Can you have MS without bladder problems or numbness

[jenniferk86]

My question is, I know that most people that have ms can have bladder and bowel problems as well as numbness and or weakness in the limbs.  Can you have MS without these symptoms?

As far as MS symptoms, I have severe fatigue. I have blurry vision intermittently out of my left eye for a couple of months, recent balance problems, becoming clumsy and dropping things, very bad memory and concentration problems, severe joint and muscle pain especially in my low back, and hips and now my right leg, no numbness or bladder problems though, I have also been having a continuous dull type of headache for about 2 weeks now.  The rest of my symptoms have been going on for about 10 months now.

My doctor wants to test me for MS, but I am not sure that I have enough symptoms of MS to worry, can you have ms without all those symptoms? is it a possibility that I have ms?  I am 25 years old.

[COBOB]

Urine retention (failure to empty)  can be a symptom.  60% of PwMS having bladder symptoms. Failure to store is the most common.  Some PwMS have both failure to store and failure to empty at the same time.   You should mention this to your doctor.  

There are some tests that can be done to see if this is the problem.   There are also some techniques that you can learn that might help.

Bob

[jenniferk86]

When we talk about bladder problems, I do have to get up 2 or three times at night to go pee, and when I pee sometimes it feels like I still have to pee even after I empty my bladder, is this a symptom or is this normal bladder function?

[jenniferk86]

Thank you, that gives me reassurance I.have read about the addicts and usually they are taking 30 and upwards pills a day. I just ain't want to every be one of them I know addiction of a serious struggle.

[Sumanadevii]

I, too, need narcotics and without them I also would not be able to function.  My neurologist has assured me that people using narcotics for pain do not become addicted to the drugs like those that use for recreation.  Unfortunately so many abuse them that doctors hesitate to prescribe them for those of us that need them.  

I would be honest with my doctor.  I doubt he will judge you for being frank.  What you want to avoid is taking more than is prescribed without permission.  So, before it gets out of hand it is best to let him know.  I also do not think it is unusual that eventually our bodies become used to the medication and a higher dose is needed or a new medication is needed.

I take Percocet 5/325 four or five times per day.  My neurologist is adding a low dose pain patch.  I have used one but a higher dose.  I am hoping that this one will not be too strong.  I wish you the best in speaking with you doctor.

[jenniferk86]

No, No, I need narcotics to function, I would not be able to do anything without them, I am asking if there is an alternative, I am afraid to get addicted to something ... I dont have an addictive personality, but I am on percocet 7.5/325 3 times a day.. Sometimes I only take it twice a day because I am afraid I wont have enough when the pain gets really bad.  i probably need a little more but, I dont want to increase dose or make my doctor think I am addicted, its just the pain wakes me up at night sometimes and he prescribes me 90 per month, which on my ok days, that is more than enough, but on the bad days, i would have to take as many as 5... most the time it evens out but I am unnecessarily in pain because I am afraid if I take too many that day, that I will run out and that would be god awful...

[Sumanadevii]

If you don't want to be treated wtih narcotics, all you have to do is let your doctor know.  There isn't a doctor out there that would force narcotics on you.  In fact, most prefer not to prescribe them.

[jenniferk86]

I have normal but on the low end of hypoparathyroidism, definitely not that... Thanks for the idea though

[COBOB]

By the way, with TSH and T4 falling, have they checked to see if you might have hypoparathyroidism?  

Bob

[COBOB]

I'd say you need a new doctor.  Again, just my opinion.  In medical terms, any abnormal sensation is a paraesthesia.  With neuropathic pain, anti-seizure (Keppra, Tegritol, etc.) or GABA (gabapentin, pregabalin) drugs may be more effective  than opiates.  The long explanation of "why" follows.

The concepts of nociceptive vs. neuropathic pain and what drugs work for which is pretty complicated.  I'll try and answer this without putting anyone to sleep.

There is "somatogenic" (Body) pain and psychogenic (Mind) pain. Somatogenic pain is divided into "nociceptive" (a special sense trying to prevent damage to the body) and "neuropathic" (lesion or disease affecting the somatosensory system).

So nociceptive pain come from burns, broken bones, a punch to the face, etc.  The body "feels pain" to tell you that there is a "risk of damage," so don't do that.  Narcotics bind to opiate receptors in the midbrain and "tone down the pain signal"  from the nociceptors in the peripheral nervous system."

Neuropathic pain is pain arising out of the central or peripheral nervous system.  When the pain arises out of the peripheral nervous system (like whacking your "funny bone",) narcotics may provide some relief since the signal travels to the brain using sensory afferent nerves up through the midbrain.  There are other types of neuropathic pain that are generated in the brain or CNS due to lesions that don't travel through the midbrain so opiates have a very limited effect on the pain.

In the cases of pain not relieved by opiates, anti-seizure (Keppra, Tegritol, etc.) or GABA (gabapentin, pregabalin, etc) medication are used to alter the way nerves conduct the impulses.  What the drugs attempt to do is raise the voltage threshold (gating potential) required for specific ion channels in the nerve to conduct.  This can reduce the "electrical storm" that causes seizures and reduce the signals getting through that cause neuropathic pain.

Hope that is not overload.

Bob

[jenniferk86]

oh, and I have cold and tingly sensations all the time, just no numbness, I didnt think that was parasthesias, my dr. didn't seem to think so... that is interesting.

[jenniferk86]

Thank you.... Is there any treatments for the pain besides narcotics?  That is if they exclude everything else, which at this point is pretty close.. either that or fibromyalgia.... that is what fibromyalgia is as well, a diagnosis of exclusions... if I am diagnosed as probable ms, will insurance cover treatments for that or only if it is definitive ms?  sorry for all the questions, I have just been going through so much and I need to find out answers before I go insane....

[COBOB]

Yes.  Paraesthesias (numbness, tingling, burning,wetness, cold...any abnormal sensation) is common, but there are PwMS that do not have them as a symptom.  The same goes for bladder and urinary issues.  I was diagnosed with just sensory symptoms (mainly Optic Neuritis and Trigeminal Neuralgia.  The motor symptoms have developed since my diagnosis.

Some PwMS have more motor symptoms and others have more sensory symptoms.  My symptoms have mainly been sensory until recently.  I was diagnosed with just sensory symptoms as my "attacks."   The "tests for MS" is a bit of a misnomer.  You can do an MRi to look for demyelination, you can do a VEP to look for conduction defects in the optic nerves, you can do a Lumbar Puncture to see if there are OC Bands or IgG synthesis.  These are all signs that can support a diagnosis of MS.

MS is a diagnosis of exclusion.  You have to rule out everything else, and in the end, if MS is the only thing left, that is the diagnosis.  The tests help "limit the field of possible diagnoses."
So if you have MRI T2 hyperintensities, and you have OC Bands in your CSF and you and negative for HIV, Syphilis, CMV, etc.  and you have had two attacks in different neurologic domains separated by more than 30 days, the probability of MS goes up.  There is no single test of group of tests for MS.  A definitive diagnosis can only come from the biopsy of a lesion and this is might only be done postmortem.  

It is not unusual to have a diagnosis that is "coded as ICD-9-CM: 340 Multiple Sclerosis, but in your Medical Record you may see: Probable Multiple Sclerosis.  

Bob