Stephen J. Schueler, M.D.

Overview Incidence Risk Factors Symptoms Evaluation Treatment questions for doctor specialist Home Care catheter care constipation depression taking control warning signs Prevention Outlook Complications Underlying Cause

Multiple Sclerosis Home Care

Home care for multiple sclerosis includes:

  • Drink plenty of liquids.
  • Avoid exposure to hot environments:
    • Multiple sclerosis symptoms often worsen when your body temperature increases.
  • Follow an exercise plan developed with your doctor.
  • Eat a healthy diet:
  • Get plenty of rest
  • Try and get regular sleep
  • Reduce stress and anxiety:
    • Stress can trigger or worsen symptoms of multiple sclerosis.
  • Acetaminophen for pain
  • Nonsteroidal anti-inflammatory medications for pain:
  • Take your prescribed medications as directed:
    • Don't skip doses of your medication. This makes them less effective.
    • Avoid running out of your medication. Refill your prescriptions early.
    • Don't stop taking your medication just because you feel better.
    • If you feel worse, talk to your doctor before you stop your medication.
    • Be aware of the common side effects that may be caused by your medication.
    • Do not stop prescription medications without talking to your doctor.
  • Learn everything you can about multiple sclerosis:
    • The more you know about your condition, the easier it will be to participate with your doctor in making treatment decisions.
    • Ask your doctor about good sources for information.
    • Write down questions to ask your doctor.

Multiple Sclerosis Catheter Care

Some people with multiple sclerosis require a urinary catheter temporarily or for longer periods of time. General care includes:

After Catheter Removal Care

  • Drink plenty of fluids to flush out your urinary system
  • Use pain medications as prescribed by your urologist.
  • Use acetaminophen or ibuprofen for mild pain.

Basic Catheter Care
  • Wash your hands. This helps avoid infection.
  • Gently wash the area (twice a day for men; once a day for women) with soap and water where the catheter enters your body. This may be done in the shower, but not in the bath. Do not take a tub bath while you have a catheter in place.
  • Dry the area gently.
  • Males with a Foley catheter should place a small amount of Bacitracin ointment on a Q-tip and apply it to the tip of the penis where the catheter enters . If you can, do this twice each day. This will help keep the area from becoming infected.

Use of the Leg Bag
If you are up and about, you'll want to use a leg bag to drain your urine. The bag is attached to the end of your catheter and is strapped to your thigh.
Empty your leg bag every 3-4 hours or sooner if it is 1/2-3/4 full.

To empty the bag:
  • Wash your hands.
  • Stand or sit near a toilet or sink
  • Loosen the strap closest to your knee so that the bag hangs over the toilet (or sink).
  • Push lever on the bottom of the bag out and down.
  • Drain the urine.
  • Close the lever.
  • Wash your hands.

Night Drainage Bags
Before you go to sleep at night, you should change your drainage bag to a night bag (see next section). When you aren't using your leg bag, it should be washed out with soap and water and hung up to dry. This should be done once a day.

The night drainage bag is larger than the leg bag and holds more urine. It is designed to hang on the side of a bed or chair, or to be attached to any loose-fitting pants (such as sweat pants). Remember, your urine drains into the bag by gravity, so you need a bag that will be below the level of your bladder. So whenever you are spending a lot of time lying down or sitting still, the night bag will work better. The night bag should always be used at night while you are sleeping.

Using a night drainage bag:
  • Wash your hands.
  • Empty the leg bag as explained above.
  • Pinch off the catheter with your fingers.
  • Disconnect the leg bag.
  • Clean the tip of the night bag with an alcohol swab, and then connect the night bag to the catheter.
  • Tape the catheter to your thigh so that the bag doesn't "pull" on the catheter when you lay down. That is, make sure there is some slack above the tape.
  • Wash your hands.
  • When you get into bed, arrange the tubing so that it does not kink or loop.
  • Hang the night bag on the side of your bed, or place it on the floor. Be sure to keep the bag below the level of your bladder at all times.
  • In the morning, wash your hands and empty the night bag into the toilet.
  • Clean the tip of the leg bag with an alcohol swab.
  • Pinch off the catheter, and re-connect the leg bag.
  • Rinse out the night bag with soap and water, and hang it up to dry.
  • Wash your hands again.

Other Catheter Tips
  • Drink 4-6 glasses of water a day to keep your kidneys and bladder flushed out.
  • You may shower, but do not take a tub bath.
  • You may feel "bladder spasms" while your catheter is in place.
    • This might feel like a cramp or a sudden, strong urge to urinate.
    • You might feel it when you are moving your bowels, which is normal.
    • If spasms are causing a lot of discomfort, let your doctor know.
  • Take any prescribed medications.
  • Keep scheduled appointments.

Multiple Sclerosis Constipation

Home care for constipation in those with multiple sclerosis includes:

  • Avoid foods that seem to give you constipation. Some cheeses, white flour, and white rice can trigger constipation.
  • Avoid straining on the toilet, this can cause hemorrhoids and complicate things further.
  • Don't ignore the urge to move your bowels -- this can throw off your schedule and cause you problems.
  • Drink more water.
  • Eat more fiber.
  • Get regular exercise.
  • Try mild caffeine-containing beverages. These often have a mild laxative effect.

A high fiber diet helps most people with constipation. Fiber works by increasing the amount of stool in your colon (large intestine). The most well known fiber is bran. Common fiber supplements include Citrucel and Metamucil. Regular use of these high-fiber products is safe. They are also more effective when used regularly. Drink plenty of water when taking extra fiber.

General Dietary Guidelines
Fruits, vegetables and whole grains are high in fiber. Check food labels of prepared products to see if there are at least 3 grams of dietary fiber per serving. Look for the term 'whole grain' as a major part of the food.

Raw foods tend to have more fiber than cooked, canned or pureed items. Even chopping and peeling skins removes some fiber. Dried fruits are especially high in fiber. Beans, black-eyed peas, brans and oatmeal are very high in fiber.

Unprocessed wheat bran can be added to many home meals and most baked foods. Bran is the outer layer of the wheat grain, and is present in 'whole grain' foods. Adding 2-3 teaspoons of bran per serving is a great way to increase the fiber content of casseroles, meat loaf, and baked goods. Whole grain flour has 6 times the fiber of standard, bleached flour. Oat bran can be used in place of about 1/3 of regular flour when baking.

Try adding nuts or bran to dairy foods such as yogurt or cottage cheese, which normally have very little fiber. Avoid white bread and flour pasta.

Change your diet slowly and drink plenty of fluids to allow the fiber to do its work. Rapid changes in the diet can cause bloating, gas and diarrhea. A varied, high-fiber diet is much better than taking fiber supplements.

Multiple Sclerosis Depression

Home care for depression in those with multiple sclerosis includes:

  • Avoid alcohol.
  • Do not abuse drugs.
  • Do not stop taking any prescribed antidepressant medications without first discussing it with your doctor.
  • Eat a nutritious and balanced diet. Avoid high sugar foods, and eat more complex carbohydrates.
  • Even if you don't feel up to it, continue daily personal activities such as work, normal meals, and seeing friends and family.
  • Follow a regular exercise plan developed with your doctor.
  • Get plenty of sunshine.
  • Keep appointments with your doctor.
  • Supplement B complex vitamins.
  • Take any prescribed medications as directed.
  • Consider self-care books such as Feeling Good: The New Mood Therapy and The Feeling Good Handbook; written by Stanford University psychiatrist Dr. David Burns.

Multiple Sclerosis Taking Control

The successful treatment of multiple sclerosis requires your participation. Here are answers to some important questions.

Do you have control over your health and wellness?
Many people believe they have no control over their health and wellness. Many ignore personal health decisions or simply leave them to their doctors, relatives, or friends. In reality, you have the greatest potential to determine your relative health.

How is this possible? Do people really have control of their own health? The biggest killers are heart disease and cancer. Although many of these diseases seem to strike at random, our lifestyle choices greatly influence personal risk.

How can you participate in your health care?
To participate you must:

  • Learn to take responsibility for your own health.
  • Learn to partner with your doctor.
  • Learn how to make active decisions about your health.

How can you learn what you need to know?
  • Educate yourself.
  • Be skeptical: Learn to separate fact from fiction.
  • Billions of dollars are spent each year marketing dietary supplements, vitamins, and new medical treatments. Much of this is unnecessary and wasteful.
  • Be careful about where you get your health information.
    • Some of the best sources for health information on the web are professional societies and non-profit organizations.
    • Ask your doctor what he or she recommends.
  • Examine the credentials of the authors.
    • If you are reading about symptoms and disease, your best source is a licensed physician.
    • Pay attention to when the content was last updated.
    • Make sure the person is not just trying to sell you something.

Important questions you need to answer:
  • What things in your control can increase your risk for disease?
  • What can you do to decrease this risk?
  • What are vaccines and how can they help you?
  • How do your lifestyle choices increase your risk for disease?
  • How can you reduce stress?
  • What minor health problems can you treat at home?
  • When is a medical problem "serious"?
  • When should you call the doctor?

How can you find the right doctor?
Key points:
  • Everyone should have a primary care physician or family doctor. A primary physician is usually a family practitioner, internist, or pediatrician.
  • Establish a relationship in advance with your doctor.
  • Make sure you are comfortable with your primary care physician.
  • The internet contains many resources where you can do research to locate the doctor that is best for you.
  • You may wish to schedule a brief visit with the doctor to see if he or she is right for you.
    • Be open-minded, and allow your doctor to know you well. This will improve communication.

Important information you need to make your decision:
  • Physician credentials:
    • Internship and residency training is usually best from respected institutions, universities, and major hospitals.
    • Look for board certification in the specialty.
    • Ask about membership in medical societies.
  • Community and professional reputation are also important.
    • Are other patients happy with the doctor?
    • Has the doctor been disciplined by hospitals or agencies?
    • How long has the doctor been in practice?
    • In general, more than a few malpractice suits over a 5-10 year period should trigger caution.
  • Does the doctor communicate well? Are your questions answered during busy times?
  • Does the doctor welcome you to help make decisions about your care?
  • Is the doctor available when you need care?
  • What is the doctor's after-hours coverage?
  • Is he or she a member of a large group?
    • Do the doctors' cross-cover one another?
  • Where do they admit patients?

What is shared decision making?
You and your doctor must work together to jointly decide the best course of action to manage your health. This process is called "shared decision making". Your doctor becomes a guide and teacher and helps steer you toward the best treatment. Most doctors welcome this partnership. You must learn about your illnesses for shared decision-making to work.

For any recommended test, medication, or surgery, remember to ask:
  • How will this help me?
  • How much will it cost?
  • Is it covered by your insurance?
  • What are the potential side effects and risks?
  • What are my alternatives?

For tests, remember to ask:
  • Is it done in the office or at another facility?
  • Is it painful?
  • How will the results of this test influence my care?

For surgery or other procedures, remember to ask:
  • How long will it take to heal?
  • How many cases has the doctor done?
  • What would your doctor do if he or she were the patient?
  • Where is it done?
  • Who will perform it?
  • What are the doctor's qualifications?

What should you expect?
Shared decision making becomes impossible if you do not know what to expect from your doctor.

The American Hospital Association has published a "Patient's Bill of Rights" that is a good guide. It states that you have the right:
  • To be spoken to in words that you understand
  • To be told what's wrong with you
  • To know the benefits of any treatment and any alternatives
  • To know what a treatment or test will cost
  • To share in treatment decisions
  • To read your medical record
  • To refuse any medical procedure

What should you do before an office visit?
  • Bring all important medical information with you to the visit.
  • Make sure you can answer questions about the following:
    • Allergies and side effects to medicines
    • Current medicines you are taking. This includes herbs and vitamins. Make a list if necessary.
    • Insurance information
    • Marital and sexual history
    • Past injuries and hospital stays
    • Past medical problems
    • Past surgeries and operations
    • Pre-visit questionnaires
    • Use of tobacco, alcohol and drugs
    • Work history

What should you expect from the visit?
  • You should plan to wait if you go without an appointment. Emergencies or sick patients in the hospital may interrupt your doctor.
  • Bring along a book or toys for the kids. You may also have to wait during busy times.
  • Tell your doctor about your problem in a clear manner. Start from the beginning and go through each symptom as it appeared.
  • Before the visit, think about what makes your problem better or worse. Your doctor will probably ask you questions about this.
  • Most doctors ask many questions about unrelated symptoms. These questions help assure that there are no other problems that need attention.
  • Be sure to answer all questions truthfully. This includes sensitive questions about smoking, drug use, sexual activity, and work. Your history is the most important part of deciding what is wrong with you.
  • If you have any difficulty communicating your concerns, bring a family member or friend to assist in this task.
  • Talk to your doctor and do not leave the office without asking necessary questions. Your doctor can make you more comfortable if he or she understands your concerns.

What should you know about your medications?
Every year many people become ill because of problems with medications.

Remember to ask:
  • What side effects to expect.
  • What drug interactions are possible.
    • Find out if a new medicine reacts with those that you are taking now.
    • Many over-the-counter drugs and dietary supplements can also cause serious side effects and drug interactions.
    • Some drugs interact with certain foods, vitamins, nicotine, and alcohol.
  • Make sure you can drive or operate machines safely while taking a medicine.
  • Ask your doctor how much a prescription costs.
    • Is there a less expensive option or a generic version?

What is a treatment plan?
A treatment plan is what you and your doctor decide to do for an illness. A treatment plan cannot be effective without your participation.

Three simple questions can help you get the most from your treatment plan:
  • What is my main problem?
  • What do I need to do?
  • Why is it important for me to do these things?

Other important points:
  • Be sure you understand your treatment plan.
  • Stick with the treatment plan and allow time for improvement.
  • Don't stop medicines when you feel better; check with your doctor first.
  • Call your doctor if your condition is becoming worse.
  • Your doctor should tell you what to expect and when to follow-up or call the office.

Multiple Sclerosis Warning Signs

Notify your doctor if you have multiple sclerosis and you develop any of the following:

Continue to Multiple Sclerosis Prevention

Last Updated: Mar 15, 2011 References
Authors: Stephen J. Schueler, MD; John H. Beckett, MD; D. Scott Gettings, MD
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PubMed Multiple Sclerosis References
  1. Filippini G, Munari L, Incorvaia B, Ebers GC, Polman C, D'Amico R, Rice GP. Interferons in relapsing remitting multiple sclerosis: a systematic review. Lancet. 2003 Feb 15;361(9357):545-52. [12598138]
  2. Kahana E. Epidemiologic studies of multiple sclerosis: a review. Biomed Pharmacother. 2000 Mar;54(2):100-2. [10759294]
  3. Poser CM, Brinar VV. Diagnostic criteria for multiple sclerosis: an historical review. Clin Neurol Neurosurg. 2004 Jun;106(3):147-58. [15177763]
  4. Sorensen PS. Treatment of multiple sclerosis with intravenous immunoglobulin: review of clinical trials. Neurol Sci. 2003 Oct;24 Suppl 4:S227-30. [14598048]
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