Understanding visible and invisible symptoms of MS

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Problems with walking are a common visible symptom. Your mobility can be affected, as can balance and coordination. You might stumble when you walk, or feel unsteady, or walk with an abnormal gait – for example walking with your legs wide apart rather than them being close together (this is called a wide based gait). A dropped foot, when the ankle is weakened, can occur. This makes it harder to move the foot as you would normally and can lead to people noticing that you drag your foot when walking.

"I had foot drop for about 3 months earlier this year. Feels like my left foot just freezing in mid air for a millisecond then back to normal. I do look like I’m limping when I walk but not in pain. Now it’s disappeared and back to normal." @Cheebazoe

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Multiple sclerosis can affect the way your mouth and throat functions, so one common symptom as MS advances is swallowing – whether that be food or fluids. But that’s more likely to be an invisible symptom. Problems with speech, though, are a visible symptom. You may find it hard to speak without slurring, or struggle to speak clearly; you might also stumble when talking or have problems recalling words – making conversations stilted.

"I go through phases where it becomes really hard to swallow. I feel like food gets “stuck” at the bottom of my throat, not like I’m choking but it’s uncomfortable and a sip of something usually helps it go down." @Jace

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Spasticity affects the muscles, making them stiff to the point of almost ‘freezing’. Spasms are the opposite – these can make an arm or a leg jerk suddenly. When these kinds of symptoms are mild, they may not be so noticeable, but in more severe cases they’d definitely be considered a visible symptom.

"I get this tugging feeling a lot when I lie on my side (feels like a rubber band is tightening around the muscle on the left side of my spine) until I stand or sit up." @ann4marie

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Invisible symptoms are those that are considered hidden, or not easily detected. During an increase in your MS symptoms you may be experiencing challenges that other people are totally unaware of. It can feel like a silent struggle.

“When someone asks me about MS, if they know anything, it’s usually that it affects a person’s ability to walk. If only it was that simple… We (MSers) have a little of almost every disease to deal with. Think about it – the brain controls everything the body does.” @calNFFC

With that observation in mind, it’s no surprise to learn that the range of invisible symptoms in multiple sclerosis can be wide and varied. Here are some of the most common.

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Bladder and bowel problems are unfortunately pretty commonplace if you live with MS. That can mean issues going to the toilet - both in terms of being able to ‘go’ and with control. You might need to empty your bladder more often, or feel like you’re losing the ability to perform the functions as well as you did before. Like most symptoms of MS, treatment and self management advice can help.

"Make sure to mention it to your MS team. Mine are obsessed with my pee! They can refer you to the right people and they can give you advice. Do not be ashamed or embarrassed. It can't be helped." @Luci15b

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Possibly the number one symptom of multiple sclerosis, fatigue can vary from a feeling of being more tired than usual, right to being completely wiped out and exhausted. It can come and go, sometimes without much warning. How you may experience fatigue isn’t related to how long you’ve had MS or the severity of MS.

There are two types of fatigue with MS – primary fatigue and secondary fatigue. Primary fatigue is a result of the nerve damage directly caused by MS, while secondary fatigue is a consequence of having MS. Secondary fatigue includes things like pain and muscle stiffness or weakness.

Fatigue that comes with multiple sclerosis can be especially frustrating, when trying to explain to others how much it can affect you – it’s not just ‘feeling tired’! It can be one of the most challenging symptoms to manage so seek advice from your doctor on how to most effectively tackle fatigue. 

“When MS fatigue hits, it HITS. It feels like gravity has upped its game and I feel like I'm on another planet." @LookWoolly

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Multiple sclerosis can trigger a number of issues with vision, including a condition called optic neuritis, which is often one of the very first symptoms someone with MS notices. With optic neuritis, you can get blind spots in your vision, and pain when you move your eyes. Blurred vision or double vision – technically called diplopia – are other eyesight issues that are common. 

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Uhthoff’s Phenomenon is a temporary worsening of MS symptoms which typically presents in problems with vision when the body becomes overheated, such as in hot weather, during/following exercise, fever, hot baths, hot tubs etc.

“My right eye normally starts twitching if I am worried about things. It's annoying as other people can’t see it but you can and feel it." @Robs79

There’s also something called nystagmus, which causes unusual eye movement in different directions and sometimes head shaking. This is more of a visible symptom though, as other people may notice nystagmus.

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Multiple sclerosis takes an obvious toll on your mental health, so it’s not unusual to experience symptoms relating to that. This includes anxiety, depression and perhaps stress. Of course, while anxiety affects many people who don’t have MS, if you’re living with multiple sclerosis it’s quite common to experience anxiety at one time or another.

"It can be all consuming and exhausting to constantly process at times. It’s 💩 but you’re definitely not alone. Be present and make the most of what you can. Some days are just gonna be easier than others. Be kind to yourself ❤️🩹" @CristinaOlympia

If you’re suffering from anxiety, depression, or another mental health challenge, please do talk to someone. Therapy, as well as medication, can help – and simply talking to others and reaching out for support can have a positive effect.