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Spasticity triggers

Identifying and managing trigger factors for spasticity and spasm in multiple sclerosis can help to manage these symptoms effectively.

Why is it important to know about trigger factors?

Muscle stiffness and/or spasms are common symptoms experienced by people with multiple sclerosis. These symptoms can worsen significantly as a result of other influences such as an infection or other changes to your routine. These are called trigger factors (also known as aggravating factors). If the trigger factor is managed appropriately then your symptoms of stiffness and spasm will ease without needing any medication. If the trigger factor is not managed appropriately then this can lead to worsening of your symptoms, unnecessary medication changes or secondary problems such as muscles becoming tighter and shortened. This can be very distressing and can result in worsening of your mobility.

Trigger factor list

Identifying what is triggering these symptoms is usually straightforward, though sometimes it can be difficult to pinpoint what is responsible. The form below has been developed to help identify potential trigger factors and to provide a guide to manage these situations effectively.

Where you identify a change in your normal function or routine, check the Yes option. There is space at the bottom of each section where you can record anything you think might be relevant, either for your own information or to discuss with your healthcare professional.

Once you have completed the list you can email the results to yourself. 

If you have difficulty identifying your trigger factor, you may find it helpful to keep a muscle stiffness and spasm diary.

Bladder

A urinary tract infection is one of the most common causes of worsening of spasms/stiffness and may require antibiotic treatment.

Going to the toilet more often than normal, pain on passing urine or an unpleasant smell from your urine may indicate that you have a urinary tract infection. Take a sample of urine to your GP practice for testing.

If you have a catheter and notice any change in colour or smell from your urine take a sample of urine to your GP for testing. If your catheter is causing pain or is blocking then contact your district nurse.

People with MS who have a urine infection may not have any of the above signs but if your stiffness/spasms has worsened it is always worthwhile taking a urine sample to your GP practice for testing.

Going to the toilet to pass urine but needing to go back again shortly after, or difficulty starting a flow of urine may mean that your bladder isn't emptying properly. This can irritate your bladder and make you more at risk of infection. You need to be referred to a continence specialist nurse for further assessment - your GP can refer you.

Recurrent urinary infection or pain in the lower abdomen may require further investigation. You need to see your GP for further assessment.

Bowel problems

It is very important that your bowels move regularly and freely. A change in your normal bowel routine is one of the most common causes of worsening of spasms or stiffness. If you have more difficulty moving your bowels, or are moving them less often than normal, or your stools are hard and difficult to pass, this can indicate that you are constipated. Contact your GP for further guidance.

Constipation with episodes of diarrhoea may indicate that you are extremely constipated and have a full bowel, known as an impacted bowel. This may need urgent attention and you should see your GP for further management.

Any other bowel problem such as loose stools or irritable bowel syndrome can also impact on your stiffness and spasms. Your GP can help with appropriate treatment.

Skin problems

Anything rubbing on your skin can cause irritation, redness or blistering. Common causes include tight clothing, friction from new footwear or rubbing from a leg splint or urinary catheter. Skin irritation may also occur as a side effect of medication.

It is important that the cause of the irritation is dealt with or you may risk developing an infection or skin breakdown, which can be serious. If you are unable to manage this problem yourself, then see your GP for further advice.

Excessive pressure on the skin affects your circulation and leads to skin damage and breakdown. This can occur if you have difficulty moving and changing position. It is a good idea to check your skin on a daily basis for any signs of damage. Skin damage and breakdown is a very serious problem and needs immediate medical attention from your GP. They can refer you to a tissue viability nurse or you may receive treatment from your district nurse or practice nurse.

Advice on appropriate positioning will be essential and can be provided by your local physiotherapist or occupational therapist. Your GP will be able to refer you.

Loss of weight increases the risk of skin problems. If loss of weight is an issue, your GP can refer you to a dietician.

Any burn to your skin can cause a worsening of your stiffness or spasm. It is important that any burns are properly dealt with or you may risk developing an infection, which can be serious. See your GP who may organise treatment from your district nurse or practice nurse.

Infection

Any infection will aggravate your stiffness and spasms until the infection has settled. Common types of infection are urinary tract infections, chest infections, infections in the mouth or teeth and common illnesses such as a cold, flu or tummy bug. If you suspect you have persisting symptoms due to infection you should see your GP or dentist for appropriate treatment.

Some people can experience a worsening of their symptoms after the flu vaccination. This is generally a short-term effect and symptoms will settle down in time. If you are concerned then you should see your GP for further advice.

Pain and discomfort

If you have difficulty changing your position in lying and sitting you may experience discomfort. This may mean that you have too much pressure on certain parts of your body. If this is causing worsening of your symptoms then contact your local physiotherapist or occupational therapist for further advice.

This should be checked by your GP. They can prescribe appropriate pain medication and refer you for further investigation if required. If you have nerve pain, your GP may refer you to your MS nurse or neurologist for further advice regarding appropriate pain medication.

If you have a new joint or muscle pain contact your local physiotherapy service or ask your GP to refer you.

Other possible trigger factors

If your body is overtired then this can temporarily worsen your symptoms. This may be due to physical tiredness, mental exhaustion or difficulty sleeping. Your symptoms will generally ease as your energy levels improve, but you may benefit from advice from your local physiotherapist or occupational therapist to help you pace your activities and manage your fatigue.

Being too hot or too cold can cause your stiffness and spasms to temporarily worsen. Try to keep your temperature as constant as you can. The spasms and stiffness will ease once you become more comfortable.

If you are feeling stressed or anxious about something, then your symptoms may worsen. Sometimes being aware of your feelings helps but you may benefit from speaking to someone about your issues. Your GP can refer you for counselling if required.

This project has been developed collaboratively between organisations committed to supporting and developing condition-specific specialist nursing in neurological conditions.

Based on the Spasticity triggers booklet written by Jane Lough and Paula Cowan, MS specialist physiotherapists

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