There are many different symptoms of multiple sclerosis (MS), not to mention possible side effects of the disease-modifying therapies used to treat the condition. It can sometimes be hard to tell if what you’re feeling is related to MS itself, a treatment, or a different health issue that might need attention.

For example, some people with MS experience a common symptom called the MS hug, which can be confused with potentially serious problems with the gallbladder. In this article, we’ll explore gallbladder issues and how to distinguish them from the MS hug.

What Is the Gallbladder?

In order to understand gallbladder pain, 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 ribs in the top right part 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 you’ve eaten a meal — especially a large or fatty meal.

What Causes Gallbladder Problems?

The most common problem with the gallbladder is gallstones. Gallstones are formed when bile ingredients are out of balance, especially when there’s too much cholesterol. Autoimmune conditions also can cause gallstones, and in some cases, they’re hereditary. Many people have gallstones and never know it because they don’t cause symptoms.

Sometimes gallstones grow large or get stuck in the biliary ducts, tubes that carry bile to the small intestines. The gallbladder will squeeze and spasm trying to force out the bile, causing a painful gallbladder attack (also called biliary colic). A gallbladder attack will usually happen after you’ve eaten a large or fatty meal.

Sometimes gallstones cause the gallbladder to become inflamed, a condition called cholecystitis. (There are other, less common reasons for cholecystitis — such as tumors, infection, and certain diseases — but it’s usually gallstones.) The symptoms of cholecystitis are similar to the symptoms of a gallbladder attack, but they’re typically more severe and last longer.

What Are the Symptoms of Gallbladder Problems?

The most common symptom of gallbladder problems is pain. It’s usually described as a sharp pain, often felt just under the ribs on the right side or more toward the center. The pain can extend to the upper back or right shoulder. It can sometimes make breathing difficult.

Other possible symptoms of gallbladder issues include:

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

What Is the MS Hug?

The MS hug — also known as 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 reasons for an MS hug, and both are the result of nervous system dysfunction. In MS, the immune system attacks the central nervous system, 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 your MS has caused damage to the nerves controlling your muscles, you may experience muscle spasms. Spasms in the small intercostal muscles between the ribs can trigger an MS hug.

The other cause of MS hugs is dysesthesia. Dysesthesia is characterized by sensations such as pain, burning, itching, or numbness. It’s caused when damaged nerves start sending the wrong signals, telling your brain that you are experiencing something painful or uncomfortable. Dysesthesia may cause the phantom itching and burning sensations in MS. It’s also a possible trigger for 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. Other MyMSTeam members have shared their descriptions of an MS hug:

• “An ever-tightening corset without the benefits of a 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 vs. Gallbladder Pain

The MS hug and gallbladder problems share many of the same symptoms, which can make it hard to tell which one you’re dealing with.

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.
• Both can cause nausea.

How To Tell Them Apart

Depending on your symptoms, there might be some key differences that help you figure out whether it’s an MS hug or your gallbladder.

It’s more likely to be an MS hug if:

• The feelings are in the lower part of your belly, on the left side of your body, or your throat
• You haven’t eaten in the past 30 to 60 minutes
• It feels more like tingling or pressure than a sharp pain

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

• A fever
• Yellowing of the skin or eyes
• Pale feces
• Dark urine

Depending on exactly what’s wrong, your doctors can help you figure out the best way to ease your symptoms.

When Should You See a Doctor?

If you are experiencing abdominal or chest pain, you should always let your health care team know. An MS hug might indicate a flare, and a gallbladder issue may require immediate attention. Since the symptoms may also be similar to those of other health issues (such as a heart attack), it’s important to know exactly what is going on.

Preventive Measures

Figuring out your triggers to prevent symptoms is better than trying to treat the symptoms once they appear.

How To Prevent an MS Hug

Everyone is different, so your triggers could be different from someone else’s. To figure out your triggers, you can try keeping a diary of your MS hugs, noting what you were doing or feeling just before they occurred.

Some common MS hug triggers are:

• Temperature changes
• Stress
• Exhaustion
• Eating a large meal

How To Prevent Gallstones

The best ways to avoid gallstones include:

• Eating foods low in fat and high in fiber
• Maintaining a healthy weight — If you need to lose weight, do so slowly (1 to 2 pounds a week).

Management and Treatments

Always speak with your doctor before taking medications or supplements, even if they are over-the-counter.

How To Manage and Treat the MS Hug

There are various treatments to relieve your MS hug symptoms. Some medications may help:

• If the MS hug is caused by muscle spasms, muscle relaxants like baclofen or painkillers like ibuprofen (Advil or Motrin) or acetaminophen (Tylenol) might help.
• If the MS hug is caused by dysesthesia, your doctor might suggest anticonvulsants like gabapentin (Neurontin) or pregabalin (Lyrica), or certain antidepressants like amitriptyline (Elvail) or duloxetine (Cymbalta).
• 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 options you can try that don’t involve medication:

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

Remember that everyone is different — while a certain treatment may work for one person, it may even worsen another’s symptoms. For example, some MyMSTeam members find that heat eases their spasms. Others find that heat makes things worse — as one MyMSTeam member put it, “Ice is my best friend!”

Go slowly until you find the right combination 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. Often, though, the only way to fix the problem is surgery to remove the gallbladder.

Talk With Others Who Understand

MyMSTeam is the social network for people with both relapsing-remitting and progressive MS, and their loved ones. On MyMSTeam, more than 186,000 members come together to ask questions, give advice, and share their stories with others who understand life with MS.

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