Fatigue and fluid hydration status in multiple sclerosis: A hypothesis

Mult Scler. 2016 Oct;22(11):1438-1443. doi: 10.1177/1352458516663854. Epub 2016 Aug 19.


Background: Fatigue is a prevalent and functionally disabling symptom for individuals living with multiple sclerosis (MS) which is poorly understood and multifactorial in etiology. Bladder dysfunction is another common MS symptom which limits social engagement and quality of life. To manage bladder issues, individuals with MS tend to limit their fluid intake, which may contribute to a low-hydration (LoH) state and fatigue.

Objective: To evaluate the relationship between patient-reported MS fatigue, bladder dysfunction, and hydration status.

Methods: We performed a prospective cross-sectional study in 50 women with MS. Participants submitted a random urine sample and completed several fatigue-related surveys. Using a urine specific gravity (USG) threshold of 1.015, we classified MS subjects into two groups: high-hydration (HiH) and LoH states.

Results: LoH status was more common in MS subjects with bladder dysfunction. Statistically significant differences in self-reported Fatigue Performance Scale were observed between HiH and LoH subjects (p = 0.022). USG was significantly correlated with fatigue as measured by the MS Fatigue Severity Scale (FSS) score (r = 0.328, p = 0.020).

Conclusion: Hydration status correlates with self-reported fatigue, with lower fatigue scores found in those with HiH status (USG < 1.015).

Keywords: Multiple sclerosis; bladder control scale; dehydration; fatigue; fatigue severity scale; lifestyle; modified fatigue impact scale.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cross-Sectional Studies
  • Dehydration / epidemiology
  • Dehydration / physiopathology*
  • Drinking Behavior
  • Fatigue
  • Female
  • Humans
  • Middle Aged
  • Multiple Sclerosis / epidemiology
  • Multiple Sclerosis / physiopathology*
  • Prospective Studies
  • Severity of Illness Index
  • Urinary Bladder, Neurogenic / epidemiology
  • Urinary Bladder, Neurogenic / physiopathology*
  • Urinary Incontinence / epidemiology
  • Urinary Incontinence / physiopathology
  • Water-Electrolyte Balance*