MSA Trust



Having a diagnosis of MSA does not mean all possible symptoms will be experienced – no two people have exactly the same set of issues or style of progression. There is currently no cure or specific treatment to prevent MSA progressing but there are ways of assisting and alleviating symptoms. The MSA Trust is here to support people at every stage of their diagnosis, along with their families, friends, carers and health professionals.

What are the first signs of MSA?

For men, the first symptom is often erectile dysfunction (the inability to achieve or sustain an erection). It is unknown why this should happen but the problem is often incorrectly attributed to ageing without exploring other possibilities.

Both men and women may have early bladder problems: urgency, frequency, incomplete bladder emptying or even an inability to pass urine (retention). Again these complaints are sometimes attributed to ageing; and sometimes to prostate enlargement in men or pelvic floor muscle weakness in women.

Other early problems can include feeling stiff and slow in movement as well as changes in handwriting. Some people become clumsy or unsteady when walking .If blood pressure control has been affected then people may feel dizzy when standing up or experience episodes of fainting.

There are three groups of symptoms which reflect the three main regions of the brain that may be involved:

  • the basal ganglia causing problems with movement (parkinsonism)
  • the cerebellum causing poor balance and co-ordination
  • the brain stem causing autonomic problems such as poor bladder and blood pressure control.
Basal ganglia causing problems with movement (parkinsonism)

Feeling slow and stiff when moving

Difficulty in starting to move

Writing becoming small and spidery

Difficulty turning in bed

The cerebellum causing poor balance and co-ordination

Feeling clumsy, dropping things

Finding it difficult to fasten buttons

Feeling unsteady in crowds

Unable to balance without support

Difficulty writing
Slurred speech

Brain stem causing autonomic problems such as poor bladder and blood pressure control

For men, difficulty with erection

Bladder problems

Feeling dizzy or fainting (blood pressure problems)

Pain around neck and shoulders (known as ‘coat hanger pain’)


Cold hands and feet

Problems with sweating control

Other problems

Weakness of arms and legs

Poorly controlled emotional response, laughing or crying

Restless sleep


Noisy breathing during the day, snoring at night

Unintentional sighing

Weak, quiet voice

Swallowing problems, difficulty chewing, choking episodes

Eye muscle weakness which may cause blurred vision

Having a diagnosis of MSA does not mean you will experience all of these symptoms.

There is currently no specific treatment to prevent MSA from progressing (although clinical trials and research are being undertaken) but there are ways of assisting and alleviating symptoms. These include lifestyle adaptations, medications for specific symptoms and ensuring you get the support and advice from the professionals involved in your care. Remember the MSA Trust is here to help.

What happens next?

MSA is degenerative, which means that unfortunately symptoms are likely to worsen over a period of time. In due course the need to rely on others for help may arise. The speed of these changes is difficult to predict as people with MSA experience it  differently and the rate of progression varies from person to person.

Some people feel they cope better if they know what lies ahead. Whilst MSA progression is very individual and unpredictable, you can discuss what might happen in the future with your specialist or our MSA Nurse Specialists.

We have taken every care to ensure the accuracy of the information contained in this publication. It is produced independently, is not influenced by sponsors and is free from endorsement. The information should not be used as a substitute for the advice of appropriately qualified professionals, if in any doubt please seek advice from your doctor or legal professional.
References for this information sheet are available by contacting
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