Chronic Megacolon Treatment & Management

  • Author: David M Manuel, MD; Chief Editor: Julian Katz, MD   more...
 
Updated: Feb 28, 2010
 

Medical Care

In the absence of perforation, initial management is conservative. Some experts believe a role exists for as-needed fecal disimpaction and for evacuation by enemas and suppositories.

Pay close attention to exclusion of any underlying cause. If identified, correct electrolyte/metabolite abnormalities, and remove medications that may influence colonic motility (eg, narcotics, anticholinergic agents, calcium channel antagonists).

The use of biofeedback for a colonic inertia etiology for chronic megacolon is probably not effective, although successful treatment of functional outlet obstruction with biofeedback has been reported.

In patients requiring hospitalization, decompression using nasogastric tubes and rectal tubes may assist in treatment. When such tubes are used, anecdotal experience has demonstrated that frequent position changes for the patient may help to improve decompression.

If the dilatation persists or worsens, colonoscopic decompression can be attempted, with consideration of placement of a decompression tube, per rectum, to the right side of the colon. Unfortunately, following decompression, the dilatation usually recurs; therefore, decompression with colonoscopy must be carefully considered, as it is not without risk in an unprepared, dilated colon. Many gastroenterologists no longer consider placement of a drainage tube at the time of colonoscopy, as it nearly always becomes clogged with stool and rapidly ceases to function.

Beyond these options for the treatment of acute megacolon, the recommended regimen for chronic megacolon in a stable patient is as follows:

  • Empty the bowel (eg, osmotic laxatives, enemas, suppositories, cathartics, digital disimpaction).
  • Practice a bowel habit retraining program (eg, scheduled times for defecation, increased physical activity if possible).
  • Consume bulking agents/bowel agents.
  • Slowly alter/individualize the regimen.
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Surgical Care

Surgical care is generally recommended if the dilatation is persisting or worsening after the above medical measures have been exhausted.

Megacolon operative options include total abdominal colectomy with ileorectal anastomosis, total proctocolectomy with ileostomy, and total proctocolectomy with ileoanal anastomosis, depending on the site of the colon affected.

Total abdominal colectomy with ileorectal anastomosis is the operation of choice of megacolon with normal-sized rectum.

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Consultations

These problems require a multidisciplinary approach, including the primary care provider, a gastroenterologist, a nutritionist/dietitian, and possibly a surgeon.

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Diet

Patients with acquired, nonacute megacolon should follow a high-fiber, high-fluid intake diet, which usually helps to decrease constipation. Some patients with severe constipation state that a high-fiber diet produces greater difficulty with bloating and constipation.

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Contributor Information and Disclosures
Author

David M Manuel, MD  Fellow, Department of Internal Medicine, Section of Gastroenterology, Providence Hospital and Medical Center

David M Manuel, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Medical Association, American Society of Gastrointestinal Endoscopy, and Crohns and Colitis Foundation of America

Disclosure: Nothing to disclose.

Coauthor(s)

Michael H Piper, MD, FACG, FACP  Clinical Assistant Professor, Department of Internal Medicine, Division of Gastroenterology, Wayne State University School of Medicine; Consulting Staff, Digestive Health Associates PLC

Michael H Piper, MD, FACG, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Gastroenterology, American College of Physicians, and Michigan State Medical Society

Disclosure: Nothing to disclose.

Roberto M Gamarra, MD  Consulting Gastroenterologist, Digestive Health Associates, PLC

Roberto M Gamarra, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Medical Association, American Society for Gastrointestinal Endoscopy, and Crohns and Colitis Foundation of America

Disclosure: Nothing to disclose.

Clifford Y Ko, MD  MS, Professor, Department of Surgery, University of California at Los Angeles School of Medicine

Clifford Y Ko, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Society of Colon and Rectal Surgeons, Association for Academic Surgery, California Medical Association, and New York Academy of Sciences

Disclosure: Nothing to disclose.

Specialty Editor Board

Terence David Lewis, MBBS, FRACP, FRCPC, FACP  Program Director, Internal Medicine Residency, & Assistant Chairman, Associate Professor, Department of Internal Medicine, Division of Gastroenterology, Loma Linda University Medical Center

Terence David Lewis, MBBS, FRACP, FRCPC, FACP is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Medical Association, California Medical Association, Royal College of Physicians and Surgeons of Canada, and Sigma Xi

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Douglas M Heuman, MD, FACP, FACG, AGAF  Chief of GI, Hepatology, and Nutrition at North Shore University Hospital/Long Island Jewish Medical Center; Professor, Department of Medicine, Hofstra North Shore-LIJ School of Medicine

Douglas M Heuman, MD, FACP, FACG, AGAF is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Physicians, and American Gastroenterological Association

Disclosure: Novartis Grant/research funds Other; Bayer Grant/research funds Other; Otsuka Grant/research funds None; Bristol Myers Squibb Grant/research funds Other; Scynexis None None; Salix Grant/research funds Other; MannKind Other

Alex J Mechaber, MD, FACP  Senior Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine

Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD  Clinical Professor of Medicine, Drexel University College of Medicine

Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law, Medicine & Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

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