There are many different symptoms of multiple sclerosis (MS), not to mention possible side effects from disease-modifying therapies used to treat the condition. Sometimes, it’s hard to know whether what you’re feeling is due to MS, a treatment, or another health issue that might need medical attention.

One example is a common symptom called the MS hug, which can sometimes be mistaken for potentially serious gallbladder problems. Gallbladder issues may cause pain or a tingling feeling in some people. This article explains how gallbladder problems differ from the MS hug and how to tell them apart.

What Is the Gallbladder?

In order to understand why you may feel pain and tingling in your gallbladder (such as a pins-and-needles sensation), it’s important to know what the gallbladder is, how it works, and what happens when it stops working correctly.

The gallbladder is a small organ that sits under your liver, just below your rib cage on the top right side of your belly. Its main job is to store and release bile.

Bile is a greenish-yellow liquid that helps break down the fats that you eat. Your liver makes bile, and your gallbladder stores and releases it into your small intestine after meals — especially those high in fats.

What Causes Gallbladder Problems?

The most common gallbladder problem is gallstones. Gallstones form when the components of bile are out of balance, especially when there’s too much cholesterol. Autoimmune conditions, which can be hereditary, can also cause gallstones. Because gallstones don’t cause symptoms, many people don’t know that they have them.

Sometimes, gallstones grow large or get stuck in the biliary ducts — the tubes that carry bile to the small intestine. The gallbladder then squeezes and spasms to push out the bile, causing a painful gallbladder attack (also called biliary colic). These attacks usually happen after eating a large or fatty meal.

Gallstones can also cause the gallbladder to become inflamed, a condition called cholecystitis. Less common causes of cholecystitis include tumors, infection, and certain diseases — but gallstones are the most frequent culprit. Cholecystitis symptoms are similar to those of a gallbladder attack, but they tend to be more intense and last longer.

What Are the Symptoms of Gallbladder Problems?

Pain is the most common symptom of gallbladder problems. It’s usually sharp and felt just under the ribs on the right side or toward the center. The pain can sometimes radiate to the upper back or right shoulder. It can sometimes make breathing difficult. If you’ve ever wondered, “Can the gallbladder cause numbness and tingling?” you may be interested to know that some people do report experiencing a tingling sensation.

Other possible symptoms of gallbladder issues include:

• Nausea
• Fever
• Bloating
• Dark urine
• Pale or clay-colored stools
• Jaundice (yellowing of the skin or eyes)

Are There Warning Signs Before a Gallbladder Attack?

Gallbladder symptoms usually appear quickly, with little or no warning. Sometimes, certain foods trigger attacks. Avoiding those foods may also help prevent other symptoms.

What Is the MS Hug?

The MS hug — also called banding or girdling — is a common symptom of MS. It can feel like a tight band squeezing the chest or ribs. An MS hug can last anywhere from a few seconds to a few days.

There are two possible causes of an MS hug, and both are related to nervous system dysfunction. In MS, the immune system attacks the central nervous system, which is made up of the brain and spinal cord. This can lead to incorrect signals being sent between the brain and other parts of the body.

For example, if MS has damaged the nerves that control your muscles, you may have muscle spasms. Spasms in the small muscles between the ribs (called intercostal muscles) can trigger an MS hug.

The other cause of MS hugs is dysesthesia. Dysesthesia causes abnormal sensations such as neuropathic pain (neurological pain or nerve pain), burning, itching, tingling, or numbness. Dysesthesia happens when damaged nerves send the wrong signals to your brain, making it feel like you’re having pain or discomfort. Dysesthesia can cause the phantom itching and burning sensations that some people with MS experience. It can also trigger an MS hug.

What Does an MS Hug Feel Like?

An MS hug can feel mild, like a tickle or tingle, or it can cause intense pain. Some MyMSTeam members have said it feels like they’re having a heart attack. Others have described the MS hug as:

• “An ever-tightening corset.”
• “It feels like I am wearing Spanx that are a tiny bit too tight 24 hours a day.”
• “I have been getting these sudden onsets of chest pain.”
• “I’d call it ‘the squeeze of death.’”
• “I can’t breathe. It’s so, so scary.”

MS Hug or Gallbladder Pain?

The MS hug and gallbladder problems share many of the same symptoms, which can make them hard to tell apart.

How They’re Similar

Some of the similarities between an MS hug and gallbladder issues are:

• Both kinds of pain can be sharp or intense.
• Both can make it difficult to breathe or take a deep breath.
• Both can be triggered by a large meal.

How To Tell Them Apart

There are some key differences in symptoms that can help you figure out whether you’re having an MS hug or gallbladder problems.

It’s more likely to be an MS hug if:

• The feelings are in your lower belly, the left side of your body, or your throat — away from the gallbladder area.
• You haven’t eaten in the last 30 to 60 minutes.
• It feels more like tingling or pressure than a sharp pain.

It’s more likely to be a gallbladder issue if you have:

• A fever
• Yellowing of the skin or eyes
• Pale-colored stool
• Dark urine

If you have these symptoms, your doctors can run tests, give you medical advice, and help you find the right treatment.

When Should You See a Doctor?

If you have belly or chest pain, always let your healthcare team know. An MS hug could mean you’re having a flare, and a gallbladder issue may require immediate attention. These symptoms can also be similar to those of other serious health issues (such as a heart attack), so it’s important to find out the cause right away.

Preventive Measures

It’s better to avoid triggers than to treat symptoms after they start.

How To Prevent an MS Hug

Triggers can be different for each person. To figure out your triggers, try keeping a diary of your MS hugs, writing down what you were doing or feeling just before they happened. This can help you figure out what to avoid.

Common MS hug triggers include:

• Changes in temperature
• Stress
• Exhaustion
• Eating a large meal

How To Prevent Gallstones

Healthy lifestyle choices can lower your risk of gallstones. These include:

• Eating foods low in fat and high in fiber
• Keeping a healthy weight. If you need to lose weight, aim for 1 to 2 pounds a week.

Management and Treatments

Always check with your doctor before taking any medication or supplement, even if they're over-the-counter.

How To Manage and Treat the MS Hug

There are different ways to treat your MS hug symptoms. Some medications may help:

• If the MS hug is caused by muscle spasms, muscle relaxants or anti-inflammatory painkillers may help.
• If the MS hug is caused by dysesthesia, your doctor might suggest anticonvulsants or certain antidepressants.
• If your neurologist thinks your MS hug is part of an MS flare, they may recommend a course of steroid treatment.

There are also some non-medication options you can try:

• Try relaxation techniques, like deep breathing
• Practice gentle moving and stretching
• Massage or apply pressure to the affected area
• Use a TENS (transcutaneous electrical nerve stimulation) unit
• Apply heat or cold
• Wear either tight clothing or loose clothing — whatever feels better

Everyone is different. A treatment option that works for one person may make symptoms worse for another. For example, some MyMSTeam members find that heat eases their spasms. Others find that heat makes things worse, but ice helps. As one MyMSTeam member put it, “Ice is my best friend!”

Go slowly until you find the combination that works best for you.

How To Treat Gallbladder Problems

There are several ways to treat gallbladder issues. Sometimes, medication, an injection, or shock waves can break up gallstones. But often, the only long-term solution is surgery to remove the gallbladder.

Talk With Others Who Understand

On MyMSTeam, the social network for people with multiple sclerosis and their loved ones, members come together to ask questions, give advice, and share their stories with others who understand life with MS.

Have you had an MS hug or gallbladder issues? Do you have trouble knowing what’s causing your pain? Share your experience in the comments below, or start a conversation by posting on your Activities page.