Navigating Flares and Daily Symptoms

Living with Relapsing-Remitting Multiple Sclerosis (RRMS) involves managing two different types of challenges: the sudden “storms” of relapses and the “background noise” of daily symptoms. Understanding how to distinguish between these and knowing the tools available for each can help you feel more in control of your health ^[1][2].

Is it a True Relapse?

A relapse (also called a flare, attack, or exacerbation) is a clear sign of new inflammatory activity in your central nervous system. To be considered a “true” relapse, the symptoms must meet specific criteria ^[1]:

1. New or Worsening: You experience new neurological symptoms (like vision loss or limb weakness) or a significant worsening of old ones.
2. Duration: The symptoms must last continuously for at least 24 hours.
3. No Infection/Fever: The symptoms must occur without an underlying fever or active infection.
4. Stability: They must begin at least 30 days after the onset of your previous relapse.

Because infections, strokes, or severe migraines can mimic MS flares, contact your MS team promptly for evaluation rather than trying to classify a relapse alone.

The “Pseudorelapse”

It is common for old MS symptoms to temporarily “re-awaken” or feel worse during times of physical stress. This is known as a pseudorelapse. It is not caused by new damage to your nerves, but rather by the body’s temporary inability to conduct signals efficiently through old areas of scarring ^[3]. Common triggers include:

• Fever or infections (even a minor cold or UTI) ^[1].
• Heat exposure (Uhthoff’s phenomenon).
• High stress, overexertion, or poor sleep.

Once the trigger is addressed—for example, once a fever breaks or you cool down—pseudorelapse symptoms typically fade away ^[1]. Do not try to self-treat a pseudorelapse with leftover steroids.

Treating Acute Relapses

If a relapse is “functionally significant”—meaning it affects your vision, balance, or ability to work—your doctor may recommend treatment to speed up recovery ^[3].

• Corticosteroids: The standard treatment is high-dose methylprednisolone. This can be given through an IV or as equivalent high-dose oral pills (standard low-dose oral steroids are not equivalent); studies show that the high-dose oral and IV versions are comparable for most people ^[4][5]. While steroids help you recover faster from the immediate attack, they do not change your long-term underlying disability outcome ^[3].
• Plasma Exchange (Plasmapheresis): If a severe relapse does not respond to steroids, your doctor may suggest plasma exchange. This specialized procedure filters your blood to remove inflammatory proteins. It carries procedure-related risks and is an escalation option for severe, refractory attacks ^[6][7].

Managing Daily Symptoms

Many people with RRMS experience lingering symptoms even when they are in “remission.” These are managed through a combination of lifestyle changes, therapy, and medication.

Fatigue

MS fatigue is more than just feeling tired; it is an overwhelming sense of exhaustion that isn’t always fixed by sleep. Management should be individualized:

• Physical Strategy: While some people benefit from aerobic or resistance training, others require strict energy conservation. Working with an MS-trained physical or occupational therapist ensures your routine is safe and accounts for heat sensitivity and balance ^[8].
• Behavioral Strategy: Cognitive Behavioral Therapy (CBT) and mindfulness-based interventions can help you manage the mental toll of fatigue, address sleep problems, and improve daily functioning ^[9].

Spasticity

Spasticity is a feeling of stiffness or involuntary muscle spasms.

• Management: Stretching and physical therapy are the first lines of defense. Medications like baclofen or tizanidine are commonly used to relax the muscles ^[10]. For severe cases that don’t respond to standard pills, specialized options (like an add-on THC:CBD spray, where legally available) may be considered, though these come with cautions regarding sedation and driving ^[10].

Bladder and Bowel Health

MS can disrupt the signals between your brain and your bladder or bowels.

• Urological Assessment: If you experience urgency, frequency, or “accidents,” it is important to see a urologist. They may check your post-void residual (PVR)—a simple ultrasound to see if your bladder is emptying completely ^[11][12].
• Interventions: Management may include pelvic-floor muscle training, medications like mirabegron, or clean intermittent catheterization (CIC) if the bladder is not emptying properly ^[13][14][15].
• Bowel Health: For constipation or fecal incontinence, a consistent bowel regimen and lifestyle adjustments are the starting points ^[16].

Remember, you do not have to “just live with” these symptoms. Each one has a specific management strategy designed to help you maintain your independence and quality of life.