Bladder dysfunction is common and affects many people with neurological conditions. In MS, areas of inflammation, demyelination, scarring or nerve damage in the brain or spinal cord, can affect the way signals travel along the nerves. This can disrupt normal bladder function. This is a symptom that can affect people in many different ways and can be distressing. It can interfere with sleep patterns which can in turn affect fatigue levels. It can restrict social activity and daily living activities.

With advances in bladder management and support from specialist teams, it possible for people with MS to have confidence in carrying out their daily activities. Types of bladder dysfunction include:

• emptying problems where people can experience hesitancy
• incontinence and urgency
• storage problems where people can experience frequency and increased night time urination

If you feel that you are experiencing bladder dysfunction contact your MS nurses who will be able to advise you further or refer you to a specialist bladder nurse or incontinence service.

Another common debilitating problem for people with MS is bowel dysfunction. This refers to the inability to control bowel movements, including problems with the frequency and consistency of bowel movements. This symptom can also be upsetting for people, as well as discomfort and pain it can affect fatigue levels and be a cause of social problems. Specific bowel dysfunction problems common in MS include chronic constipation, incontinence, loss of muscle control or weakness, slow motility, and diarrhoea.

A specialist bladder and bowel service can discuss various treatment options to help with this symptom. This can be in the form of simple advice or medications, to more structured management strategies such as Botox injections, self-catheterising, urodynamic testing, bowel management plans and irrigation. As you can see there are many options to help with these symptoms.

Please contact your MS nurse if you wish to be referred to the local Bladder and Bowel services.

Cognitive dysfunction is one of the hidden symptoms in MS. It can occur at any stage of the disease.

During the course of MS, more than 60% of patients experience cognitive impairment. Unlike other neurological diseases, MS affects specific domains and it can cause attention problems, decreases in information processing speed, it can affect executive function (interfering with activities which require planning and performance of certain sequences, such as cooking) and long term memory. Some people can find that cognitive function can affect their communication as they can experience word finding difficulties, this is when the person knows what they want to say however they have difficulty in finding the right words.

MS Trust - for more details and tricks on how to deal with cognitive dysfunction in MS

Sexual dysfunction can be a problem for both men and women. It can be caused by the MS itself, or the emotional implications coming with the disease.

For men, the most common problems are difficulties in achieving and maintaining erections, decreased sensation in the penis and difficulties achieving ejaculation.

Women could experience decreased sensation in the external genital area and vagina, vaginal dryness, painful sensation.

For information about treatment options and suggestions to improve sexual problems, we recommend the webpages:

• MS Trust - Sexual problems for men with MS
• MS Trust - Sexual problems for women with MS
• National MS Society - Intimacy

MS does not affect fertility. When discussing decisions about disease modifying treatments and symptomatic treatment for MS, family planning needs to be considered.

MS very often causes muscle stiffness, which can be painful and distressing. There is an array of anti-spastic medications, including Baclofen, Gabapentin, Tizanidine, Dantrolene and more recently Sativex, which is included in the NICE guidelines, but CCGs have previously declined funding. We are in the process of challenging this and we will update you accordingly. If spasticity is very severe, other treatment options, such as Botox injections in specific areas or intrathecal Baclofen can be considered.

 If the muscles are weak, spasticity sometimes helps in walking and transfers. Physiotherapists can help recommend stretching exercises and positioning. If you find that you require input from a physiotherapist please contact your MS team.

MS can affect mood. Depression is more common than in the general population. Patients can also suffer from anxiety, sleep disturbance or apathy. These are helped if the patient receives emotional support.

• Lets Talk counselling service for people in the Hull and East Riding.
  Self referral - 01482 247111
• ACT MySelf – An emotional wellbeing tool for people with multiple sclerosis (MS) (Biogen)
• Hull mental health crisis support
• Bereavement support - Hull Hospitals
• Carers support services - CHCP
• MHFA England - Mental health training
• Mind - Mental health charity

Quitting smoking is one of the most beneficial lifestyle changes to patients with MS. Smoking is detrimental to people’s general health. But smoking is also directly linked to MS progression. MS patients who smoke are more likely to have more frequent relapses and to progress from relapsing-remitting MS to secondary progressive MS much more quickly.

Research has shown that smoking affects the function of the immune system, making infections more likely. This can cause deterioration of MS symptoms. For MS patients on Disease Modifying Treatments, smoking is known to reduce the effects of those treatments. This leads to increased relapse rates and disease progression.

There are many benefits to quitting smoking. It can help:

• improve your general health
• make you feel fitter and stronger
• reduce relapses and disease progression
• cognitive ability and brain function
• improve fatigue levels and ability to undertake more physical activity.

There are many ways that help you give up smoking such as various nicotine replacement therapies, group or 1-2-1 support. You can find out further information by clicking the links below or by contacting your GP for advice.

• MS Trust - Smoking
• NHS Smoke Free - Help and support
• MS Society - Smoking and MS

PIP is an extra payment that you can apply for if you have a long term disability or health condition such as Multiple Sclerosis. This can help with the financial costs of everyday living. This benefit is extra to any other income you may receive such as money from employment or benefits. It is awarded regardless of the amount of income or savings a person has. You can apply for PIP if you are aged between 16 and the state pension age.

PIP is not based on the condition itself, it is based on the level of help that you need to be able to complete daily living tasks. The help you get may be from a person, an aid (such as a walking stick or therapy dog) or an adaptation to your home or car. It is split into two parts, a mobility element and a care element. You could consider applying for PIP if you require help in the following areas:

• preparing and cooking food
• eating and drinking
• managing your treatments
• washing and bathing
• managing toilet needs or incontinence
• dressing and undressing
• communicating with other people
• reading and understanding written information
• mixing with others
• making decisions about money
• planning a journey or following a route
• moving around

Apply for PIP on the government website

Further guidance:

• Citizens Advice
• MS Society - Applying for PIP

Hull and East Riding Citizens Advice Bureau (Beverley)

They give drop in and telephone advice including advice on benefits.

• 100 Lairgate, Beverley, HU17 8JQ
• Telephone: 03003 300888
• Email: e-advice@hull-eastridingcab.org.uk
• Drop in advice sessions Tuesday and Friday 10.00am – 4.00pm
• Telephone advice Monday to Friday 9.30am – 4.00pm

Cherry Tree Centre (Beverley)

They give advice including benefits advice. Call to book an appointment.

• 117 Cherry Tree Lane, Beverley, HU17 0AY
• Telephone: 01482 871993
• Email: ctca@ctca.karoo.co.uk
• Cherry Tree Centre website
• Advice service:
  • Monday 9.00am – 12.00pm
  • Tuesday to Thursday 9.00am – 5.00pm
  • Friday 9.00am – 12pm, and 1.00pm – 4.00pm

 Age UK Beverley

The Beverley office provides advice and information and specialises in benefits including support in applying for benefits.

• 16 North Bar Within, Beverley, HU17 8AX
• Telephone: 01482 869181
• Email: info@ageukeastriding.org.uk
• The office is open Mondya to Friday 9.30am – 4.00pm

There are also drop in sessions at East Riding venues, but please ring the office number before attending:

• Goole Clinic
  • Goole Business Centre, Carlisle Street, Goole DN14 5DS
  • Call 01405 767654
  • Open every Tuesday 10.00am - 2.00pm
• Bridlington Clinic
  • Victoria Business Centre, Victoria Road, Bridlington YO15 2BW
  • Call 01262 606677
  • Open every Wednesday and Thursday 10.00am - 3.00pm
• Cottingham Clinic
  • Cottingham Methodist Church, 166 Hallgate, Cottingham HU16 4BD
  • Call 01482 847164
  • Open the first Friday of the month 10.00am - 11.30am

Goole Citizens Advice Bureau

They give drop in and telephone advice

• 80 Pasture Road, Goole, DN14 6HD
• Telephone: 03003 300888
• Drop in sessions, Monday, Wednesday and Friday 9.00am – 4.00pm
• Telephone advice Monday to Friday 9.00am – 4.00pm

Bridlington Citizens Advice Bureau

They give information and advice.

• 5a Prospect Arcade, Bridlington, YO15 2AL
• Telephone: 03003 300888
• Drop in advice Tuesday, Wednesday, Thursday 9.00am – 4.00pm
• Telephone advice Monday to Friday 9.00am – 4.00pm

Hull Advice

Hull Advice is part of Hull City Council’s Customer Service Team. It has a specialist welfare rights team for benefits advice and support including representing people at benefit appeal hearings. Available to Hull residents only.

• 1st Floor, The Wilson Centre, Alfred Gelder Street, Hull, HU1 2AG
• Telephone: 01482 300303
• Hull City Council website
• Drop in and telephone service
  Monday, Tuesday, Thursday, Friday 9.00am – 4.30pm
  Wednesday 11.00am – 4.30pm

Hull Citizens’ Advice Bureau (CAB)

Drop in and telephone advice service

• The Wilson Centre (1st floor), Alfred Gelder Street, Hull, HU1 2AG
• Telephone: 01482 224608
• Telephone advice Monday to Friday 9.00am – 4.00pm
• Drop in
  Monday, Tuesday, Thursday, Friday 9.00am – 4.30pm
  Wednesday 11.00am – 4.30pm

Hull Council of Disabled People

Benefits advice and information officer available.

• 35 – 37 Ferensway, Hull, HU2 8NA
• Telephone: 01482 326140
• Email: hcdp@hcdp.karoo.net
• Hull Council of Disabled People website
• Drop in Mondays 10.00am – 11.30am and 1.00pm – 3.00pm

Age UK Hull

Gives a range of advice and information including benefits advice.

• The Healthy Living Centre, Bradbury House, Porter Street, Hull HU1 2RD
• Telephone: 01482 324644
• Email: mailbox@ageukhull.org.uk
• Monday to Friday 9.00am - 4.00pm

Hull Women’s Centre

Gives a range of advice including benefits – limited opening hours so phone first

• First Floor, Queens Dock Chambers, Queens Dock Avenue, Hull, HU1 3DR
• Telephone: 01482 226806

Carers’ Information and Support Service

• 30 King Edward Street, Hull, HU1 3SS
• Telephone: 01482 222220
• Carers Information and Support Service website
• Telephone support and drop in service Monday to Friday 9.00am – 5.00pm

Scunthorpe Citizens’ Advice Bureau

Gives telephone and drop in information and advice

• 12 Oswald Road, Scunthorpe, DN15 7PT
• Scunthorpe Citizens' Advice Bureau
• Information line: 01724 870941 (10am - 4.00pm)
• Advice line - 03444 111444 (10am - 4.00pm)
• Drop in advice sessions Monday to Friday 9.15am – 12.00pm and 2.00pm – 4.00pm
• Telephone advice Monday to Friday 10.00am – 4.00pm
• Outreaches in Ashby, Barton, Crowle and Westcliffe, but call on the information line above for details.

Age UK - North Lincolnshire

Gives advice and information to over 50s.

• 34a Crosby Road, Scunthorpe, DN15 6SF
• Telephone: 01652 636208
• Email: info@ageuknorthlincs.org.uk

Carers Support Centre

Information and advice for carers.

• Jessie Wilcox House, 11 Redcombe Lane, Brigg, DN20 8AU
• Telephone: 01652 650585
• Email: info@carerssupportcentre.com
• Drop in and telephone Monday to Friday 10.00am – 5.00pm  Also telephone only on Saturday and Sunday 10.00am – 4.00pm

Grimsby, Cleethorpes and District Citizens Advice Bureau

Information and advice.

• 16 Town Hall Street, Grimsby, DN31 1HZ
• Call Adviceline: 03444 111444
• Call Reception: 01472 252500
• Grimsby, Cleethorpes and District Citizens Advice Bureau
• Monday to Friday 10.00am – 4.00pm

Age UK – North East Lincolnshire

Advice and information for over 50s. Phone for information about the advice service.

• 27 Osborne Street, Grimsby, DN31 1EY
• Telephone: 01472 344976

Carers' Support Service

Information and advice for carers.

• The Old Waterworks Offices, 1 Town Hall Square, Grimsby, DN31 1HY
• Telephone: 01472 242277
• Email: info.nel@carerssupportcentre.com
• Telephone service available Monday to Friday 8.00am – 7.00pm
• Saturday and Sunday 10.00am – 2.00pm

• MS Society - The MS Society provides a range of information and leaflets about benefits.
  • Download factsheets - includes:
    • ES09 Benefits and MS
    • BK12 Claiming Employment and Support Allowance (ESA)
    • BK11 Claiming Personal Independence Payments (PIP)
    • ES30/FS Changing from DLA to PIP
• Benefits and Work - The Benefits and Work website offers information and guides to understanding and claiming benefits and tips for filling in application forms.
• Citizens Advice - This website offers a range of information on all benefits
• DIAL (Disability Information Advice Line) provides advice on benefits.
  Freephone: 08088 003333
• Disability Rights UK - gives information on benefits including free factsheets.
• Turn2us - online charity that helps people find the benefits they are eligible for.
  Telephone: 08088 022000
• Advice Now - independent website with information about claiming benefits.
• Jobcentre Plus - has specialised Disability Employment Advisers and Access to Work advisers who can help. Also check local Job Centre Plus centres.
  Telephone: 08456 060234
  Textphone: 08456 055255
• Disability Law Service - gives free, confidential legal advice and support in welfare and benefits.
  The MS Society funds an MS legal officer who provides legal advice.
  Telephone / textphone: 02077 919800
• The government website - offers information and guidance about all benefits:
  • Personal Independence Payment (PIP)
  • Attendance Allowance
  • Employment Support and Allowance (ESA)
  • Carer’s Allowance
  • Department for Work and Pensions telephone: 08457 123456

MS and driving

Multiple Sclerosis is a reportable condition for driving and you will be required to inform the DVLA that you have been diagnosed. This is to ensure that you are safe to drive. You can do this by various methods. It is likely that you will be placed onto a medically restricted driving licence which will need to be verified either every three years or five years by your clinician. When your licence needs to be verified the DVLA will contact the clinician directly by post.

Find out more, and to report your condition:

• Visit: Government website - Multiple Sclerosis and driving
• DVLA Medical Enquiries - Telephone: 03007 906806
  • Monday to Friday 8.00am - 1.00pm and 2.00pm - 7.00pm
  • Saturdays 8.00am - 2.00pm
• By post - please download and fill out MS form CN1
  • All forms must be sent together to this address: Drivers' Medical Group, DVLA, Swansea, SA99 1TU

See also on the government website:

• To use for vision problems - This for is for people who experience vision problems associated with MS such as nystagmus or optic neuritis.
• To surrender driving licence
• Blue Badge - Many people with MS may be entitled to a blue badge to assist them with their mobility and independence, for information about this please click the link below.

For many people falls cause no serious harm other than embarrassment and damage to their pride. However, the consequences of falls can be severe, such as:

• distress
• loss of confidence
• fear of further falls
• injuries
• pain
• loss of independence

There are many reasons why people fall e.g. trip hazards, issues relating to their condition. Below are some of the condition related issues that can cause falls:

• Vision problems – These are common in MS and can cause  you difficulties in focussing
• Mobility and balance issues – You can have weakness, numbness, drop foot, coordination problems or possibly fatigue
• Continence problems - this can be a problem if you are trying to get to the toilet too quickly.
• Cognition – This can include disorientation, confusion, misjudging distances., not fully concentrating or memory problems e.g. tripping over something you have forgotten was there
• Side effects of medication – some side effects of medications cause tiredness or increased fatigue or dizziness.
  Your own GP or MS Nurse can refer you to the Falls Prevention Programme. You may also get advice from your physiotherapist or occupational therapist. They can advise on adaptations to the home and car to help prevent falls.

To find out more visit the NHS choices website – falls