What is fatigue?
Fatigue is a symptom that is experienced by the majority of people with MS at some time. The ability to carry out physical activities and also the ability to concentrate or think may both be affected.

It is much more than just feeling ‘tired’. It is described by people in many ways.

Fatigue can arrive without warning and can subside just as fast.  For others this can be a constant but tolerable symptom that makes everything more of an effort.

Fatigue can differ very much from person to person. It can often worsen existing symptoms or can bring on new ones. Some people find that fatigue can make limbs feel heavy and grip more difficult. Things like concentration, vision and speech can temporarily worsen. Severe fatigue can make you feel like the exhaustion you have during the flu and put you in bed for a few days.

There are certain things, which can bring on fatigue, as well as other MS symptoms.  When you know what these things are fatigue is easier to either deal with or avoid completely. Some of the most common triggers are: a hot day, humid weather, a hot bath, over-exertion, over-tiredness, a heavy meal, smoking and stress.  Fatigue can also be one of the major symptoms of a food allergy.

What Causes Fatigue?
Fatigue in MS is thought to be caused by many factors. There are what we know to be two types of fatigue, primary and secondary.

Primary fatigue is thought to be down to the disease process itself and is caused by the demyelination in the central nervous system. The slowing of messages from the brain and spinal cord and a build up of muscle weakness combined, can be a cause of primary fatigue.

Secondary fatigue is not directly caused by MS itself but where the body tries to compensate for the symptoms caused by MS. For example, sleep disturbance can be common due to spasms, pain or bladder problems. This will contribute to MS related fatigue. Side effects from medications, stress, depression and other symptoms can all cause secondary fatigue.

Treatment for Fatigue
Firstly, it is important to find out the best way of managing fatigue. It is important to find out what triggers it and how to understand it. It may be caused by another symptom which could be easily treatable or it may be about learning how to conserve energy, for times of the day when more is needed, and prioritising daily activities.

Be aware of your own symptoms and ones that could possibly be a trigger; this will be important in finding the best way to manage your fatigue. For example, if bladder problems at night are disturbing your sleep then make an appointment to see your GP/MS Nurse/Continence Advisor. This can be assessed and hopefully solved.

MS Nurses and MS Specialist Occupational Therapists can help in your fatigue management. Some run their own fatigue management courses that will teach you strategies and ways to help reduce the fatigue and deal with day to day activities. Something as simple as prioritising daily tasks can make such a difference.

It is very important to listen to your body. If you need to rest, then rest. If you know you have a really busy day coming up - a day out, a wedding or something that is going to take a lot of energy, then make sure you rest well for a couple of days leading up to it.

Don’t be tempted to over do it when you have a really good day! You may well end up making yourself feel a lot worse for a few days after. Use that good feeling wisely and then you should get more out of it and feel less fatigued for longer.

This is all basic fatigue management skills. Learning how to conserve your energy for times when you need it most. Once you start implementing this into daily life it will become much easier. It could be useful to keep a diary taking into account the daily activities done that day; what you have eaten, the time of day you might have felt more tired and anything else that could possibly be a trigger.

Exercise
If you are physically fit, you have a better chance of withstanding fatigue. To keep fit, you must keep the muscles exercised. You should never exercise to the point of exhaustion and should stop before feeling tired or hot. Exercise tones up the whole system. After a session of gym, yoga or swimming, for example, you should have more energy, not less.  Your body will give you early warning signals as to when it is time to stop and rest.

Heat and Humidity
A common experience with MS is to become very sensitive to heat, particularly humid heat. Hot, humid summers can be very uncomfortable for someone with MS. It is important to keep cool.  Air conditioning can be very nice but if that isn’t available then a fan in every room is a second best. Items such as Kool-Ties and Cooling Vests can be helpful. The Kool-Ties work for up to three days by cooling the whole body and particularly the blood flowing to the carotid arteries.  Cooling Vests have special cooling crystals incorporated into the material and are soaked in cold water, holding the temperature for a substantial period of time.

Where you choose to go for your holiday may need to be more carefully thought about. It may be better to go on holiday off-season, when it is not too hot.

A hot bath can sometimes bring on MS symptoms very rapidly, as well as leaving you feeling weak. These symptoms tend to go away once the effects of the hot bath have worn off.  A cool bath or shower will be a much better option.

Combating and Treating MS Related Fatigue

We have further information and tips on combating fatigue. We also have information on Amantadine (a drug commonly prescribed by Neurologists to treat MS Fatigue), and Modafinil (the latest drug proving effective in treating MS related Fatigue).

© Multiple Sclerosis Resource Centre (MSRC)