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Describe the steps involved in ISC. Recognize and support the spouse partner's emotional reactions to this change in the relationship. Recommend a support group or other counselling if necessary. 9. What kinds of emotional responses can I anticipate from my patients and spouses partners? Some patients are so embarrassed about bladder and or bowel symptoms that they will not talk about them with you, even when asked. Most people are relieved to know that their constipation is related to MS and can be managed with appropriate strategies. Some patients are so resistant to ISC that they will withhold information about symptoms they are having in order not to be told to catheterize. Some patients are so relieved to know that there are bladder medications and strategies that will give them back their comfort and freedom that they comply without difficulty. If any of these patients who are successful and comfortable with ISC are willing to share their experiences with others, they can be very helpful to people who are frightened or resistant. ; Some spouses partners are willing and able to provide the necessary assistance with catheterization; others are not. If, in spite of information about the importance of catheterization and emotional support in the form of counselling, the spouse partner is non-compliant, arrangements must be made for someone else to provide the help, or an indwelling catheter must be used. See Sexual Dysfunction booklet for ways to address the impact of caregiving activities on the sexual relationship. ; 10. What should I say do if the patient's emotional responses are interfering with treatment compliance? Emphasize the importance of effective symptom management in order to address the problems, avoid complications, and maintain health. Reinforce the idea that utilizing effective management strategies is a way to take charge of one's MS and regain a sense of control and independence. Encourage participation in a support group. Recommend individual counselling with a therapist who is familiar with MS. The nucleus for outbreaks formerly the with medical died.

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