Ask Elizabeth:  What is There to Treat Idiopathic Megacolon?

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Q: For three years, our cat had a chronic problem with constipation. When we realized she had a problem, she was so impacted that the veterinarian had to remove the feces. We then gave her stool softeners, which helped for a while. Later, as the problem worsened, we tried cisapride (which is no longer available), but it didn't help. Finally, we resorted to monthly enemas. After about 4 months, even the enemas didn't seem to help. We were told that her condition - megacolon - was hopeless, and that the humane thing to do was to put her to sleep. I made some desperate inquiries and found out about a surgical procedure called a subtotal colectomy that was reported to be effective for cats. We took her to the nearest veterinary college where the surgery was performed the next day; now, 5 months after the surgery, Ebony is healthy and happy. I think it's important for other cat owners to know about this surgery.

A: I'd like to provide a little information about the colon disorder called idiopathic (meaning the cause is unknown) megacolon. Constipation (infrequent or difficult defecation) is fairly common in cats. If it occurs only occasionally there's usually not much to worry about. However, in some cats, constipation begins to occur more and more frequently, ultimately leading to obstipation: constipation that can't be controlled by medical means. There are many potential causes of obstipation, but over half result from idiopathic megacolon.

As the name implies, the cause of idiopathic megacolon is unknown, but cats with mild or moderate forms (or perhaps those with early stages of the disease) often benefit from increased dietary fiber, administration of laxatives or stool softeners of various kinds, and drugs called prokinetic agents (like cisapride) that stimulate the muscles of the colon. As things progress, the occasional enema performed at a veterinary hospital may be necessary. Unfortunately, the need for enemas or other methods of removing feces from the colon becomes more and more frequent; ultimately, cats with advanced stages of the disease simply stop responding to any medical therapy and the colon becomes little more than a big, flaccid bag containing a mass of hard feces.

Subtotal colectomy - surgically removing the major portion of the colon - is really the only remaining option. This is major surgery, but the overwhelming majority of cats respond quite favorably. The most common postsurgical problem is diarrhea, but most cats begin to form stool of an acceptable quality within several weeks or less. Life returns to normal, or near normal, within several weeks. Though a subtotal colectomy is not necessarily a perfect solution, the majority of people whose cats have had one are quite pleased with the results. They continue to share life with a cat friend who, without the surgery, would not have survived.