

Speech and swallowing difficulties

Some people with MS experience difficulty chewing or swallowing (dysphagia) at some point.

Speech may also become slurred, or difficult to understand (dysarthria).

Exactly why someone develops multiple sclerosis (MS) isn't known. It's not caused by anything you have done and it's not clear whether it can be prevented.

What's known so far suggests it's caused by a combination of genetic and environmental factors.

What happens in MS

MS is an autoimmune condition, which means your immune system mistakes part of your body for a foreign substance and attacks it.

In the case of MS, it attacks the myelin sheath in the brain and spinal cord.

This is the layer that surrounds your nerves, protecting them and helping electrical signals travel from the brain to the rest of the body.

The attacks cause the myelin sheath to become inflamed in small patches (plaques or lesions), which can be seen on an MRI scan.

These patches of inflammation can disrupt the messages travelling along the nerves.

It can slow them down, jumble them, send them the wrong way, or stop them getting through completely.

This disruption leads to the symptoms and signs of MS.

When the inflammation goes away, it can leave behind scarring of the myelin sheath (sclerosis).

These attacks, particularly if frequent and repeated, can eventually lead to permanent damage to the underlying nerves.

Why do people get MS?

It's not clear what causes the immune system to attack the myelin sheath.

It seems likely that it's partly caused by genes you inherit from your parents and partly by outside factors that may trigger the condition.

Some of the factors that have been suggested as possible causes of MS include:

• your genes – MS isn't directly inherited, but people who are related to someone with the condition are more likely to develop it; the chance of a sibling or child of someone with MS also developing it is estimated to be around 2 to 3%
• lack of sunlight and vitamin D – MS is more common in countries far from the equator, which could mean that a lack of sunlight and low vitamin D levels may play a role in the condition, although it's not clear whether vitamin D supplements can help prevent MS
• smoking – people who smoke are about twice as likely to develop MS compared with those who don't smoke
• teenage obesity – people who were obese during their teenage years have an increased risk of developing MS
• viral infections – it's been suggested that infections, particularly those caused by the Epstein-Barr virus (responsible for glandular fever), might trigger the immune system, leading to MS in some people
• being female – women are 2 to 3 times more likely to develop MS than men; the reason for this is unclear

Further research is needed to understand more about why MS occurs and whether anything can be done to prevent it.

It can be hard to tell whether your symptoms might be caused by multiple sclerosis (MS) at first, as some of the symptoms can be quite vague or similar to other conditions.

See your GP if you think you have symptoms of MS.

Letting them know about the type and pattern of symptoms you're experiencing in detail will help them determine whether you might have the condition.

If your GP thinks you could have MS, you should see a neurologist, a specialist in conditions of the nervous system, for an assessment.

Tests for MS

Diagnosing MS is complicated because no single test can positively diagnose it. Other possible causes of your symptoms may need to be ruled out first.

It may also not be possible to confirm a diagnosis if you have had only 1 attack of MS-like symptoms.

A diagnosis can only be made with confidence once there's evidence of at least 2 separate attacks, although this may include signs of attacks on an MRI scan that you may not realise you have had.

Some of the tests you may need to confirm MS are discussed below.

Neurological examination

Your neurologist will look for abnormalities, changes or weakness in your vision, eye movements, hand or leg strength, balance and co-ordination, speech and reflexes.

These may show whether your nerves are damaged in a way that might suggest MS. 

MRI scan

An MRI scan is a painless scan that uses strong magnetic fields and radio waves to produce detailed images of the inside of the body.

It can show whether there's any damage or scarring of the myelin sheath (the layer surrounding your nerves) in your brain and spinal cord. Finding this can help confirm a diagnosis in most people with MS.

A standard MRI scanner is like a large tube or tunnel. The machine is noisy and some people feel claustrophobic while the scan is done. Tell your neurologist if you're worried about this.

Newer scanners are more open and work quicker than those used in the past, and most people have scans without any problems. 

Evoked potential test

There are several types of evoked potential test. The most common type assesses how well the eyes work.

Light patterns are shown to the eyes while your brainwaves are monitored using small, sticky patches called electrodes placed on your head.

It's a painless test and can show whether it takes your brain longer than normal to receive messages.

Lumbar puncture

A lumbar puncture is a procedure to remove a sample of your spinal fluid by inserting a needle into the lower back.

Spinal fluid is the fluid that surrounds your brain and spinal cord, and changes in the fluid can suggest problems with the nervous system.

The procedure is done under local anaesthetic, which means you'll be awake, but the area the needle goes in will be numbed.

The sample is then tested for immune cells and antibodies, which is a sign that your immune system has been fighting a disease in your brain and spinal cord.

Lumbar punctures are very safe, but are often uncomfortable and can cause a headache that occasionally lasts for up to a few days.

A lumbar puncture will often be performed to provide extra information if your symptoms or scans are unusual.

Blood tests

Blood tests are usually performed to rule out other causes of your symptoms, such as vitamin deficiencies or a very rare, but potentially very similar, condition called neuromyelitis optica.

Determining the type of MS

Once a diagnosis of MS has been made, your neurologist may be able to identify which type of MS you have.

This will largely be based on:

• the pattern of your symptoms – such as whether you experience periods when your symptoms get worse (relapses) then improve (remissions), or whether they get steadily worse (progress)
• the results of an MRI scan – such as whether there's evidence that lesions in your nervous system have developed at different times and at different places in your body

But the type of MS you have often only becomes clear over time because the symptoms of MS are so varied and unpredictable.

It can take a few years to make an accurate diagnosis of progressive MS because the condition usually worsens slowly.

There's currently no cure for multiple sclerosis (MS), but it's possible to treat the symptoms with medicines and other treatments.

Treatment for MS depends on the specific symptoms and difficulties the person has.

It may include:

• treating relapses of MS symptoms (with steroid medicine)
• treating specific MS symptoms
• treatment to reduce the number of relapses (disease-modifying therapies)

You'll be supported by a team of different healthcare professionals working together.

This may include a neurologist (specialist in treating conditions of the nervous system), a physiotherapist, a speech and language therapist, and a number of other professionals.

Your team will also include a specialist MS nurse, who'll usually serve as your main point of contact.

Further information

• Department of Health and Social Care: National Service Framework for long-term conditions (PDF, 127Mb) 
• NICE: multiple sclerosis in adults

Treatment for MS relapses

Contact your specialist MS nurse or GP if you think you're having a relapse.

A flare-up of symptoms can sometimes be caused by something other than a relapse, such as an infection, so your nurse or GP needs to check for other possible causes.

Treatment for a relapse usually involves either:

• a 5-day course of steroid tablets taken at home
• injections of steroid medicine given in hospital for 3 to 5 days

Steroids can help speed up your recovery from a relapse, but they don't prevent further relapses or stop MS getting worse over time.

They're only given for a short period of time to avoid possible steroid side effects, such as osteoporosis (weak bones), weight gain and diabetes, although some people will still experience problems.

Not using steroids more than 3 times a year (if possible) will also help to reduce the risk of side effects.

Further information

• MS Society: treatments
• MS Trust: steroids

Treatment for specific MS symptoms

MS can cause a range of symptoms that can be treated individually.

Treatments for some of the main symptoms are discussed below.

Fatigue

Many people with MS experience fatigue.

You may be prescribed amantadine for fatigue caused by MS, although this medicine may only have a limited effect.

You should also be given general advice on ways to manage fatigue, such as:

• exercise
• keeping healthy sleep patterns
• energy-saving techniques
• avoiding medicine that can worsen fatigue (including some painkillers)

Specialist fatigue management courses or therapy, such as cognitive behavioural therapy (CBT), can also help some people with MS cope with their fatigue.

Visual problems

MS-related visual problems will often improve on their own, usually within a few weeks, so you may not need any treatment.

If your symptoms are particularly severe, you may be prescribed steroids to help speed up recovery.

If you have problems with involuntary eye movements, medicine such as gabapentin can sometimes help.

Some people with double vision need help from ophthalmologists (eye specialists).

Muscle spasms and stiffness

Muscle spasms and stiffness (spasticity) can be improved with physiotherapy. 

Techniques like stretching exercises can help if your movement is restricted.

If your muscle spasms are more severe, you may be prescribed a medicine that can relax your muscles.

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 of these would be best for you with your specialist MS nurse or GP.

If these medicines are not effective, you may be offered a 4-week trial of nabiximols (Sativex). This is a cannabis-based medicine sprayed into the mouth. Read about medical cannabis.

Mobility problems

Mobility problems are often the result of muscle spasms and spasticity, but they can also be caused by muscle weakness, or problems with balance or dizziness.

If you have problems with mobility, you might benefit from:

• an exercise programme supervised by a physiotherapist
• special exercises called vestibular rehabilitation if you have problems with balance
• medicine for dizziness or tremors
• mobility aids, such as a walking stick or occasionally a wheelchair
• home adaptations, such as stair lifts or railings

An occupational therapist can carry out an assessment of your home and suggest adaptations that may be of help.

Neuropathic pain

Neuropathic pain is caused by damage to your nerves, and is usually sharp and stabbing.

It can also occur in the form of extreme skin sensitivity or a burning sensation.

This type of pain can be treated using the medicines gabapentin or carbamazepine, or with a medicine called amitriptyline.

This is an older type of antidepressant, but these days it's mainly used for pain control.

Musculoskeletal pain

Living with MS can cause stresses and strains to the muscles and joints in your body.

A physiotherapist may be able to help with this pain by suggesting exercise techniques or better seating positions.

If your pain is more severe, you may be prescribed painkillers.

Alternatively, you may have a device that stimulates your nerves called a transcutaneous electrical nerve stimulation (TENS) machine.

Problems with thinking, learning and memory

If you experience problems with thinking and memory, any treatment you receive will be fully explained and recorded so it's clear to you.

You should be referred to a clinical psychologist, who will assess your problems and suggest ways to manage them.

Emotional problems

If you experience emotional outbursts, such as laughing or crying for no apparent reason, you should be assessed by a specialist like a clinical psychologist.

They may suggest treatment with an antidepressant.

People with MS who have depression can also be treated with antidepressants or therapy, such as CBT.

If you often feel anxious or worried, you may be prescribed antidepressants or benzodiazepines, which are a type of tranquilliser that have a calming effect.

Sexual problems

Men with MS who find it hard to obtain or maintain an erection (erectile dysfunction) may be prescribed medicine to temporarily increase the blood flow to the penis, such as sildenafil (Viagra). This is provided by the NHS if you have MS.

Relationship counselling or seeing a sex therapist may also help both men and women with MS who are having problems with reduced interest in sex or difficulty reaching orgasm.

Bladder problems

Various medicines are available if you have an overactive bladder or need to pee frequently during the night.

If you find it difficult to empty your bladder, advice from a continence nurse or physiotherapist can help.

Handheld external stimulators can also help some people start peeing or empty the bladder.

Occasionally, a catheter can be used to empty the bladder when needed.

In rare cases, people with MS may need a long-term catheter to keep the bladder emptying safely.

You may be referred to a continence adviser or urologist, who can offer specialist treatment and advice, such as botulinim toxin injections, bladder exercises or electrical treatment for your bladder muscles.

Read more about treating urinary incontinence.

Bowel problems

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 bottom, or an enema.

An enema involves having a liquid medicine rinsed through your bottom and large bowel, which softens and flushes out your stools.

Bowel incontinence can sometimes be treated with anti-diarrhoea medicine or by doing pelvic floor exercises to strengthen your rectal muscles.

Speech and swallowing difficulties

A speech and language therapist can help you find ways to overcome problems with speech and swallowing.

For example, they can offer advice about foods that are easy to swallow and recommend exercises to strengthen the muscles used in speech and swallowing.

If swallowing problems become very severe, some people need to be fed using a tube, which is fitted into the stomach through the skin.

Further information

• MS Society: signs and symptoms
• MS Trust: treating MS symptoms

Disease-modifying therapies

If you have relapsing MS talk to you specialist team about other possible treatments to help with your symptoms.

Although MS can't be cured, there are medicines that can help people have fewer and less severe relapses. These are called disease-modifying therapies.

These aim to reduce the amount of damage and scarring to the myelin sheath (a layer surrounding your nerves), which is associated with MS relapses.

These treatments may also help to slow worsening disability in MS, although definitive research into their long-term benefits is limited.

Disease-modifying therapies aren't suitable for everyone with MS. They're only prescribed to those with relapsing-remitting MS or secondary progressive MS who meet certain criteria, such as the number of relapses they have had.

People without relapses are very unlikely to benefit from the treatments and could still experience side effects from them.

Further information

You can find further information about disease-modifying therapies on these websites:

• MS Decisions
• MS Society: disease-modifying therapies 
• MS Trust: disease-modifying drugs

Clinical trials

Much progress has been made in MS treatment thanks to clinical trials, where new treatments and treatment combinations are compared with standard ones.

All clinical trials in the UK are carefully overseen to ensure they're worthwhile and safely conducted.

Participants in clinical trials sometimes do better overall than those in routine care.

Speak to your care team if you're interested in taking part in a clinical trial.

Further information

• Clinical trials and medical research
• MS Society: get involved in research

Complementary and alternative therapies for MS

Some people with MS find that complementary therapies help them feel better.

Many complementary treatments and therapies claim to ease symptoms, although scientific evidence is often not clear about how effective they are.

Many people think that complementary treatments have no harmful effects. But people can occasionally experience problems, and it's not a good idea to use them as an alternative to medicines prescribed by your doctor.

If you're considering using an alternative treatment alongside your prescribed medicines, it's important to let your doctor know your plans.

Further information

• MS Society: complementary and alternative medicines 
• MS Trust: complementary and alternative medicine

Care and support

If you find it difficult to look after yourself, your local authority may be able to provide you with some help. Ask for a care and support needs assessment.

For more information, read about:

• assessing your care and support needs
• care and support plans
• planning for your future care needs

You may have to adapt your daily life if you're diagnosed with multiple sclerosis (MS), but with the right care and support many people can lead long, active and healthy lives.

Self care

Self care is an integral part of daily life. It means you take responsibility for your own health and wellbeing, with support from people involved in your care.

Self care includes the things you do each day to stay fit, maintain good physical and mental health, prevent illness or accidents, and effectively deal with minor ailments and long-term conditions. 

People living with long-term conditions can benefit enormously from being supported to care for themselves.

They can live longer, have a better quality of life, and be more active and independent.

Regular reviews

Although you'll probably be in regular contact with your care team, you should also have a comprehensive review of your care at least once a year.

This is a good opportunity to discuss your current treatment, mention any new problems you're having, think about any further support you may need, and be kept informed about any new treatments that are available.

Make sure you let your care team know about any symptoms or concerns you have. The more the team knows, the more they can help you.

Healthy eating and exercise

There's no special diet that's been proven to slow the progression of MS, but a generally healthy, balanced diet can help you manage specific problems such as fatigue and constipation.

It can also reduce your risk of other health problems, such as heart disease.

Regular activity and exercise is important for both general health and fitness.

Research has shown specific benefits of exercise for people with MS, including reduced fatigue and improved strength, mobility, and bowel and bladder function.

Stopping smoking

Smoking is associated with an increased risk of a wide range of health conditions, and may also increase the speed at which MS gets worse.

If you smoke, stopping may help to slow the progression of your MS.

Find out more about stopping smoking

Keeping well

If you have significant disability related to MS, you'll usually be encouraged to get a flu jab each autumn.

But vaccines that contain live organisms, such as the BCG (TB) vaccine and one form of the shingles vaccine, may not be suitable if you're having treatment with some (but not all) of the disease-modifying therapies.

These treatments can weaken your immune system, which means live vaccines may not work or could make you ill.

Further information

• MS Society: diet
• MS Society: exercise
• MS Trust: diet
• MS Trust: exercise
• MS Trust: smoking

Relationships, support and care

Coming to terms with a long-term condition like MS can put a strain on you, your family and your friends.

It can be difficult to talk to people about your condition, even if they're close to you.

Dealing with the deterioration of symptoms, such as tremors and increasing difficulty with movement, can make people with MS very frustrated and depressed. 

Inevitably, their spouse, partner or carer will feel anxious or frustrated as well.

Be honest about how you feel, and let your family and friends know what they can do to help.

Don't feel shy about telling them that you need some time to yourself, if that's what you want.

Support

If you have any questions, your MS nurse or GP may be able to reassure you or let you know about other support that's available.

You may find it helpful to talk to a trained counsellor or psychologist, or to someone at a specialist helpline.

Some people find it helpful to talk to other people who have MS, either at a local support group or in an internet chatroom.

Care and support services

It's worth taking time to think about your specific needs and what you might need to achieve the best quality of life.

For example, if your balance and co-ordination are affected, you may want to think about equipment and home adaptations.

It may be useful to read your guide to care and support.

It includes information and advice on:

• planning for your future care needs
• what social care services are available
• choosing care services
• care services in your home
• practical support for carers

Further information

• MS Society: MS support 
• MS Society: forum 
• MS Society: MS Helpline 
• MS Trust: support groups

Having a baby

Being diagnosed with MS shouldn't affect your ability to have children.

But some of the medicine prescribed for MS may affect fertility in both men and women.

If you're considering starting a family, discuss it with your healthcare team, who can offer advice.

Pregnancy

Women with MS can have a normal pregnancy, deliver a healthy baby and breastfeed afterwards.

Having a baby doesn't affect the long-term course of MS.

Relapses tend to be less common in pregnancy, although they can be more common in the months after giving birth.

You may need to continue taking medicine throughout your pregnancy.

But some medicine shouldn't be taken during pregnancy, so it's important to discuss this with your healthcare team.

Further information

• MS Society: pregnancy and birth
• MS Trust: pregnancy

Money and financial support

If you have to stop work or work part-time because of your MS, you may find it difficult to cope financially.

You may be entitled to one or more of the following types of financial support:

• If you have a job but can't work because of your illness, you're entitled to Statutory Sick Pay from your employer.
• If you don't have a job and can't work because of your illness, you may be entitled to Employment and Support Allowance.  
• If you're aged 64 or under and need help with personal care or have walking difficulties, you may be eligible for Personal Independence Payment or Disability Living Allowance. 
• If you're aged 65 or over, you may be able to get Attendance Allowance. 
• If you're caring for someone with MS, you may be entitled to Carer's Allowance.
• You may be eligible for other benefits if you have children living at home or a low household income.

Further information

• Care and support guide: benefits for carers
• GOV.UK: benefits
• Money Advice Service
• MS Society: benefits and money 
• MS Trust: benefits
• MS Trust: working and studying with MS

Driving

If you have been diagnosed with MS, you must tell the Driver and Vehicle Licensing Agency (DVLA) and also inform your insurance company.

In many cases, you'll be able to continue driving, but you'll be asked to complete a form providing more information about your condition, as well as details of your doctors and specialists.

The DVLA will use this to decide whether you're fit to drive.

Further information

• GOV.UK: MS and driving
• MS Society: mobility, driving and transport
• MS Trust: driving and transport 
• RiDC: Motoring with MS