With MS, maintaining safe and independent mobility can sometimes be difficult. The result is often a marked decrease in overall activity – which leads to preventable disuse weakness and deconditioning. If inactivity continues, other problems can develop. These include: muscle tightness and/or weakness; increased spasticity; bowel problems (usually constipation); decreased heart and lung function; pressure sores; depression; and social isolation.

Sexuality and intimacy have an important impact on the quality of life for nearly everyone, including those with a chronic disease such as multiple sclerosis (MS). In MS, sexual dysfunction may be one of the less talked-about symptoms of the disease. It is important to recognize and understand this symptom in order to adequately address it.

Spasticity is a common symptom in MS. It is a tightness or stiffness of the muscles – occurring typically in the legs (calf or thigh), groin, and buttocks. Although less common, some individuals may experience spasticity in their back. These are all muscles that help people to stand and balance in an upright position.

From a neurological perspective, speech abnormalities may be due to a disturbance of primary language function (aphasia) or due to mechanical disturbances of word formation (dysarthria). With aphasia, an individual may partially or fully lose the ability to communicate verbally or with written words, either temporarily or permanently, and this may be related to a loss of memory. With dysarthria, an individual will have difficulties speaking due to reduced control of muscles, often a result of nerve damage.

I remember being quite surprised when a survey of multiple sclerosis (MS) patients conducted by MSAA several years ago revealed that 39 percent of respondents indicated they had some degree of swallowing difficulty. Fortunately, most of the swallowing (medically known as dysphagia) problems are mild and are self-managed by the patients.

Tremor is a difficult symptom to manage. This is a back-and-forth or “oscillating” movement that usually affects the arms or legs, but can also (less frequently) affect the head or body (trunk). Individuals experiencing tremor may find that this symptom varies and is not always present. However, when tremor does occur, it can interfere with one’s balance and coordination. To follow are examples of how tremors vary:

Anxiety is perhaps the most taxing and under-treated psychological effect of living with multiple sclerosis. It does not appear to result from the physical disease process of multiple sclerosis, but rather stems from the realities of living with multiple sclerosis. Individuals living with multiple sclerosis know that it’s the unpredictability, and therefore the difficulty, in planning and preparing for the effects of multiple sclerosis on your life, that drives one’s anxiety. Anxiety disorders are estimated to affect 43 percent of those with multiple sclerosis, and are also more common among women.

Traditionally, cognitive issues were not believed to be a symptom of MS. In more recent years, researchers and physicians have come to find that roughly half of the MS population will experience some type of change in their cognitive abilities during the course of their disease.

Researchers believe that the high rate of major depressive disorder, dysthymia (a chronic type of depression), and bipolar disorder with MS, is a result of the disease process or the etiology of the disease itself. In other words, the damage to the nerves within certain areas of the brain is believed to increase the chance of greater depressive reactions. Depressive reactions are not to be confused with sadness or fatigue.

Pseudobulbar affect (PBA) is a neurologic effect that occurs in 10 percent of people with MS, although some research suggests a much larger percentage. It is characterized by sudden, uncontrollable expressions of laughter or crying without an apparent trigger.