Here is from the veterinary board website. It sounds manageable, but definitely very specific (not doing the wrong things as well as doing the right things.) In human beings once the colon gets distended, it loses its ability to contract normally, but that this function can be brought back after a concerted long-term management of the problem.
Treatment Options Medical Treatment For idiopathic megacolon, initial management is medical. These cats should be appropriately hydrated (IV fluids if dehydrated) and then an enema and deobstipation (manual removal of feces) should be performed. This almost always requires general anesthesia, as it is extremely painful for an awake cat. NEVER attempt to give a cat an enema at home unless instructed by your veterinarian, and NEVER use an over-the-counter Fleet phosphate enema (infant enema), which is toxic to cats. After they have been “cleaned out”, medical management begins. In the past, a high fiber diet and bulking agents such as Metamucil and fiber pills were recommended in an effort to make the cat more “regular.” These are actually contraindicated, and can worsen the signs. Best medical management includes a low-residue diet (your veterinarian can suggest low-residue prescription diets) and prescription medications such as lactulose and Cisapride. Lactulose is a mild cathartic (helps speed defecation) and is a stool softner. Cisapride stimulates colonic motility (propulsion) by increasing the release of a certain neurotransmitter important in nervous supply to the colon. The low residue diet helps to stimulate the colonic cells without increase in bulk. Most cats will respond to this therapy, but some will eventually become refractory to treatment. When medical therapy is no longer effective, surgery to remove the enlarged colon is recommended.
Surgical Treatment The surgery is referred to as a “subtotal colectomy”(removal of most, but not all, of the colon), although occasionally a total colectomy (removal of the entire colon) is required. Before surgery, cats are started on broad spectrum antibiotics, because the colon, containing feces, is the most bacteria-laden part of the intestinal tract. Antibiotics help to prevent bacterial contamination at surgery.
In subtotal colectomy, the entire affected colon (Figure 4) is resected (cut out) and the two ends are sutured back together (Figure 5). Depending on how dilated the colon is, your cat’s surgeon has the option of performing two slightly different procedures. In one, the ileocecal valve (area which connects the ileum, which is the last part of the small intestine, and cecum to the colon) is left intact. In this case, the short segment of proximal colon is sutured to the distal colo-rectum. In the other, the end of the ileum, cecum and ileocecal valve are removed and the proximal ileum (or distal jejunum – mid-section of the small intestine) is sutured to the distal colo-rectum. Though there is no statistical difference in how the cats do clinically long-term, preservation of the ileo-cecal valve can reduce post-op diarrhea in the short term. Preserving this valve is not optional; if your cats’ surgeon removes it, it is because the area was too diseased to preserve. Although the ileum functions in Vitamin B12 absorption and reabsorption of bile salts, it is rare for cats to have chronic diarrhea or need vitamin replacement treatment even if the ileum has to be removed. Failure to remove an affected portion of bowel can cause formation of a new dilated area of bowel, leading to recurrence of clinical signs of constipation and obstipation. Sub-total colectomy is a challenging surgical procedure, so your general practice veterinarian may wish to refer you to a surgical specialist for this procedure.
Thanks for that and very informative, how many mls/day of lactulose and does this give them stomach cramps the more you give them? I am currently giving Ozzie 6mls/day how high can I go up to?I am currently waiting on the vet to get cisipride hard to get locally in NZ.I am giving him fish oil and wet food but he has hardly any appetite. Iam also giving him anti biotics as our vet gives him up to 7 enememas of Miralax a day and never puts him to sleep, wish he did as very stressful for Ozzie.
Appreciate your input.How long can you keep them with a good quality of life?
It's from the American College of Veterinary Surgeons website, and you can find it if you google "mega colon in cats." (Accompanied by a photograph of a colon all distended with stool that was removed from a cat -- the thing looked like a man's tube sock full of material.) Sometimes MedHelp's software blocks links, but here is the link: www.acvs.org/AnimalOwners/HealthConditions/SmallAnimalTopics/Megacolon/
I know this is long, but please consider this advice from a LONG TERM patient ... I have an 18yr old Manx (pushing 19 now) who was diagnosed when he was 6... yes, 6. He hasn't been able to poo on his own since he was about 7yrs old. I didn't want to do the surgery in fear of the other side effects or lack of success, so I've had been treating him for 12 years using high doses of Lactulose/Enulose and canned pumpkin into his canned food 2x per day AND weekly enemas. He is an amazing cat that allowed me to do this. My vet always said I was the most patient pet owner ever. In any case Monkey (that's his name) was always grateful and is a wonderful cat. This past February 2012, I saw him taking a downward spiral due to his old age ... very thin, seemingly dehydrated and was not eating like he used to. When I saw blood in his stool, I thought this was the end. As a last effort resort and a peaceful "way out", I decided to try administering IV fluids only out of coincidence while my other cat was also ill and getting fluids (with the acceptance from my vet). I you tubed how to do it and had to get over being squeamish... it literally takes 2 minutes of your life each day to do this and thankfully again, Monkey is so willing to allow me to do this to him. The first time was awkward ... and the bag of fluids I had was called Normosol. I later found out that the vet accidentally gave me Normosol instead of Lactated Ringers, but this was the start of something amazing ... I'm guessing due to the high doses of minerals (magnesium) and such, the Normosol CLEANED HIM OUT in a day. Only 100 CC's (the first few days) and he completely emptied his bowels the very next day. He immediately felt spunky again. From then on (since Feb 2012), he gets only 50 cc's per day of fluids ... we have it down to a science ... takes one minute to stick and squirt him each morning ... he's happy, he doesn't hide and he purrs. There is nothing mean about it; there's no blood & there's no pain. Here is the amazing part ... ever since the first bag of Normosol and then changing to only Lactated RIngers, he has not needed ONE enema and I stopped the Lactulose/Enulose (honestly, I thought I was going to have to put the poor guy to sleep). I can finally say, 9 months later, he is doing AMAZING - I was afraid to say it until enough time went by. He's gained weight, looks great, feels great and poops in the litter box. I do still add canned pumpkin (good for him anyways) and feed him grain free canned food along with dry food on the side (other cat mostly eats that). I know he's almost 19, so he doesn't have much longer with me, but he's living the MOST comfortable, normal & happy life he's had with me yet. Please ask your vet if you can try administering IV fluids over ANY other treatment ... if you can and if they agree. I saw results within one week. If you have the success I have, you will be so happy. Best of luck to all.
PS : Normosol is too strong - use Lactated Ringers, Normosol gave him awful gas and diahreah ... also, warm up the bag in a bowl of hot water before administering ;)
thank you so much for posting this valuable information....you've been very committed to Monkey for a very long time, I am so happy he has lived to be such a grand age b/c of your care and love....many more Monkey♥
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