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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Cat Veterinary
Satisfied Customers: 24465
Experience:  University of California at Davis graduate veterinarian with 44 years of experience.
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My cat was diagnosed with megacolon and is still constipated

Customer Question

My cat was diagnosed with megacolon and is still constipated after several enemas. The Vet has been hydrating him and also giving him a laxative. Vet does not want to operate on him, is there something else that can be given to him to help his constipation.
Submitted: 1 year ago.
Category: Cat Veterinary
Expert:  Dr. Michael Salkin replied 1 year ago.
Yes, cisapride is an oral GI prokinetic agent which while no longer available commercially can be obtained from a veterinary compounding pharmacy. It appears to be safe in small animals and is initially dosed at 2.5 mg per cat twice daily preferably 15-30 minutes before food. Dosages may be titrated upwards if tolerated to as high as 7.5 mg per cat three times daily in large cats. Here's a thorough review of megacolon treatment and prognosis taken from Clinical Veterinary Advisor, 3rd edition, 2015, Cote'... Chronic TreatmentMedical therapy includes stool softeners or laxatives (e.g., polyethylene glycol PEG 3350 [Miralax] teaspoon [0.6-1.3 mL] powder/cat PO q 12h; or lactulose 0.25-0.5 mL/kg PO q 8-12h; or docusate sodium/dioctyl sulfosuccinate 50 mg/cat PO q 12-24h) and prokinetics (cisapride 0.1-1 mg/kg PO q 8-12h or 2.5-5 mg/cat PO q 8-12h). Polyethylene glycol is easier to use than lactulose (not sticky). The dosage for any of these is titrated to produce a soft to semiformed stool.Bulk-forming laxatives (cellulose, psyllium) will not be effective in cats prone to dehydration or in cats with poor colonic muscle function, because their mechanism of action is similar to high-fiber diets.Stimulant laxatives (e.g., bisacodyl, castor oil, cascara) should not be used for relieving constipation but are best used as a preventive in cats that still have normal colonic function.Prokinetic therapy may assist smooth-muscle function in cats with recurrent constipation or obstipation. The most effective drugs are the serotonergic agonists (cisapride, prucalamide).Correct underlying cause when present: remove masses or strictures causing obstruction to outflow, or correct pelvic fractures obstructing outflow with pelvic osteotomy.Subtotal colectomy (with or without preservation of the ileocolic valve) may be indicated if lack of response to medical treatment or pelvic fracture malunion > 6 months from onset of obstipation.Nutrition/DietControl recurrent constipation with high-fiber/low-residue diet.High-fiber diets induce colonic contraction and are useful in management of constipation when the patient still has a functional colon and is well hydrated. Avoid high-fiber diets in patients that are prone to dehydration (high-fiber content can exacerbate colonic mucosal dehydration).Low-residue diets are often best used in patients with chronic recurrent obstipation or true megacolon, because they reduce the amount of material reaching the colon and make it easier to maintain a soft stool.Possible ComplicationsMedical treatment: perforation secondary to trauma from enemas and evacuation of feces; gentle manipulation and being patient (don't be in a hurry to remove the concretion) are essential.Subtotal colectomy: leakage, dehiscence, and peritonitis; chronic diarrhea (may be associated with bacterial overgrowth from loss of ileocolic sphincter); recurrent constipation; strictureRecommended MonitoringFor cats undergoing medical management, close observation of fecal passage by the owner is essential for prevention of severe recurrent constipation.After subtotal colectomy, monitor:HydrationAppetiteTemperature, blood glucose, abdominal pain (signs of leakage or dehiscence of anastomosis) Prognosis & OutcomeFair prognosis with medical management. Recurrent constipation requiring repeated enemas and manual evacuation is common.Good to excellent prognosis with subtotal colectomy. Owner needs to be aware that stools are usually soft, and the frequency of defecation is increased, for 2 to 3 months after surgery. Occasionally diarrhea is a persistent long-term problem.Guarded prognosis with pelvic osteotomy for pelvic fracture malunion. Correction of obstruction may not resolve megacolonand constipation. Please respond with further questions or concerns if you wish.
Expert:  Dr. Michael Salkin replied 1 year ago.
Hi Everett,

I'm just following up on our conversation about your pet. How is everything going?

Dr. Michael Salkin