Multiple sclerosis (MS) triggers include anything that worsens your symptoms or causes a relapse. You can often avoid MS triggers by simply knowing what they are and trying to sidestep them. If you can’t avoid certain triggers, you may find other approaches helpful, including a healthy lifestyle, regular exercise, and a balanced diet.

Just as no two people will have the same experience with MS, no two people will likely have the same MS triggers. You may have some triggers in common with others who have MS, as well as some that are unique to you.

Over time, you and your doctor may be able to identify triggers that make your symptoms worse. Keeping a journal of your symptoms, when they occur, and what you were doing beforehand can help you identify potential triggers.

Here are some of the most common triggers you may experience with MS and tips to avoid them.

Having a chronic disease like MS can establish a new source of stress. But stress can stem from other sources, including work, personal relationships, or financial worries. Too much stress may worsen your MS symptoms.

How to avoid: Find a relaxing, stress-reducing activity that you enjoy. Yoga, meditation, and breathing exercises are all practices that may help reduce stress and eliminate the risk of making symptoms worse.

The heat from the sun, as well as artificially heated saunas and hot tubs, may be too intense for people with MS. They can often lead to a period of exacerbated symptoms.

How to avoid: Skip high-heat environments like saunas, hot yoga studios, and hot tubs. Keep your home cool and run extra fans if necessary. On hot days, avoid direct sunlight, wear loose, light-colored clothes, and stay in the shade as much as possible.

Pregnant people with MS may experience a relapse after delivering their baby. About 20 to 40 percent of women may have a flare-up in the period just after giving birth.

How to avoid: You may not be able to prevent a flare after childbirth, but you can take steps to reduce its severity and impact. In the immediate days after giving birth, let friends and family members help you with your new baby so that you can get rest and care for yourself. This will help your body recover more efficiently.

According to limited research, breastfeeding may have a potential protective effect against postpartum flare-ups, but the evidence isn’t clear. If you’re taking disease-modifying medication, you may be unable to breastfeed. Talk with your OB-GYN and neurologist about your post-birth options.

Infections can cause MS flare-ups, and MS is also more likely to cause certain types of infection. For example, people with reduced bladder function are more likely to develop urinary tract infections. The infection may exacerbate other MS symptoms. Infections like the flu or common cold can worsen MS symptoms.

How to avoid: A healthy lifestyle is an important part of treatment for MS. Plus, it helps prevent other diseases and infections. Wash your hands during cold and flu season. Avoid people who are ill when you’re experiencing a flare. See your doctor if you think you’re getting sick.

Vaccines are generally safe — and recommended — for people with MS. Certain vaccines that contain live pathogens can potentially exacerbate symptoms. If you’re experiencing a relapse or taking certain medications, your doctor may also recommend you postpone vaccination.

How to avoid: Talk with your neurologist about any vaccine you’re considering. Some vaccines, like the flu vaccine, may help you prevent a future flare-up. Your doctor can help you determine which are safest for you.

One study found that people with lower vitamin D levels have a higher risk of flare-ups than those with adequate vitamin D levels. There is increasing evidence that vitamin D can protect against developing MS. Still, more research on how this vitamin affects the disease course is needed.

How to avoid: To help prevent this, your doctor may monitor your vitamin D levels regularly. Supplements, food, and safe sun exposure may help. Be sure to talk with your doctor about your safest supplement options before trying any.

Sleep is vital for your health. Your body uses sleep as an opportunity to repair your brain and heal other areas of damage. If you aren’t getting enough sleep, your body doesn’t have this downtime. Excess fatigue can trigger symptoms or make them worse.

MS can also make sleep more difficult and less restful. Muscle spasms, pain, and tingling may make it difficult to fall asleep. Some common MS medications may also interrupt your sleep cycle, preventing you from getting shut-eye when you feel tired.

How to avoid: Talk with your doctor about any sleep problems you may have. Sleep is vital to your overall health, so this is an important area of treatment and observation for your doctor. They can rule out other conditions and give you tips for managing fatigue.

A balanced diet and regular exercise can go a long way to helping you avoid a flare-up and ease MS symptoms. A diet high in processed foods is unlikely to provide you with the high quality nutrition it needs.

How to avoid: Work with a dietitian to develop an eating plan you can stick to. Focus on good sources of protein, healthy fats, and carbohydrates. While research isn’t yet clear on the best diet for people with MS, studies do suggest eating healthy foods can have a positive effect.

Cigarettes and other tobacco products can increase your symptoms and make progression happen more quickly. Likewise, smoking is a risk factor for several medical conditions that can worsen your overall health, including lung disease and heart disease.

One study found that tobacco smoking is associated with more severe MS. It also may speed up disability and disease progression.

How to avoid: Quitting smoking, even after your diagnosis, can improve your outcome with MS. If you smoke, talk with your doctor about effective smoking cessation options.

Certain medications have the potential to worsen your MS symptoms. Your neurologist will work closely with all of your doctors to make sure you don’t take medications that may trigger a flare-up.

At the same time, your neurologist may closely watch the number of medications you’re taking. Medications can interact with one another, which can cause side effects. These side effects could trigger an MS relapse or make symptoms worse.

How to avoid: Report all medications you take to your doctor, including supplements and over-the-counter drugs. They can help you narrow down your list to the necessities so you can prevent problems.

Sometimes, MS medications can cause side effects. They may also not seem as effective as you’d hope. But this doesn’t mean you should stop taking the medications without your doctor’s approval. Stopping them can increase your risk of flare-ups or relapses.

How to avoid: Don’t stop taking your medications without talking with your doctor. Though you may not realize it, these treatments are often working to prevent damage, reduce relapses, and stop new lesion development.

Fatigue is a common symptom of MS. If you have MS and push yourself to go without sleep or overexert yourself physically or mentally, you may experience flare-ups. Exertion and fatigue can trigger a relapse or make flares last longer.

How to avoid: Take it easy on yourself and listen to your body’s cues. Slow down when you’re feeling tired. Rest as long as you have to. Pushing yourself to the point of exhaustion will only make recovery more difficult.

When you have MS, you may need to make a few lifestyle changes to prevent relapses and reduce your symptoms. You may be able to easily avoid some triggers, but others may require more work. Talk with your doctor if you’re having difficulty managing your MS symptoms.