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Megacolon can be curable when handled the right way

Feline megacolon is a progressive condition that leads to irreversible distension of the colon

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Megacolon in a 12-year-old cat.
Photos courtesy Dr. Phil Zeltzman

Garfield, a 12-pound, 8-year-old domestic shorthair cat, had become constipated in the past few months. His family veterinarian initially prescribed psyllium fiber (Metamucil). Then, a few weeks later, the vet prescribed methylcellulose fiber (Citrucel). Then a few weeks later, lactulose. Then a few weeks later, a high-fiber canned diet. Then a few weeks later, mineral oil and petrolatum (Laxatone). Then a few weeks later, dioctyl sulfosuccinate (docusate or Colace). Then a few weeks later, polyethylene glycol (MiraLAX). Then a few weeks later, cisapride was started. Then a few weeks later came canned pumpkin. Then a few weeks later Garfield received a low-residue diet.

Garfield was hospitalized multiple times along the way to receive subcutaneous fluids. None of the above options worked well, so he had a few enemas along the way, as well.

His owner spent hundreds and hundreds of dollars in total, and she became incredibly frustrated with the lack of results.

Many months later, Garfield weighed 8 pounds. He technically was obstipated. He had been vomiting and had a rough hair coat, chronic tenesmus, and a poor appetite. He was dehydrated, anorexic, and experiencing pain. He was miserable. A subtotal colectomy finally was recommended. Sadly, our feline patient was a much worse anesthetic candidate than he was a few months ago.

What happened?

Megacolon in a 10-year-old cat with huge fecoliths.

Feline megacolon is a progressive condition that invariably leads to irreversible distension of the colon. Two thirds of the time, we don’t know the cause of megacolon in cats, so it can be called an idiopathic, functional obstruction. It is believed that the cause is a degenerative neuromuscular disorder, which is ineluctable, irreversible, and untreatable. This is the reason why medical management is so often palliative at best.

In some cases, megacolon is secondary to untreated pelvic fractures (and rarely a tumor or a foreign body), i.e., a mechanical obstruction. Simple radiographs and rectal examination under heavy sedation or anesthesia will confirm that the fracture malunion is indeed causing stenosis of the pelvic canal.

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Feces (fecoliths) in a megacolon are large and rock hard, and cannot mechanically move through a poor cat’s anus. Recall that one of the colon’s main jobs in life is to reabsorb water. So we can administer all the cisapride, lactulose, and special diets in the world—that poop is just not coming out.

And then, there’s the dreadful enema. At best, it will help temporarily; at worst, it can cause traumatic tears of the colon. Either way, the smells and sights probably will make your toughest technicians sick to their stomachs. And it just doesn’t accomplish much, once the colonic distension has reached the point of no return.

None of the medical options above provides a cure. In many case, they’re a temporary Band-Aid approach. Even cisapride, a prokinetic agent, can stimulate only those feline colonic smooth muscles that are functional. When the colon is overdistended, i.e., when a megacolon is present, cisapride won’t help one bit. However, in the vast majority of cases, megacolon is curable with surgery.

Garfield finally goes to surgery

After a thorough a physical and neurological exam, Garfield had a CBC, a biochemical profile, and a urinalysis. The results ruled out metabolic causes for constipation such as hypokalemia and hypercalcemia. Any patient who has been treated for hyperthyroidism also should have thyroxine levels checked to ensure that constipation is not caused by iatrogenic hypothyroidism.

Presurgical preparation is important to improve the outcome. Food is classically withheld 12 hours prior to anesthesia. Access to water should be allowed to reduce the chance of dehydration. Broad spectrum, parenteral antibiotics, analgesics, and IV fluids are administered before, during, and after surgery.

Garfield underwent a thorough laparotomy and a subtotal colectomy. His colon was the size of your forearm. During this procedure, 90 to 95 percent of the colon was resected, regardless of gross appearance. It is important to leave as little colon as possible—just enough to allow for anastomosis without any tension along the suture line.

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Failure to remove enough of the colon can lead to a recurrence of the megacolon, as it is a progressive disease. The colon separates nicely into two layers, which allows for a double layer closure. The colon is emptied and sent for histopathology to rule out inflammatory bowel disease or cancer.

Removal of the ileocolic junction is avoided, unless it is necessary to avoid having tension along the anastomosis. The ileocolic valve is responsible for allowing small intestinal contents to pass into the colon, without allowing reflux of colonic bacteria. Removal of the valve causes reflux of colonic contents, which results in small intestinal bacterial overgrowth (SIBO). Studies have shown that patients who had ileocolic junction resection had significantly looser stools than those who in which the one-way valve was preserved. These patients go from being obstipated to having chronic diarrhea, which typically improves over time as the intestine adapts and a source of fiber is provided.

Food and possibly an appetite stimulant are offered as soon as possible post-op.

In good, experienced hands, complications are rare. However, they are possible, including colonic leakage, peritonitis, stricture, ischemic necrosis, and abdominal incision dehiscence.

Garfield went home two days after surgery. The next follow-up occurred after four weeks of strict confinement. He was a happy, purring, comfortable cat with a great appetite and a new lease on life.

So please remember: Megacolon does not have to be a horrible, chronic, debilitating nightmare. It can be a curable disease with early surgical intervention.

 MEGACOLON UNKNOWNS, MISTAKES, AND MISCONCEPTIONS
  • Cats should never receive an enema during the preop period. Otherwise, it dramatically increases the risk of fecal leakage during the anastomosis.
  • Fibers may help in the early stages of idiopathic megacolon when the colon still has some ability to contract. But in the later stages, fiber supplementation may worsen distention and subsequent symptoms.
  • Misoprostol, ranitidine, and nizatidine have shown positive effects in vitro on feline colonic smooth muscle contraction. In vivo studies have yet to confirm whether they are a good option for treating idiopathic megacolon.
  • Erythromycin has no effect on feline colonic smooth muscle; therefore, is it not indicated in the treatment of feline constipation, obstipation, or megacolon.
  • Metoclopramide and domperidone enhance gastric motility, but they have no effect on colonic transit times, therefore making them useless for megacolon.
  • It is important to inform cat owners to never use over-the-counter enemas, even infant enemas, such as Fleet (sodium phosphate), which can be toxic to cats.
  • Using daily bisacodyl (Dulcolax) long term is not recommended because of potential injury to nerves cells in the colon (myenteric neurons).
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Dr. Phil Zeltzman is a board-certified veterinary surgeon and author. His traveling surgery practice takes him all over Eastern Pennsylvania and Western New Jersey. Visit his websites at DrPhilZeltzman.com and VeterinariansInParadise.com.

Kat Christman, a certified veterinary technician in Effort, Pa., contributed to this article.

33 thoughts on “Megacolon can be curable when handled the right way

  1. I’m so thankful I found your news about megacolon. My 3-year old kitten has just been diagnosed with it. We knew something was wrong when she started pooping all over the house. Our vets are so “trained” by this VCA group they sold out to that we don’t know who to trust anymore. I will be checking your website for more information.

    1. My cat named Tux a long hair domestic cat 8 years old. He had been treated multiple times to receive subcutaneous fluids. None of the above options worked for very long and so he had a few enemas along the way, as well. His diet was Id chicken flavor food and some tuna along with some Iams dry chicken flavor food. The had him on Cisapride and Miralax and lactulose. None of this worked for him. I had spent a lot of money between office visits and mediacation that did not work. Then the last visit in later part of Januray he deobstipated and that work for a while and then two months later he became sick and the Vet suggested several options one was deobstipate or consider urthernize or take him to the Vet Er Hospital. So I took him to the Hospital and he was in there for two days on IV before they attempted to do anything? This was critical time for him and I feel they wasted to much time and was a very busy place for an Er/Hospital and I feel Tux was pushed off to wait. Then over the weekend they gave him go litely to remove the feces and then gave him an enema and he was doing fine for that afternoon and evening but, early the next day his condition became worse. The idea was to have the Colon Surgery but, sadly his medical condition got worse and they said he had other issues with his blood platelets and kidney stones and then they suggested euthanizing him. So sadly he is gone as 03/25/2019. I do not believe they handled everything properly between the Vet and especially the Er Hospital from the time he arrived… They didn’t move quickly enough he kept being put off because of all of walk-ins and emergencies they had and I don’t
      feel like some of them had enough knowledge/Medical Students simply because one of would tell they would to speak with someone from another department for assistance with him… Really ? Of course I am upset he was my Pretty Baby Boy and now I am going to have a huge bill to pay-off when I do not feel they handled this the right way.

  2. My cat had megacolon surgery about 3 week ago she jumped of off the bad about 17 inches will that hurt her please let me know

  3. I have two cats from two different cloweders who have mega colon. My one cat, Izzy, has had it for 8 years and with cisapride, Lactulose he is doing fine. About every two or three weeks he gets 1/4 tsp of Miralax (my vet recommended it). My girl, Precious has the classic huge stools but I supplement her food (Royal Canin Fiber Response) with lactulose, just a .5 dose 3 times a day, she seems to do fine with that. I keep them on a strict regiment which helps bowel movements plus I monitor their litter. Precious take no other meds but Lactulose and the Royal Canin food and does just fine. Unfortuately I have found the Cisapride is not available locally here in my home town for the past 3 months and have resorted to using a send away compounding pharmacy which I am not happy with. I also know they charge me almost double for their cisapride.

    1. When you say “classic huge stools” , how large are they and and is a large diameter stool (18mm) a sign of megacolon ? My 3 yer old Female Siamese Mix had constipation out of nowhere and after vet enemas she has been on the fiber response dry food. Her stools have gotten larger and larger and now goes every 48 hours rather than every 24..

      1. Have her get Xrays so you can see if the poop is backed up. if the poop is larger and thicker than a pinky finger. It’s most likely megacolon.

    2. I’m not sure who you’re using but I used road runner pharmacy and found their pricing and service to be excellent. I was using a local pharmacy and paid twice what R. R. P. Charged me.

    3. Hello, I’m not sure what state you live in but Archway Apothecary in Louisiana is a compounding pharmacy that ships to most states. I know they make Cisapride in a liquid and in capsules. I use the capsules for my cat.

    4. You can get Cisapride on 1800pedmeds.com! They will contact your vet for the prescription – so much cheaper than compounding pharmacies. 🙂

  4. I too was paying exorbitant amount of money for the compounded Cisapride and Lactulose. Until my Vet prescribed the larger quantity bottle script. It has helped. with cost. This compound has worked well for my cat along with the Royal Canin.

    1. We are using lactalose which worried well for a few months and now our 15 year old cat is in her 4 th day of no bowl movement.
      Is surgery necessary?

      We live in Miami,Fla

      1. Dont EVER post a message to ANY ONLINE VET when your cat is actively sick! GET THEM TO A VET IMMEDIATELY! online Vets are writing an article they are NOT ACTIVE ONLINE ANSWERING QUESTIONS

      2. My 19 year old cat is currently on cisapride and loxicam (pain relief and will be for the rest of her life. Currently she is experiencing a blockage also, I reccomend under any circumstances do not give your cat dry food, wet food only , as this has been a few years on going my vet does give me enemas for me to try at home on my cat . Prior to this recent blockage she has been great for 4 months, hopefully it passes in a day or to and we are back on track. Hopefully this helps as there is not much info out there for older cats.

  5. My cat Bella was born without the use of her back legs. Since becoming an adult she developed megacolon. I do give her Miralax 1/8 of a tsp daily.At times she has stool that gets backed up in the rectum. She may not pass the stool for several days. If she goes 2-3 days without a stool I manually from the outside squeeze her rectum and help her pass part of the stool then she will usually pass the remaining stool within a day or 2. When I do this she complains, gets mad and yells. Am I causing her pain? Or is she just complaining?

    1. I have been putting vaseline on my cats bottom it seems to relax her enough to help pass it.I would never squeeze her may cause damage I have been sing Restoralax,& taken her off dry food period

      1. That should say, using Vaseline,which she also lick’s some of it off,which is good
        Read up more on Megacolon & do what you need to do with a change of food or go to the vet .

  6. My kitty is not doing good at all:( we have been dealing with this for 4 yrs now. Used restorlax cispride lactose n hydration and he was good for 2 yrs but now it has happened all over again. 3500 dollar vet bill this weekend n he is still not going:( I’m so upset

  7. My cat is not doing well either. One week after manual obstipation he is impacted again. He will not take the cisapride, and if we manage to get it in him he throws up. He does not regularly drink water either. It’s not looking good. We were afraid to put him through surgery when this first started because he is so afraid of people and everything. We thought if we kept him on track we could avoid it, and he was fine for a long time. It happens very quickly. Now they say it’s too late for surgery. We never thought it would get this bad this fast. Not a happy Christmas for us.

  8. Just to add, we have been giving him Miralax and recently lactulose. They work for a while, but not effective enough for his megacolon. The cisapride was in addition, but not effective since he could not retain it.

    1. So sorry for what you’re going through. Our cat just passed two weeks ago. We are heartbroken. But she lived 14 years and was diagnosed with megacolon as a kitten. The combination that worked best was cisapride 5 mg two times a day. Crushed up pills mixed it with a little wet food she ate it up, then 15 minutes later gave her her full meal. The Royal Canaan fiber response for cats was a game changer. Greatly improved her overall health. And 100 mg subcutaneous fluids once every 3 to 4 days. The colon must have liquids. Best of luck.

      1. Is there a Royal Canin fiber response dry food or something that works the same? I’m struggling to get my cat to eat the wet food.

      2. hello Leslie, our cat is just now trying the cisapride but we were only prescribed to use 1mg two times a day, I wonder if your cat was on 5mg because it was in pill form? my cat has had 3 doses but no bowel movement yet 🙁
        Also, did you use the Royal Canin dry or wet food?
        and how did you give the subcutaneous fluids every 4 days?

  9. My cat (10yrsold) developed megacolon. The cause is dry food. Nature did not design cats to eat dry food; they are meat eaters. It took me 3 days to convert her to wet food (after 10 yrs). I confined her with wet food, water and a litter box; she responded. The cisapride was a tremendous help to clear blockage. The ex-ray showed several balls of compacted waste. Now she no longer moans while sleeping; no regurgitating hair balls; no cries during defecation. You can use the cheapest no name can cat food on the shelf and it’s better than that expensive dry vet prescribed bag of dry. Royal Canin Saitey cost $71 a bag. With wet food just add water; rinse the can with a little water and add to food. Cats have a low thirst drive and that’s why water fountains (expensive) are promoted to encourage drinking; cats get most moisture from meat. Please do not start or continue dry food feeding; it’s killing them. There is no cure for megacolon. Yet. Wet food is the cure to the digestive issue.

    1. I was wondering if those water fountains were actually as good as advertised. Expensive, yes, but do they really attract cats to drink more water? I had thought about getting one; my megacolon kitty drinks hardly any water. Have you tried one? I wasn’t sure from your comment. I’d like to hear opinions from others; I don’t want to waste miney on something that doesn’t do what I need it to, when that money can go to my vet bill.

    2. Shirley, I agree. I wish the vets would stop prescribing that nasty dry food for cats. I took cats off dry food years ago. Their coats are shinier, they lost weight and seem to do better overall.

  10. Any suggestions on how to convince a vet to write a prescription for subcutaneous fluids? A bag with needles cost approx $30+ from their facility.
    I’ve researched mail order, as a source and it is considerably less costly. Plus, I want to be able to administer fluids, as soon as my cat starts exhibiting signs of constipation (stops drinking and eating).
    The subcutaneous fluids does appear to make him more comfortable and coherent.
    After that, he will consume very small quantities (usually only a teaspoon mixed with water) of a post op, Hills Science Diet, canned recovery food. (Note: Cost approx $2.75 for a 5 oz can. I highly recommend it because the formulation and odor is the only food that he’ll even consider consuming once he’s no longer eating his regular canned food.)
    My cat is 12 years old and had his first serious bout of constipation approx 3 months ago.
    He does not like dry food and I have always mixed his canned food with hot water to a pourable consistency. Plus, occasionally the addition of an egg mixed in with the canned food and hot water.
    Since his first episode, I’ve been adding even more water and discovered that a pinch of Miralax powder needs to also be added, at least every other day.
    We still have a bottle of the liquid, feline laxative the vet prescribed and if he gets constipated, it helps along with the subcutaneous fluids.
    To get more personal and if it might help others, I will share the fact that if you research online, there is some info on finding your cats colon by using your finger on both sides of its spine. Pressing below the spine as you move your fingers down. On my cat, I am able to feel the rounded and expanded colon filled with hardened feces.
    My cat is docile enough that I’ve been able to compress his colon enough to separate a section of clay like firm stool.
    Also, when his rectum is noticeably larger and obvious that hard stool is pressing on it. He’s not pleased with having a latex covered finger inserted. But will tolerate it and I’ve been able to gently break off a fraction of an inch to relieve the discomfort of the pressure on his rectum.
    He’s noticeably more comfortable afterwards.
    When he first got ill, I was protective and would not allow him out in the enclosed backyard.
    That was a mistake, as he was uncomfortable and needs to move around and pass stool whenever and wherever he feels the urge to expel feces.
    When he’s outdoors, he is dropping stool on the deck. Which is okay with me, as long as he is comfortable and doesn’t get constipated.
    Back to subcutaneous fluids – again, any suggestions on obtaining a prescription with refills from vet to be able to take advantage of mail order fluids would be appreciated.

    1. I would find a new vet if they are unwilling to help you save money by writing a prescription so you can have it filled at a pharmacy of your choice. This seems to be a big problem with vets marking up the prices on meds they dispense from their office. They have competition from the online pharmacies and they know it. I have the same problem with my vet so I am leaving and going elsewhere. For the past year, they were making me refill the lactulose monthly with a tiny bottle that cost me 24 dollars. Then they were calling my home trying to get me in there for my cat’s exam when it hasn’t even been a year. Then I went online and found out you can a large bottle of lactulose for 15 dollars and 10 dollars at King Soopers!after that I had enough. You have to insist because most of them won’t bring it up.

  11. My female cat is 13 years old, when I rescued her her tail was broken in 6 places and her right leg was broken in several places with bone protruding thru her skin, she was cut to pieces all over her body and both her tail and leg had to be amputated from her hip , she had massive internal injuries which required surgery, and she was extremely malnourished, now her remaining back leg has “shifted” to the center of her back and she has mega Colin, when she tries to push out stool her her leg just gives out, she weighs less than 2 lbs and is extremely small, does anyone have suggestions on what might help her or if you have had or are having this same problem please let me know, thank you.

    1. Susie,

      Whete are you located? Please get her to a good vet as soon as possible, poor baby to be going through that – I’m hoping you live near me where I can recommend someone

  12. You know what? I don’t remember constipation ever being a problem in years past. Not until all the vet & pet shows started getting popular, along with people treating their pets like they are people, did this constipation issue arrise, but also the huge vet bills (but the cost for my Vvet friend says he doesn’t have to charge so much for a spay/neuter $300, he could charge $50 or a little less, but if the people will pay it he’ll charge it, along with a lot of other people) I think the pet food is causing the constipation problems, what else could it be? This little issue has set people back thousands of dollars. My vet, no fee to visit, charges what he feels is fair, typical operation… $40 on a cat.

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