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Patient Instructions

Your doctor has told you that you have multiple sclerosis. This disease affects the brain and spinal cord (central nervous system). Symptoms may vary with each attack. They may last days to months, then lessen or go away, and then come back after weeks, months, or sometimes years.

Over time, symptoms get worse, and it becomes more difficult to take care of yourself.

Exercise can help your muscles stay loose and help you keep your balance. It is good for your heart. It may also help you sleep better and have regular bowel movements.

• Ask your doctor or nurse what activity is safe for you.
• Try walking or jogging, if you can. Stationary bicycle riding is also good exercise.

Keep from getting overheated.

• Exercise in the morning and the evening. Be careful not to wear too many layers of clothes.
• Take warm baths and showers. Avoid water that is too hot.
• Be careful in hot tubs or saunas. Make sure somebody is around to help you if you become overheated.
• Keep your house cool in the summer with air conditioning.
• Avoid hot drinks if you notice problems with swallowing, or other symptoms get worse.

If you have problems with spasticity, learn about what makes it worse. You or your caregiver can learn exercises to keep muscles loose. See also: Caring for muscle spasticity or spasms

Make sure your home is safe. See also:

• Preventing falls
• Bathroom safety - adults

If you are having trouble moving around in your house easily, talk with your nurse or doctor about getting help.

Your doctor or nurse can refer you to a physical therapist to help with:

• Exercises for strength and moving around
• How to use your walker, cane, wheelchair, or other devices
• How to set up your home to safely move around

You may have problems starting to urinate or emptying all of the urine out of your bladder. Your bladder may empty too often or at the wrong time. Your bladder may become too full, and you may leak urine out of an overfilled bladder. See also: Urinary incontinence - self-care

Some people with multiple sclerosis need to use a urinary catheter. This is a thin tube that is inserted into your bladder.

See also:

• Self catheterization - men
• Self catheterization - women
• Catheter care - indwelling

Your doctor or nurse may also teach you some exercises to help you strengthen your pelvic floor muscles. See also: Kegel exercises

Urinary infections are common in people with multiple sclerosis. Learn to recognize the symptoms, such as burning when you urinate, fever, low back pain on one side, and a more frequent need to urinate.

Do not hold your urine. When you feel the urge to urinate, go to the bathroom. When you are not at home, take note of the location of the nearest bathroom.

Nerves that help your bowels work smoothly can be damaged when you have multiple sclerosis. Have a routine. Once you find a bowel routine that works, stick with it. See also: Daily bowel care program

• Pick a regular time, such as after a meal or a warm bath, to try to have a bowel movement.
• Be patient. It may take 15 to 45 minutes to have bowel movements.
• Try gently rubbing your stomach to help stool move through your colon.

Avoid constipation:

• Drink more fluids.
• Stay active or become more active.
• Eat a diet with lots of fiber.

Ask your doctor about medicines you, or your loved one, are taking that may cause constipation (such as some medicines for depression, pain, bladder control, and muscle spasms).

If you are in a wheelchair or bed most of the day, you need to check out your skin every day for signs of pressure sores. Look closely at:

• Heels
• Ankles
• Knees
• Hips
• Tailbone
• Elbows
• Shoulders and shoulder blades
• Back of your head

Learn how to prevent pressure sores. See also: Preventing pressure ulcers

Keep up to date with your vaccinations. Get a flu shot every year. Ask your doctor if you need a pneumonia shot.

Ask your doctor about other checkups you may need, such as to test your cholesterol level, blood sugar level, and a bone scan for osteoporosis.

Eat a healthy diet and keep from becoming overweight.

Learn to manage stress. Many patients with multiple sclerosis feel sad or depressed at times. Talk to friends or family about this. Ask your doctor about seeing a professional to help you with these feelings.

Your doctor may place you on different medicines to help your multiple sclerosis and many of the problems that may come with it.

• Make sure you follow instructions. Do not stop taking medicines without first talking to your doctor.
• Know what to do if you miss a dose.
• Keep these and all other medicines stored in a cool, dry place and away from children.

Call your doctor if you have:

• Problems taking drugs for muscle spasms
• Problems moving your joints (joint contracture)
• Problems moving around or getting out of your bed or chair
• Skin sores or redness
• Pain that is becoming worse
• Recent falls
• Choking or coughing when eating
• Signs of a bladder infection (fever, burning when you urinate, or frequent urination)

MS - discharge

Calabresi P. Multiple sclerosis and demyelinating conditions of the central nervous system. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 436.

Updated by: Daniel B. Hoch, PhD, MD, Assistant Professor of Neurology, Harvard Medical School, Department of Neurology, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.