The treatment of idiopathic megacolon initially is medical. Cats having this disease must be hydrated (via IV fluids if needed), then an enema will be performed. This is followed by the removal of faeces manually ( deobstipation). This will require a general anaesthesia, as this operation is very painful for the cat. Under no circumstance should you attempt to give your cat an enema yourself unless specifically instructed by your veterinarian. Do not use over-the-counter fleet phosphate as is used for children as this is toxic to cats.
Once the stool is removed, the medical management of the condition begins. Previous treatments that were recommended in the past, included a high fibre diet as well as bulking agents to try make the cat become more “regular”. However, this was proven to be contradictory to a cure and can actually worsen the condition. Low-residue diet has proven to be far more helpful along with prescription medications such as Cisapride and Lactulose. Most cats will respond to this form of therapy at the start. Unfortunately, some cats become resistant to this form of treatment. If medical therapy stops being effective surgery may be required to remove the abnormally enlarged colon.
This surgery is known as a “subtotal colectomy”. This is the removal of a large part of the colon. On occasion a total colectomy is required. This is the removal of the entire colon. A pet may need to be on antibiotics before the surgery as the colon is the part of the intestinal tract which contains the highest concentration of bacteria due to the presence of faeces. Antibiotics help in the prevention of bacterial infections during the surgery.
In a subtotal colectomy, the area of the colon that is affected is cut out (resected). The two ends remaining are stitched back together. Should the affected portion of the bowel not be removed completely, this can result in the a new area of the bowel become dilated, leading obstipation and constipation and starting up the cycle again.
Cats that have pelvic obstruction due to pelvic trauma can be surgically treated by removal of the abnormal pelvic bone (pelvic ostectomy). This will allow the faeces to pass normally. In the unfortunate event, should the megacolon be untreated for more than four to six months in cats with previous pelvic trauma the condition may be irreversible. After this prolonged time the colon might not return to its usual functionality. Cats having untreated pelvic fracture for more than four months may require a subtotal colectomy as well.