When Do Multiple Sclerosis Symptoms Start?
People with multiple sclerosis (MS) tend to have their first symptoms between the ages of 20 and 40. Early on, the symptoms get better, but then they come back. This is called relapsing-remitting MS, and it's the most common type people have when they're diagnosed.
Early Signs of MS
Some people start with an episode of MS symptoms that doctors call clinically isolated syndrome (CIS). CIS could lead to MS, but it doesn’t always.
MS happens when your immune system mistakenly produces inflammation that damages myelin, the protective cover over nerve cells in your brain and spine. You may hear your doctor call this demyelination. The attack causes scars, or lesions, that make it harder for signals to travel between your brain and your body.
There are two types of CIS:
- Monofocal episode: The episode affects one part of your brain or spinal cord.
- Multifocal episode: The episode affects many parts of your brain or spinal cord.
CIS symptoms are a lot like MS symptoms. The difference is that CIS is only one episode. MS is a chronic condition. Which symptoms you have first depends on what part of your nervous system the disease affects.
A vision problem called optic neuritis is one of the first signs of MS and CIS. It happens when inflammation damages the nerve that connects your eye to your brain. Optic neuritis usually affects one eye, but it can involve both eyes.
You might notice:
- Vision loss in one eye
- Colors that look dull
- Pain in your eye, especially when you move it
Other early symptoms of CIS and MS are:
- Tiredness
- Numbness and tingling
- Stiff or weak muscles
- Trouble walking
- Problems controlling your pee or poop
- Trouble moving your body, called paralysis
Primary MS Symptoms
The most common MS symptoms are:
Bladder and bowel problems. You may have to pee more often, need to go during the night, or have trouble fully emptying your bladder. Bowel issues like constipation or trouble controlling when you poop are also common.
Walking problems. MS can make it hard to get around. You might have:
- Weakness in your leg muscles
- Trouble keeping your balance
- Changes in the way you walk, called your gait
- Numbness in your feet
Dizziness. You may feel lightheaded. Sometimes it can feel like the room is spinning. That’s called vertigo. Other conditions can also make you dizzy, such as a problem with your inner ear or medicines you take. Your doctor can do tests to find the cause of your dizziness.
Emotional changes and depression. It’s hard to adjust to the idea that you have a chronic disease, especially one that you can’t predict. Depression is common in people with MS. Fear of the unknown can make you anxious. Damage to nerve fibers in the brain also affects emotions. So can medicines like corticosteroids that treat MS.
Eye problems. In addition to optic neuritis, MS can cause:
- Fast eye movements that you can’t control, called nystagmus
- Double vision
Fatigue. This is often the most common symptom of MS. You may feel tired even after a good night’s sleep. MS fatigue is more severe than normal tiredness, and it can get worse later in the day. Fatigue can make it harder for you to work and do other daily activities.
Heat-related problems. MS can make you more sensitive to heat. Symptoms like blurred vision, tiredness, and muscle weakness may get worse when it’s hot outside or you have a fever. Once you rest and cool down, these symptoms should go away.
Muscle stiffness and spasms. Your muscles might feel stiff or twitch. These symptoms can make it hard to walk if the muscles are in your legs.
Sexual troubles. MS can cause vaginal dryness in women and erection problems in men. Both men and women may lose feeling in their genitals, have a lower sex drive, and have trouble reaching orgasm.
Swallowing problems. MS can affect muscles in your mouth and throat. Weakness in these muscles could make it harder for you to chew and swallow. You might feel like food is stuck in your throat, or you might cough when you eat or drink. If swallowing problems get worse, food or drinks could get into your lungs.
Thinking and speech problems. It might be hard to learn new things, make plans, focus, and find the right words. Your thinking may feel slow and your memory could be fuzzy. Most of these mental changes are mild. Less often, MS causes problems severe enough to get in the way of work or school.
Tremor. Up to 60% of people with MS shake or make other movements with their arms, legs, body, or head that they can’t control. That’s called tremor, and it happens because of nerve damage. Tremor can be mild or so intense that it’s hard to write and do other activities.
Trouble walking. Weakness, loss of balance, and muscle tightness can affect the way you walk. Problems with your walk, or gait, could lead to a fall. Some falls are serious enough to cause fractures and other injuries.
Unusual feelings. Along with the pins and needles feeling that’s part of MS, you might also have severe itching, burning, stabbing, or electric shock-like pain from nerve damage. You could feel a tightness around your ribs or upper belly known as the MS hug. The pressure sometimes gets so intense that it’s hard to breathe.
Secondary Symptoms
Primary MS symptoms like tiredness and trouble walking or emptying your bladder happen because of nerve damage. They can lead to other problems, called secondary symptoms, like these:
- Urinary tract infections because you can’t fully empty your bladder
- Weak muscles and bones, or trouble breathing because you don’t get enough exercise
- Pressure sores when you sit or lie down for long periods of time
- Pneumonia because food and fluid get into your lungs when you have trouble swallowing
Doctors can treat secondary symptoms, but the goal is to avoid them by treating the primary symptoms.
Tertiary Symptoms
MS also causes these types of social, mental health, and work-related problems:
- Job loss if it’s hard for you to walk, drive, or do your job well
- Trouble with your relationships because you’re stressed from living with a chronic disease
- Depression because of the way MS changes your brain and your life
MS affects each person differently. Your symptoms may be different from those of other people with this condition. It is possible to manage MS symptoms and lead a full, active life.
MS Symptoms in Men
Some research suggests that if you're a man or were assigned male at birth you may have different symptoms than women and those assigned female at birth. You might have more movement symptoms such as trouble walking and working with your hands, but less tiredness and anxiety. Overall, MS gets worse faster and causes more disability in people assigned male at birth.
Other common symptoms if you're assigned male at birth include:
- Muscle spasms
- Problems with movement and coordination
- Erection problems
- Reduced sex drive
- Trouble reaching orgasm
MS Symptoms in Women
If you were assigned female at birth, you are three times more likely to have MS than those assigned male at birth. Your MS might appear at an earlier age and cause more lesions in your brain and spinal cord.
Anxiety and fatigue are more common symptoms for people assigned female at birth with MS.
If you're under age 40, you are more likely to have more or worse MS symptoms overall than someone of the same age assigned male at birth. This may be because you have more lesions. You are also more likely to have relapses. And you may find your symptoms get worse around the time of your period.
MS symptoms like fatigue and bladder problems also tend to get worse during pregnancy, but it’s rare to have a relapse during pregnancy. That’s because your immune system quiets down during pregnancy to stop your body from rejecting your baby, which also reduces inflammation and makes MS less active. After delivery, your MS symptoms may get worse again.
Sometimes MS symptoms increase during menopause. You may have more trouble with:
- Heat sensitivity
- Mood changes
- Sleep
- Memory and thinking
- Bladder function
When to See Your Doctor for MS Symptoms
Many conditions cause the same symptoms as MS. Only a doctor can confirm whether you have MS. See your primary care doctor or a neurologist if you have any of these symptoms:
- Vision loss in one or both eyes
- Double vision
- Numbness or tingling in your arms or legs
- Trouble moving your legs or one side of your body
- Balance problems
Takeaways
MS causes symptoms like double vision, numbness and tingling, trouble walking, and tiredness. These symptoms can lead to other problems, such as urinary tract infections, weak muscles and bones, and relationship problems. See your primary care doctor if you have symptoms of MS. They might send you to a specialist called a neurologist for tests.
Multiple Sclerosis Symptoms FAQs
What is the life expectancy with MS?
MS itself isn’t life threatening, but complications like pneumonia, bladder infections, and swallowing trouble can shorten the lifespan. The average life expectancy of people with MS is 5 to 10 years shorter than in people without it.
Life expectancy also varies by the type of MS. A 2017 study showed that the life expectancy for relapsing-remitting MS was 78 years, compared to 71 years for primary-progressive MS. But new treatments are helping people live longer with this disease.
Can you live a normal life with MS?
You may have to make some changes to your life because of symptoms like fatigue and trouble walking. But with the right treatment and support, many people can live a normal, active life with MS.
Can you live with MS without symptoms?
Benign MS is a mild form of relapsing-remitting MS that causes few to no symptoms. You can still have damage to your brain and spinal cord without having symptoms.
