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Feline idiopathic megacolon can be a frustrating and challenging problem to manage. Appropriate medical management of this problem can include dietary modification, stool softeners, and pro-kinetic medications. Medical management serves to reduce the frequency and severity of obstipation in affected cats, but despite good medical management, we still see cats getting obstipated. Once obstipation occurs, there are few medical ways resolve it without mechanical removal of stool. The manual deobstipation procedure remains the most effective way to resolve feline obstipation. Unfortunately, most sources leave the specifics of how to perform this procedure up to the practitioner. However, there is a “best practice” method of performin g feline deobstipation that is effective, safe, and efficient.
The three ways to remove stool in an obstipated cat include 1) serial enemas, 2) polyethylene glycol 3350 (MiraLAX®) infusion via nasogastric tube, and 3) manual deobstipation. In milder cases of obstipation where the radiographic diameter of the stool is similar to that of the pelvic outlet, either serial enemas or percutaneous endoscopic gastrostomy (PEG) infusion can be effective. But more often than not, the stool volume (diameter) is so large and the stool is so firm that these two less-invasive methods are not likely to be effective, and they can take days to show any improvement — often still requiring manual deobstipation (Images 1 and 2). For the more severely affected cat, manual deobstipation is faster, less expensive, and more comfortable.
Since feline megacolon rarely results from a metabolic cause, full diagnostic lab work is rarely required, especially for previously diagnosed patients. An abbreviated pre-anesthetic panel will usually suffice, unless the patient’s condition dictates otherwise. A lateral radiograph of the abdomen is helpful to gauge the severity of the problem and to help determine if manual deobstipation is likely necessary. Immediate deobstipation is rarely an emergent procedure. It may be preferable to give enemas overnight (40–60 ml of warm water and about 5 ml of a water-based lubricant every eight hours) to help soften the stool. This step is often needed to make deobstipation successful if the stool is particularly desiccated. A clinical decision needs to be made if the benefits of a delayed procedure (softer stool, better hydrated patient) outweigh the benefits of deobstipating the cat on the day of presentation (ongoing patient discomfort, owner anxiety). It is rare that intravenous fluid is required overnight if the procedure is to be performed the next day. Subcutaneous fluid is adequate. Improved hydration is desired to make anesthesia safer, not because patient hydration will significantly affect the hydration of the stool — that is the role of the enemas.
Keeping your work space and the patient as clean as possible will be appreciated by your technical staff, or the whole hospital staff in smaller practices.
Your dominant hand is used to remove the stool. Always apply some lubricant to your gloved finger before inserting it into the rectum. This will help to avoid rectal abrasions. Remove any distal pieces of stool that are small and easily accessible. Once only a large firm piece of stool is palpable and cannot be retrieved, it will slowly need to be broken into smaller pieces for removal.
If you are the person in your hospital who is most willing to deobstipate cats — I commend you. The more you do it, the more you will be asked to do it. It is not the most glamorous thing we veterinarians do, but it is important. Lean into it as you help lots of cats.
