Incontinence

Incontinence happens in MS when nerves that control the bladder, bowels, or pelvic floor become damaged.

When that happens, the bladder sometimes squeezes and forces urine out. Antispasmadic drugs such as Oxytrol (oxybutinin) may help the bladder relax to produce fewer squeezes. Botox (botulinim toxin) injections can help block nerve signals to the bladder, which have become erratic due to damage from MS, and improve symptoms. And Kegel pelvic exercises may help strengthen the pelvic floor to prevent incontinence.

For bowel incontinence, most healthcare providers recommend lifestyle treatments to keep you “regular,” such as a high-fiber diet, physical activity, and plenty of fluids. Additional treatments you can explore with your doctor include biofeedback training, which help you become more aware of when you have to go, as well as transanal irrigation, which helps flush stool out. We know, no one wants to even think about this problem, but just remember that there are treatments.

Insomnia

Insomnia can have a lot of possible causes when you have MS, such as:

• Side effects of medication
• Napping during the day due to fatigue
• Chronic pain or uncomfortable spasticity
• Depression

That means you’ll need a multipronged approach to deal with insomnia. Start with healthy sleep hygiene (more on this in the very next section). And be sure to seek treatment for other MS symptoms, such as depression and pain, that may be stealing your snooze time.

If you’re still not getting the sleep that you need talk to your doctor, who might suggest you try:

• Melatonin supplements, which are made from a natural hormone in the brain that helps prepare you for sleep.
• Antihistamines like Benadryl (diphenhydramine HCI), which can make you drowsy.
• Sleep medications like Ambien (zolpidem)—but do make sure your doctor is aware of all other current medications to avoid a negative interaction.

What Lifestyle Changes Can I Make to Support My MS Treatment?

MS may throw some challenges your way, but it doesn’t take away your free will. So, choose to put your physical and emotional health first. Since MS is such a personalized disease, there’s no one-size-fits-all lifestyle plan. People with MS might have to work within the limits of their condition, sure, but most of us have some control over:

• How we sleep
• How we fuel our bodies
• How we move our bodies
• How we spend our time
• How we engage our minds
• How we manage stress

These tips can help maximize your medical treatment so you feel as healthy and strong as possible.

Make Sleep a Priority

If you’re living with MS, healthy sleep hygiene is essential—maybe more for you than for most people. Yet, because of your condition, it may be harder to come by quality, consistent Zzzs.

Problems with insomnia, spasticity, stress, nerve pain, and depression can all contribute to your not getting enough shuteye—even when shuteye is exactly what you need most to combat the fatigue that comes with a disease flare (and sometimes outside of one). Here’s what you can do to get your nightly, needed 8 hours:

• Establish a Bedtime Ritual: Going to bed and waking up at approximately the same times each day—even on the weekends!—helps you set your circadian rhythm, the body’s inner clock, which may set you up for a better night’s sleep. Lights out!
• Limit Caffeine: Stimulants like caffeine can keep you tossing and turning. Keep your java, tea, or cola intake to one (or, at most) two drinks in the morning for better shuteye later on.
• Avoid or Limit Alcohol: If you have MS and enjoy the occasional cocktail—try to have the last one a few hours before bedtime to allow enough time for the alcohol to metabolize. Alcohol is known to disrupt sleep.
• Stay Calm: Meditation, when we intentionally clear our minds of the day’s thoughts and troubles, has been shown to help reduce stress, which in turn promotes good sleep. Check out the Calm or HeadSpace apps for pre-bedtime mindfulness tips.
• Limit Liquids: People with MS often have to get up more than once in the night to urinate. Do your best to limit liquids for a few hours before going to bed.
• Exercise Regularly: Get better rest from a regular workout—just be sure to finish exercising four to six hours before hitting the sheets or your upped energy just might leave you tossing and turning.
• Turn Off Blue-Lit Screens: The blue light emitting from most digital screens activates your brain in the same way sunshine does—triggering a wakeful response. So put down your phones and tablets at least an hour before bed.
• Use the Bed for Sleep and Sex Only: No work! You don't want to have the place where you're supposed to be the most relaxed associated with any kind of stress. It's for sleeping and getting it on. That's it.

Focus on Your Nutrition

If you’re looking for a diet specifically tailored to help MS symptoms, you won’t find one. However, here are some good guidelines for anti-inflammatory, healthy eating (and drinking):

• Eat More Low-Fat Dairy: People with MS are at higher risk for low bone density from osteoporosis. This may be due symptoms of weakness that prevent much weight-bearing exercise, as well as certain medications used to treat MS that can lead to bone loss. The National MS Society recommends 1,000 mg of calcium per day for adults ages 25 to 65 and 1,500 mg per day for postmenopausal women, preferably from calcium-rich food sources like low-fat milk, yogurt, and cheese. These foods are also fortified with vitamin D, which may help reduce MS-related symptoms
• Dine on Fatty Fish: Omege-3 fatty acids found in fish like salmon, tuna, and sardines are shown to help fight inflammation in the body. Australian researchers found that the more fish people with MS eat, the less disease activity and fewer relapses they experience.
• Enjoy More Fruits and Veggies: Plants, especially colorful ones, are good for you. And a high-fiber diet is especially good for people with MS because it can help relieve constipation. Fruits and veggies are also rich in antioxidants like vitamins C, E, and A, which help tame inflammation.
• Try Fermented Foods: Sauerkraut, kefir, kimchi, and yogurt are rich in probiotics, good-for-you-kind bacteria. Aim for at least one kind of fermented food each day.
• Reach for More Nuts and Seeds: Why? Because nuts and seeds are rich in biotin, a kind of B vitamin that’s been shown to help improve symptoms of MS.
• Skip the Salt Shaker: The more sodium people with MS have in their systems, the more likely they are to relapse, according to a Harvard study. Salt can also raise your blood pressure, too. So set down the salt, limiting it to no more than 2,300 mg (one teaspoon) per day, or 1,500 mg (three-quarters teaspoon), if you already have heart disease.
• Eat (and Drink) Less Sugar: Refined sugar triggers inflammation in the body. And it’s found in our processed and packaged foods: breakfast cereals, snacks, condiments like ketchup, and sweetened beverages, too. One study shows how people with MS who drank two cans of soda or sweetened beverages per day experienced more frequent and severe symptoms. Do you best to limit—or even eliminate!—refined sugars from your diet. Alcohol—wine, beer, spirits—often contains a lot of sugar, too.

It’s worth noting that people with MS are more likely to have other chronic diseases such as high blood pressure (HBP), high cholesterol, and type 2 diabetes. Keep those in mind as well when you’re making your day-to-day diet choices. And guess what the standard diet advice is for those diseases? Yep, all of the above.

Exercise on the Regular

When you’re exhausted and in pain during an MS relapse, you may think activity could only make everything worse. It’s actually the opposite. Exercise helps in almost every way. People with MS who exercise:

• Preserve Brain Function: Moving your body may actually help you better maintain your brain—and even stave off the progression of damage to it. In a 2018 study published in the Multiple Sclerosis Journal, researchers found that when people with MS performed twice-weekly resistance-training workouts (strength training or swimming are both good) for 24 weeks, MRI scans showed that overall brain damage from MS had not progressed. Meanwhile, certain parts of the brain had actually thickened, suggesting an exercise regimen helped preserve brain tissue, and in some cases, may have promoted brain regeneration.
• Fight Weakness and Build Strength: A common symptom of MS is a feeling of weakness, which comes from interrupted nerve signals from the brain to the muscles, compounded by lowered endurance from not using these same muscles as much as you once did. Try resistance training (strength training, yoga, or swimming are all good) to help retain, and even build upon, strength.
• Improve Balance and Coordination: People with MS may experience unsteady walking, spasticity, and difficulty with balance and muscle coordination. Without exercise, these symptoms can worsen. But research shows that those who engage in daily exercise can improve such symptoms. Hit the mat to stretch and do some downward dogs, take to the streets for a nice walk, or jump in the pool to swim a few laps. (You can work these balance moves into your routine, too.)
• Up Energy Levels: Major fatigue is common in people with MS and can even occur outside a relapse or attack. One study shows how 45 minutes of swimming three times each week improved symptoms of fatigue in women with MS, compared women with MS who did not exercise in this way. Go on, dive in.
• Protect Bone Density: Bone health can be an issue for people with MS, due to reduced physical exercise and muscle strength from nerve conduction issues, lower levels of vitamin D, as well as some MS medications that can strip bone density. So it makes sense that weight-bearing exercises like daily walking and yoga may be especially helpful.
• Improve Bladder Control: Incontinence—when you pee with urgency, and all too frequently—is a typical symptom of MS. Studies show how pelvic floor training (also known as kegel exercises) can help women with MS who regularly battle with their bladders improve their symptoms.
• Boost Mood: Clinical depression is more common in people with MS than in the general population—and regular exercise has been shown to improve symptoms of low mood.

A few additional notes on working up a sweat: Although exercises for MS are largely the same as those that people without MS do, it’s important to work within any limitations of your disease. If your symptoms are dizziness and vertigo, for instance, you might do better on a stationary bike instead of a treadmill.

Water exercises are often favored by people with MS. Water walking and water aerobics can be easier on the joints than their dry-land counterparts—just make sure the water’s not too hot. In fact, heat is something you’ll have to watch closely, since symptoms can flare up or become worse when your body overheats.

If it’s feasible, seek out a physical therapist, especially one who’s worked with people who have MS, who can modify exercises appropriately. Always follow your doctor’s instructions—and, have fun! Remember: The point is to feel good.

Work Out Your Brain

Cognitive decline can be a big issue for people with MS. In fact, 65% of people with this disease sometimes have trouble focusing, processing information, and struggling with memory. The good news?

There are ways to help combat cog fog with what’s called our cognitive reserve, the brain’s backup system to form new connections, and to change and adapt. (Everyone has it, not just people with MS.) However, this reserve is not unlimited—it can only do so much. So help your brain health by doing any and all of the following:

• Read More: Reading stimulates many parts of the brain—which is good for yours! In fact, one study from Emory University suggests that reading may increase connectivity in the brain, improving brain function for at least a few days. Even a graphic novel, the sports section, or your favorite entertainment news can do the trick. Just read!
• Get Lost in Thought: Doing puzzles, playing memory games, learning a new language, or even balancing your checkbook in your head all help fight cognitive decline. One study published in Neurology shows how the more people with MS do these sorts of things, the less they experience cognitive symptoms.
• Be Social: Join a book club. (Reading!) Work out with a friend. Attend a church gathering or support a cause or foundation that speaks to your specific interests. When we’re social, we’re engaging our brains in many different ways, including the parts responsible for attention, language comprehension, and working memory—which all help boost cognitive reserve, the backup system in our brains.

Take Stress Management Seriously

Can stress cause a relapse of MS? The scientific jury is still out on this question, but many people with MS report additional symptoms during particularly stressful times. We do know that unmanaged stress can negatively affect the central nervous system—and that’s what you’re most trying to protect if you have MS.

Common signs of stress include:

• Constant worry and expecting the worst to happen
• Sleep disturbances, or sleeping too much or too little
• Distractibility
• Difficulty making decisions
• Chronic irritability
• Feeling down or demoralized
• Feeling overwhelmed
• Heart palpitations
• Clammy hands
• Sweating
• Headaches
• Stomachaches

If you have MS, stress management is an important part of managing your disease. Talk with your family, friends or a counselor, join a support group, learn to manage your anger and fears through stress-busting mindfulness and meditation, and consider exercising more, which has been shown to reduce feeling of stress.