Multiple sclerosis (MS) is an unpredictable disease that may progress over time. Although new treatments are helping to slow down progression of the disease, MS does become advanced for some people. Advanced MS is more likely to cause complications. But even if complications do arise, there are strategies for managing them. MS complications are different from MS symptoms. Symptoms can include fatigue, numbness, tingling, trouble walking, visual problems, spasticity, changes in bladder or bowel function, and trouble with memory and concentration. Complications are the problems that result from MS symptoms. For example, one of your MS symptoms may be trouble emptying your bladder completely. This could put you at risk for developing an MS complication like urinary tract infection. 1. Urinary Tract Infections (UTIs) Urinary symptoms of MS can occur because of disrupted nerve signals to the muscles that control the opening and closing of the bladder. Symptoms can include frequent urination, inability to hold urine, and incomplete emptying of the bladder. Poor bladder control, leading to urinary incontinence can also occur. Incontinence is an involuntary loss of urine and it can be stressful and embarrassing. Urine that stays in the bladder too long can lead to urinary tract infections (UTIs). These infections can spread to the kidneys, causing pain and fever. These strategies can help prevent UTIs: Avoid caffeinated drinks. Drink six to eight glasses of water a day. Plan bathroom trips every two to four hours to help train your bladder. Work with your doctor to find medications that help prevent bladder complications. Use a catheter tube to drain the bladder if necessary. 2. Osteoporosis If you've become inactive because of advanced MS, you run the risk of developing osteoporosis. Lack of weight-bearing exercise can cause your bones to lose density. Eventually your bones could become so weak that they break. Steroid medications sometimes used to treat MS may also add to this risk. These strategies can help preserve healthy bones: Get tested for osteoporosis with a low-exposure X-ray study, known as a DEXA (dual-energy X-ray absorptiometry) scan. Limit alcohol, increase weight-bearing activity, don't smoke, and avoid exposure to secondhand smoke. Talk with your doctor about your vitamin D and calcium needs and whether you might need medications that increase bone density. 3. Pressure Sores If advanced MS is causing you to spend too much time sitting or lying down, your skin can start to break down, leading to pressure ulcers or bedsores. These sores occur because constant pressure decreases blood flow to the skin and other tissues. The sore may start as a discolored area of skin and progress to an open ulcer. Common areas for sores are the shoulder blades, buttocks, and heels. These strategies can help protect your skin: Drink plenty of fluids and eat a healthy diet. Get as much exercise as you can. Move frequently on your own or with assistance. Use special mattresses or cushions. Use special dressings and treatments if you develop any sores. 4. Aspiration Pneumonia If advanced MS makes it hard for you to swallow, you may be at risk for having food or liquid spill into your lungs. This is aspiration, and it puts you at risk for developing an infection or irritation called aspiration pneumonia. This MS complication can cause choking, coughing, infection, and difficulty breathing. These strategies can help with swallowing: Change foods and positions while eating. Get an evaluation from a speech-language pathologist. Use exercises to strengthen swallowing muscles. Talk with your doctor about a feeding tube if necessary. 5. Depression Depression is more common among people with MS, even those who have less severe MS. One reason for this is the stress of living with a chronic and unpredictable disease. MS may also have a direct effect on brain chemistry that leads to depression. Some medications used for MS may add to the risk. These strategies may help you recognize and manage depression: Know the symptoms of depression—sadness, irritability, loss of interest in activities, changes in sleep and appetite, feelings of hopelessness, and thoughts of death or suicide. Let your doctor know if you have any symptoms of depression. Treat depression with medicines, talk therapy, or combination therapy. Becoming familiar with complications of MS can help you recognize them. Working closely with your doctor to get your MS symptoms under control is the best way to prevent complications. Even with the best treatment, complications can still happen. Remember that there are always options for managing them. Key Takeaways MS is an unpredictable disease that may become advanced. Common complications include osteoporosis, urinary tract infections, pressure sores, aspiration pneumonia, and depression. MS treatment can prevent many complications. Over time, your doctor may recommend adjustments to your treatment regimen to improve MS symptom control. When complications do occur, many management options are available. Your health care team is familiar with these setbacks, and has strategies that will improve your quality of life.