Symptom Management

Primary and Secondary MS Symptoms: Symptoms Causing Symptoms

By Kathleen Costello, MS, CRNP

People with MS often call me to ask about a new or returning symptom. No matter what the problem, their first question is often: “Do you think this is my MS?” Initially, the answer is not always clear. Identifying symptoms and discovering their cause requires a thorough investigation, as well as open communication between the person with MS and their healthcare provider. Some symptoms may be a direct result of multiple sclerosis, some may be a complication of a MS symptom, and some may not be related to MS at all.

Exploring Primary Symptoms

MS is a disease of the central nervous system, which includes the brain and the spinal cord. Everyone who is diagnosed with MS experiences the disease in their own way. Symptoms vary from person to person and even from day to day in each individual. The most common symptoms of MS include:


Numbness or tingling, particularly in the extremities.

• Visual loss or double vision.

• Difficulty with mobility due to muscle weakness or stiffness. 

Bladder and bowel problems.

Impaired balance and coordination.

• Nerve pain.

• Difficulty speaking and swallowing.

Cognitive and emotional changes.

These are considered primary symptoms of MS, meaning they are because of the disease process itself. In MS, areas of the brain and spinal cord become damaged, interrupting nerve transmission and often resulting in one or more of the primary symptoms listed above. It is unlikely that someone will have every symptom on the list and the severity of those that are experienced differs for each person.

As a result of these primary symptoms other health problems can occur. Secondary symptoms are complications of primary symptoms that have the potential to be more troublesome or severe than the problem from which they stem. Although secondary symptoms can develop at any time, they are more likely if primary symptoms are not well managed. 

Primary Symptom: Bladder problems

Secondary Symptom: UTI

Urinary urgency is a very common primary symptom of MS. It can be caused by a bladder that is triggered to empty even if a very small amount of urine is present, or a bladder that overfills and does not empty completely. When the bladder fails to empty, the remaining urine, called residual, can cause an infection. 

The urinary tract infection (UTI) that can result is a secondary symptom or complication of urgency related to urinary retention. UTI symptoms include: pain or pressure over the bladder or in the groin, pain when urinating, increased urgency and frequency, a strong odor to the urine, increased fatigue, fever, and chills. 

Primary Symptom:Weakness and Gait Changes

Secondary Symptom: Back or Hip Pain

Another frequent primary symptom of MS is weakness in one or both legs. When this occurs, people sometimes compensate by walking differently. This is known as a compensatory gait. Walking with a limp, swinging one leg in a circle or hiking up a hip to prevent tripping are all examples of a compensatory gait.

People with compensatory gait sometimes complain of back or hip pain. Their discomfort may likely be because of the change in their walking pattern, and thus is a secondary symptom or complication of weakness in their legs. 

In addition, when weakness occurs, a person may have reduced stamina when standing or walking.  The usual result is less activity, which can cause another secondary symptom known as disuse weakness. Muscles become deconditioned and weaken further. 

Weakness and compensatory gait patterns must be identified early so that appropriate steps can be taken to prevent the secondary symptoms or complications of pain and disuse weakness. An early referral for physical therapy is the best way to improve walking and avoid these problems. 

Primary Symptom: Immobility

Secondary Symptom: Pressure Sores  

Excessive pressure on the back, hips, arms or buttocks can result in a pressure sore.  Pressure sores can become infected and provoke other unwanted symptoms such as increased fatigue, weakness and stiffness. Pressure sores can be prevented with a thorough seating evaluation prior to the purchase of a mobility device and close follow-up once the device is in use so that alterations in seating can be made as needed.

Open Communications Helps Early Diagnosis

Early treatment of primary symptoms is very important both for symptom relief and the prevention of secondary symptoms. Secondary symptoms can be troublesome and can have serious consequences. When new or returning symptoms occur, it is important to report them to your healthcare provider so that they can start helping you manage the problem and prevent complications.

Kathleen Costello is an Adult Nurse Practitioner and MS Program Director at the Maryland Center for Multiple Sclerosis at the University of Maryland Baltimore. She is a board member and MS specialist certification project leader for the Consortium of MS Centers and the co-Chair of the Research Committee of the International Organization of MS Nurses. She often lectures about symptom management at events held for nurses, physicians and people with MS.

(Last reviewed 7/2009)