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Fatigue is an invisible symptom of MS and for some can be the most debilitating part of the disease. Unlike the tiredness experienced after a day’s hard work it has certain characteristics. It is more like an unexplained - overwhelming sense of tiredness that appears without reason that sweeps through the body.

Fatigue is one of the common ms symptoms making it unimaginably difficult to even meet one's basic needs, this ms symptom is usually the product of several factors and it is important to address these issues as part of managing the problem.

Understanding the problem.

Fatigue is:

Affected by heat and humidity.
Present in the morning, even after a good night’s sleep.
More severe than normal fatigue.
Occurring daily. heat
Suddenly occurring, sweeping over the body as a wave of tiredness.
Worsens as the day progresses.

Other related symptoms may occur:

A feeling of heaviness in the arms and legs
Depression
Difficulty concentrating
Feeling ill with flu like symptoms
Headaches
Vertigo or dizziness
Worsening of other symptoms

Maintaining a diary of symptoms will help in understanding and managing the problem. A diary will also help the clinician understand the individual problems being experienced by the MS person.

Fatigue in MS is caused by many factors, which may be grouped into those causing primary fatigue and secondary fatigue. [1]

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Primary fatigue - the result of the disease process itself:

Lassitude - an overwhelming tiredness that is not directly related to increased activity.
Heat sensitivity - fatigue comes from the heat intolerance many with MS experience .
Localised - fatigue, where nerves of individual muscle groups tire with use.

Secondary fatigue - a result of symptoms or trying to compensate for them:

Sleep disturbances - due to spasms
Depression. (It is common for people to experience anxiety or depression when diagnosed with MS, for some, these feelings may become easier to manage as they come to terms with what is happening to them, however that is easier said than done).
Anxiety.
Pain.
The frequent need to urinate at night (nocturia)

Other Causes:

Exertion - causes fatigue in people with MS as they compensate for symptoms such as spasticity or muscle-weakness.
Medications - may cause fatigue as a side effect (as in all cases of medication discuss this with your clinician).
Depression - can cause MS people to feel overwhelmingly tired.
Lack of proper nutrition - causes swings in blood sugar levels as well as nutrient deficiency, leading to general tiredness.
Infections - colds, flu or urinary tract infections .
Lack of physical fitness - will greatly contribute to fatigue. (Difficult to compensate for - exercise may cause fatigue and heat tolerance problems .
Pilates or Yoga may be helpful as well as taking steps to keep cool when exercising. [1]

There are those who can assist in the management of fatigue experienced when suffering from the disease :

Health professionals
Social care professionals
Clinicians (medication ~ drugs)
Physiotherapists
Rehabilitation centres
Complementary / Alternative therapists

None of the available help will benefit the individual sufferer unless they grasp the importance of self-management, there is no set pattern of fatigue which will provide indicators to enable the development a set of guidelines for MS people to follow. (Every person is different, therefore they require a personal management plan). [1]

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Denial.

Some people may initially go into denial when they are first diagnosed, it is not uncommon – this may cause them, and others to be unable to understand the problems surrounding their fatigue patterns. [2]

Self Report.

Identifying the intensity and frequency of fatigue is crucial for the application of palliative therapy. Fatigue may be regarded as a multidimensional phenomenon, and measurements are based upon self report. Palliative and supportive care extends to all chronic diseases and fatigue affects not only patients but carer's as well.

To enable the person to have a greater understanding and ability to manage their fatigue and at the same time enabling others (clinicians and health professionals) to understand their fatigue problems a record of how and what symptoms they are experiencing and the level of intensity, (scale 1-10), during fatigue periods may be of help.

Bladder Control (1- 10)
Bowel Control (1- 10)
Muscle Weakness (1- 10)
Heat Intolerance (1- 10)
Cold Intolerance (1- 10)
Balance - Falling (1- 10)
Coordination (1- 10)
Foot Drop (1- 10)
Use of Legs (1- 10)
Use of Hands (1- 10)
Speech (1- 10)
Swallowing - Choking (1- 10)
Breathing (1- 10)
Visual Disturbance - blurred - tracking etc (1- 10)
Sound - deafness - hypersensative (1- 10)
Pain (1- 10)
MS Hug.
Convulsive spasms (1- 10)
Rigid - stiff muscles (1- 10)
Cognitive ability - confusion - reasoning. (1- 10)

[2]

Medications for MS-related fatigue:

Medications prescribed for MS producing fatigue as a side effect:

Other potential factors:

Anaemia - a shortage of Haemoglobin in the blood. Haemoglobin (found in red blood cells) is the chemical that carries oxygen around the body, as red blood cells circulate throughout the body they carry oxygen to all the cells to give energy.

If the number of red blood cells are low, they cannot carry enough hemoglobin around the body, therefore insufficent oxygen reaches the cells. Anemia is a common cause of fatigue. People who have Anaemia may also find that they; are breathless - feel dizzy and light-headed - have difficulty sleeping -have aching in the muscle and joints - have a worsening of angina (chest pain due to heart problems). A simple blood test will determine if aneamia is a problem. (It is not always a lack of iron that causes anemia).

Dehydration - it cannot be over emphasised how important it is to ensure that you are not dehydrated – dehydration, is loss of water and important blood salts such as potassium and sodium, vital organs such as the kidneys, brain, and heart require a certain minimum of water and salt. When compromised the drop in their efficiency contributes to the fatigue pattern. Water (H2 0)

Malnutrition you may not be getting enough energy from your food – loss of appetite may occur if depression and anxiety has become a problem. As you eat less you will feel weak and tired. Loss of appetite due to disease will mean that you have much less energy in reserve, all this adds to the fatigue pattern. Small, frequent, simple meals can be more benificial than large plates of rich food. Foodstuffs Digestion & Absorbtion

Malabsorbtion leading to malnutrition may also be caused by factors outside of the disease itself.