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Dizziness Upon Standing and MS: Understanding Orthostatic Hypotension

Medically reviewed by Amit M. Shelat, D.O.
Written by Sarah Winfrey
Posted on April 5, 2022

Experiencing Orthostatic Hypotension | Why MS Causes It | Management | Support

If you sometimes feel dizzy when you stand up, you’re not alone. The scientific term for this is orthostatic hypotension, and up to half of people diagnosed with MS experience it at some point. “Hypotension” means low blood pressure — it’s the opposite of hypertension, or high blood pressure. “Orthostatic” means it’s related to standing upright. It’s also known as postural hypotension, or low blood pressure related to the position of your body.

Most of the time, orthostatic hypotension only causes dizziness very briefly, for a few seconds or maybe a few minutes. It may be just a minor inconvenience, but it can also raise the risk for falls, or indicate a serious cardiovascular symptom of MS that requires urgent treatment. Learn more about orthostatic hypotension and when it’s time to talk to your neurologist about dizziness upon standing.

How Do People With MS Experience Orthostatic Hypotension?

MyMSTeam members often discuss their experiences with orthostatic hypotension. “My last major episode was Friday,” wrote one member. “I woke up and got up to go to the bathroom. Somehow, I landed between the toilet and the wall. I have a very bruised hip, a few dings on my elbow, and a big bump on my head.”

These episodes can be (relatively) minor or significant enough to warrant a trip to the hospital. One MyMSTeam member shared how one of their episodes of dizziness escalated. “When the EMTs got here,” they wrote, “they couldn’t find a pulse or read my blood pressure. I was admitted to the hospital, and they found that I had orthostatic hypotension. I was placed on a heart monitor.”

Orthostatic hypotension can interfere with daily life in significant ways and may even be dangerous. Understanding how it is connected to MS and how to manage it can help you keep an eye on this symptom and prevent more serious problems from developing.

Why Does MS Cause Orthostatic Hypotension?

Orthostatic hypotension is one variety of autonomic nervous system dysfunction seen in people with MS. The autonomic nervous system is responsible for controlling automatic bodily functions such as blood pressure, heart rate, and digestion. Other MS-related problems with the autonomic nervous system can include sleep problems, bladder issues, gastrointestinal problems, unwarranted sweating, and cardiovascular issues.

In MS, autoimmune attacks result in demyelination, or damage to the nerves’ protective myelin coating. That damage causes symptoms like neuropathy (numbness and tingling). Some researchers believe that autonomic abnormalities may occur when critical areas of the central nervous system (CNS) — the brain and spinal cord — become demyelinated.

When a person stands up, their blood vessels automatically constrict (tighten). This keeps blood pressure high enough to avoid dizziness, lightheadedness, or syncope (fainting). The vessels of someone with MS and orthostatic hypotension do not constrict properly. This may be due to MS lesions on CNS sites that control blood pressure.

Other Causes

Orthostatic hypotension may occur unrelated to MS, too. Age counts as one risk factor for this particular type of low blood pressure, which appears more commonly in adults 65 years old or more. Some medications — like diuretics, beta blockers, and certain antidepressants — also put a person at risk for orthostatic hypotension. In some people, dizziness upon standing occurs immediately after eating a large meal. That type of dizziness is known as postprandial hypotension.

In people who experience orthostatic hypotension but do not have MS, the condition may be linked to:

  • Parkinson’s disease
  • Thyroid conditions
  • Diabetes or hypoglycemia (low blood glucose)
  • Heart disease (like heart failure or heart attack)
  • Dementia (specifically, Lewy body dementia)
  • Multiple system atrophy

Orthostatic hypotension can also be a sign that you’re badly dehydrated and your blood volume is low. Severe dehydration can occur after prolonged spells of sweating or vomiting.

Managing Orthostatic Hypotension Associated With MS

If you experience orthostatic hypotension for long periods of time, or every time you stand up, you should talk to your neurology expert. They can determine whether this symptom is related to multiple sclerosis and work with you to find the best way of managing it.

There are a number of ways to manage orthostatic hypotension associated with MS. You may need to work with both a neurologist and a cardiologist to determine the best approaches or treatments for you.

Diet and Lifestyle Changes

Some people with MS may be advised to see if lifestyle changes help them manage their orthostatic hypotension. While these will not eliminate the cause of the condition, they may help reduce how often it occurs.

Health care providers may recommend:

  • Drinking more water
  • Eating a diet higher in salt
  • Avoiding alcohol
  • Preventing overheating
  • Uncrossing your legs when sitting
  • Sleeping with your head elevated

All of these can help raise blood volume and ensure proper blood flow when you stand up.

“The cardiologist recommended that I drink at least 64 ounces of water per day and increase my salt intake,” wrote one MyMSTeam member. “I must say that a number of things have improved significantly, and my ‘plumbing’ is working better. I make sure I empty four 20-ounce water bottles per day.”

Another member echoed this, adding, “The cardiologist put me on a ‘high-salt, high-fluid’ diet to keep my blood pressure up. I live on Goldfish crackers, LOL! It has helped a lot, in addition to resting after I eat.”

Compression Garments

Orthostatic hypotension can worsen when blood pools (builds up) in the legs. Special compression stockings help prevent this from occurring and minimize orthostatic hypotension. These are fitted to suit you and help your blood vessels constrict when you stand.

Similarly, medical abdominal binders cinch around the middle of the body and serve the same purpose as compression stockings.

Pacemakers

If your orthostatic hypotension is caused by heart issues, you may need a pacemaker to help treat the issue. These can be installed during a minor surgical procedure and can help your body function properly for many years.

Medication for Orthostatic Hypotension

There are a few medications that can be useful to people diagnosed with orthostatic hypotension. These come with a number of possible side effects and may not combine well with some medications taken for MS. Your doctors will need to work together and coordinate your medications to make sure the combination is both safe and effective for you.

Treat Your MS

Achieving remission from MS may help you stop experiencing dizziness when you stand up. Thus, treating MS with effective disease-modifying therapies (DMTs) might be the best long-term approach for treating your orthostatic hypotension. There are many treatment options available for MS. You and your neurology team will work together cooperatively in a process known as “shared decision making” to decide on your best course of MS treatment.

Find Your Team

On MyMSTeam, the social support network for people with multiple sclerosis and their loved ones, more than 183,000 members come together to share tips and experiences, ask questions, and support each other. You can join and start building your team today.

Do you experience dizziness when you stand up? Have you talked to your doctor about orthostatic hypotension? Share your story in the comments below or by posting on MyMSTeam.

Posted on April 5, 2022
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Amit M. Shelat, D.O. is a fellow of the American Academy of Neurology and the American College of Physicians. Review provided by VeriMed Healthcare Network. Learn more about him here.
Sarah Winfrey is a writer at MyHealthTeam. Learn more about her here.

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