Megacolon: after the colon has stretched, what the pages say about medicine first — and when surgery is discussed

VCA’s named antecedents include spinal cord injury; mechanical obstruction from tumors, foreign bodies, hairballs or strictures; and orthopedic problems such as pelvic fractures that make normal defecation painful or impossible — megacolon can follow over time.[1] Often no reason is found for the nerves to stop working: idiopathic megacolon. It is generally a disease of middle-aged to older cats, and has been seen as young as three to four years.[1]

VCA’s clinical list: absence of bowel movements, straining, weight loss, lethargy, vomiting, anorexia. The cat may have a painful abdomen and be dehydrated and depressed; palpation often finds an enlarged colon packed with hard feces, and a rectal exam finds impaction.[1] Abdominal radiographs commonly follow, to judge colon size and look for masses; blood, urine, ultrasound or colonoscopy may be added.[1]

VCA: a medical approach is usually tried first — IV fluids, enemas, laxatives, stool softeners, colon-wall stimulants, high-fiber diets. Hospitalization for several days is common; a feeding tube may deliver high-dose softeners. Severe impactions may need general anesthesia or heavy sedation for manual removal after partial softening. That does not fix the underlying nerve problem; it lets feces pass so the cat does not stay obstructed and ill.[1]

Medical care may hold for months or years. A prescription high-fiber diet and softeners/laxatives are often long-term, titrated so the cat defecates at least every other day; if diarrhea appears, reduce dose or frequency — ask the veterinarian, do not poll a chat.[1] If medicine fails, subtotal colectomy is considered: remove the non-functioning colon, leave the anal sphincter. Most cats do reasonably well; stools are soft and frequent for one to two months, then more formed, on the order of three bowel movements every two days, without loss of control.[1] This is typically a referral surgery.[1]