Opinion statement
Patients presenting with megacolon and megarectum require extensive specialized testing to distinguish underlying Hirschsprung’s disease from other secondary causes. Diagnostic testing and long-term treatment are best initiated after disimpaction has been achieved, by large-volume tap water enemas and/or oral colonic lavage with polyethylene glycol. With intensive treatment (including biofeedback if pelvic floor dysfunction is present), at lease one half of patients can avoid surgery. Maintenance therapy relies on daily use of osmotic laxatives. Stimulant laxatives are used intermittently as rescue treatments if there has not been a satisfactory bowel movement in 3 days. Patients with idiopathic megacolon or megarectum may require surgery if they have refractory symptoms. Depending on age, pelvic floor, and anal sphincter function, patients who have isolated megacolon can be treated with either subtotal colectomy with ileorectostomy or diverting loop ileostomy. Patients with isolated megarectum can be treated with either proctectomy and coloanal anastomosis or vertical reduction rectoplasty. Patients who have combined megacolon and megarectum can be offered diverting loop ileostomy or, if pelvic floor function is normal and they wish to avoid stoma, total proctocolectomy with ileal pouch-anal anastomosis.
Similar content being viewed by others
References and Recommended Reading
Preston DM, Lennard-Jones JE, Thomas BM: Towards a radiologic definition of idiopathic megacolon. Gastrointest Radiol 1985, 10:167–169.
Redmond JM, Smith GW, Barofsky I, et al.: Physiological testing to predict long-term outcome of total abdominal colectomy for intractable constipation. Am J Gastroenterol 1995, 90:748–753.
Gattuso JM, Kamm MA: Clinical features of idiopathic megarectum and idiopathic megacolon. Gut 1997, 41:93–99. Excellent paper detailing retrospective and prospective clinical experience of patients with megarectum and/or megacolon managed medically and surgically at St. Mark’s Hospital.
Brown SR, Shorthouse AJ: Restorative proctocolectomy for idiopathic megarectum: postoperative recovery of hypotonic anal sphincters. Report of two cases. Dis Colon Rectum 1997, 40:625–627.
Gattuso JM, Kamm MA: Clinical features of idiopathic megarectum and idiopathic megacolon. Gut 1997, 41:93–99.
Narducci F, Bassotti G, Gaburri M, Morelli A: Twenty four hour manometric recording of colonic motor activity in healthy man. Gut 1987, 28:17–25.
Rao SS, Welcher K, Zimmerman B, Stumbo P: Is coffee a colonic stimulant? Eur J Gastroenterol Hepatol 1998, 10:113–118.
Voderholzer WA, Schattke W, Muhldorfer BE, et al.: Clinical response to dietary fiber treatment of chronic constipation. Am J Gastroenterol 1997, 92:95–98.
Meshkinpour H, Selod S, Movahedi H, et al.: Effects of regular exercise in management of chronic idiopathic constipation. Dig Dis Sci 1998, 43:2379–2383.
Chung BD, Parekh U, Sellin JH: Effect of increased fluid intake on stool output in normal healthy volunteers. J Clin Gastroenterol 1999, 28:29–32.
Palsson OS, Heymen S, Whitehead WE: Biofeedback treatment for functional anorectal disorders: a comprehensive efficacy review. Appl Psychophysiol Biofeedback 2004, 29:153–174. This paper describes the role of biofeedback as a valuable adjunct to medical therapy in the treatment of constipation associated with pelvic floor dysfunction.
Yerkes EB, Rink RC, King S, et al.: Tap water and the Malone antegrade continence enema: a safe combination? J Urol 2001, 166:1476–1478.
Gattuso JM, Kamm MA, Halligan SM, Bartram CI: The anal sphincter in idiopathic megarectum: effects of manual disimpaction under general anesthetic. Dis Colon Rectum 1996, 39:435–439.
Culpert P, Gillett H, Ferguson A: Highly effective new oral therapy for faecal impaction. Br J Gen Practice 1998, 48:1599–1600.
Foxx-Orenstein AE, Szarka L, Camilleri M, et al.: Nonselective opioid antagonist does not increase small intestine or colon transit effect of tegaserod in subjects with constipation predominant-IBS. Neurogastroenterol Motil 2005, 17(Suppl 2):43.
Corazziari E, Badiali D, Bazzocchi G, et al.: Long term efficacy, safety, and tolerability of low daily doses of isoosmotic polyethylene electrolyte balanced solution (PMF-100) in the treatment of functional constipation. Gut 2000, 46:522–526.
Herve S, Savoye G, Behbahani A, et al.: Results of 24-h manometric recording of colonic motor activity with endoluminal instillation of bisacodyl in patients with severe chronic slow transit constipation. Neurogastroenterol Motil 2004, 16:397–402.
Muller-Lissner SA: Adverse effects of laxatives: fact or fiction. Pharmacology 1993, 1:138–145.
Pemberton JH, Rath DM, Ilstrup DM: Evaluation and surgical treatment for severe idiopathic constipation. Ann Surg 1991, 214:403–411.
Metcalf AM, Phillips SM, Zinsmeister AR, et al.: Simplified assessment of segmental colonic transit. Gastroenterology 1982, 92:40–47.
Gladman MA, Scott SM, Lunniss PJ, et al.: Systemic review of surgical options for idiopathic megarectum and megacolon. Ann Surg 2005, 241:562–574. Comprehensive review of published surgical series of operative management of megacolon and megarectum.
Stewart J, Kumar D, Keighley MR: Results of anal or low rectal anastomosis and pouch construction for megarectum and megacolon. Br J Surg 1994, 81:1051–1053.
Gladman MA, Williams NS, Scott SM, et al.: Mediumterm results of vertical reduction rectoplasty and sigmoid colectomy for idiopathic megarectum. Br J Surg 2005, 92:624–630.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Szarka, L.A., Pemberton, J.H. Treatment of megacolon and megarectum. Curr Treat Options Gastro 9, 343–350 (2006). https://doi.org/10.1007/s11938-006-0016-5
Issue Date:
DOI: https://doi.org/10.1007/s11938-006-0016-5