Colic: What are the Signs and How to Manage?

What is Colic?

Colic is a general term meaning abdominal pain caused by gastrointestinal (GI) upset or distress. The GI tract of the adult horse is approximately 100 feet long, starting at the mouth and ending at the rectum. Colic can occur in the stomach through the intestines. A veterinarian should be consulted when a horse exhibits signs of colic because it can be fatal if left untreated. However, many cases are mild and can be resolved at home.

Colic Signs:

A horse can display a variety of signs when they are colicking. Commonly seen signs include:

• Frequently turning and looking towards the belly
• Excessive pawing
• Lying down and rolling often (foals tend to roll up on their back, getting cast)
• Kicking/biting the flank or belly area
• Increased heart rate
• Excessive sweating
• Increased respiration rate
• Increased capillary refill time
• Changes in mucous membranes (color and hydration)
• Changes in manure (absence of, mucous-covered, dry, diarrhea, etc.)
• Decreased appetite and water consumption
• Curling the lip
• Grinding teeth
• Changes in posture
• Depression/behavior changes
• Changes in gut motility (increased or decreased)

A horse can exhibit multiple signs during a colic event, but rarely shows all the signs at once. Horses evolved as prey animals and tend to hide signs of illness or pain to reduce predator attraction. Prey behavior causes some horses to be more stoic than others. Knowing your horse's normal behavior and vitals is essential to identify when something has changed.

Normal Vital Signs:

It is important to know the normal vital signs for your horse. Vital signs can be easily monitored at home, and it is recommended that vitals be assessed daily or weekly at a minimum. The only supplies needed to monitor vitals at home are a stethoscope, a thermometer, and a watch (with second hand or displayed). Typical vital signs monitored are pulse rate, respiration rate, temperature, mucous membranes, capillary refill time (CRT), digital pulses, and gut sounds.

Types of Colic

Colic is a general term used to describe abdominal pain, but there are specific types of colic that occur. A veterinarian can determine the type of colic based on signs and a physical examination. 

Gas Colic

Gas colic occurs when the microbes overproduce gas in the intestines. Gas colic can be caused by abrupt feed changes or excessive gut fermentation.

Impaction Colic

Impaction colic occurs when something is consumed or builds up in the intestines, causing a blockage. A common area for impaction colic is at the pelvic flexure (this is a specific area of the colon where the intestine makes a sharp turn) because there is a decrease in the diameter of the intestine. Impaction colic can be caused by feeding high amounts of indigestible fiber, sand/dirt consumption, dehydration, enteroliths (intestinal stones), or partially chewed feed.

Torsion/Displacement/Strangulation

Torsion colic is caused by a twist (torsion) in the intestine that reduces or cuts off blood supply to the area. Displacement colic occurs when the intestine, typically the colon, shifts out of its usual position. Strangulation colic is when blood supply is lost to a portion of the intestine. A strangulating lipoma (a noncancerous fatty tumor in the abdomen attached by a stalk that can wrap around the intestines) or intestinal torsion can cause strangulation colic. The horse's foregut is attached to the body wall by connective tissues. However, the large intestine is not attached to the abdomen, so it can move freely and result in these types of colic. They require veterinary intervention because they can be fatal if not treated.

Spasmodic Colic

Spasmodic colic is when the intestines contract more frequently than normal, causing pain. Parasitic overloads and stressful events can cause this type of colic, but sometimes the cause is unknown.

Recurrent Colic

Recurrent Colic is when a horse has multiple colic episodes a year and can be as frequent as several times per month. Recurrent colic is uncommon, and having a horse colic once does not guarantee it will happen again. Horses with recurrent colic have multiple colic episodes but return to normal between episodes. Recurrent colic can be caused by scar tissue, ulcers, colic surgery, reduced GI motility, poor dentition, horses with stereotypic behaviors (such as cribbing), partial intestinal blockages, or other medical conditions.

False Colic

False Colic is when a horse shows signs of colic, but the cause of the problem is outside the GI tract. False colic can be caused by a foal moving inside the uterus, uterine torsions, high fever, and other diseases. A veterinarian must be consulted before giving any anti-inflammatory medication because it can mask the signs of one of these other conditions and can make it harder to determine the cause of the concerning signs.

What to Do if Your Horse is Colicking

Colic is an emergency, and a veterinarian should be consulted as soon as it is noticed. Mild colics tend to resolve themselves with anti-inflammatory medications, movement, and time, but first consult your veterinarian to determine if a farm call or a haul-in appointment is needed. Assessing vital signs and giving information to the veterinarian will help them decide on a course of action. Several diseases can cause colic-like signs, so avoid giving any medications unless instructed by the veterinarian. Medication can also mask the signs of the colic, making it more difficult for the veterinarian to diagnose the cause when they arrive.

Allow the horse to stay lying down if it is comfortable. If the horse frequently gets up, lays down, and rolls, you can walk the horse to try to alleviate some of the pain. However, if there are signs of lameness or soreness, walking can worsen the issues. Owner safety is a concern for horses that are thrashing and rolling uncontrollably. Leave them in the stall and pad the areas the best you can to prevent injury, but do not get in the way of rolling/thrashing because you can be injured.

All feed should be removed from the area, but a water bucket can stay. Once the veterinarian arrives, they will perform a physical exam to determine the severity of the colic and provide a home treatment plan or determine if hospitalization or surgery is necessary.

Risk Factors and Prevention

Colic can happen very quickly and without any warning, but some things can be done to reduce the chances of some types of colic.

Nutrition

The horse's stomach is small compared to the size of the actual animal, so the amount of concentrate or grains fed should be limited to 0.5% of their body weight per feeding or less (5 pounds or less for every 1,000 pounds of body weight). Higher feeding rates can be safely fed in multiple meals per day. An overload of grains high in starch can disrupt the hindgut microbiome by changing the pH to make it more acidic, killing the gut bacteria responsible for fermentation. This can result in colic and even laminitis. Feed transitions need to be made over a 10–14-day period to allow the microbes in the hindgut to adjust to the differences in feed.

Forage is a crucial part of the equine diet. Horses are hind gut fermenters, meaning that microbes in the large intestine and cecum can break down the forages into usable energy through a fermentation process. Horses evolved eating multiple small meals throughout the day, so it is optimal for gut health to have access to forage 24/7. Reduced access to forage can cause changes in gut motility, increase the chances for ulcers, and potentially increase the chances of colic. If a horse is stalled or in a dry lot, hay can be fed in a hay bag to increase the time that forage is available to maintain gut motility.  

A horse should always have access to fresh, clean water. The average 1,000-pound horse drinks at least 6 gallons of water daily and will consume more when working or in a warm environment. Dehydration causes disturbances in gut motility, leading to impaction colic. Water consumption can be encouraged by frequently cleaning buckets/troughs, supplying water with no additives, adding a tablespoon of salt to the grain/concentrate, and removing ice in the winter.

Health Status

A horse should have a dental exam and float performed yearly because their teeth are continually growing. Chewing is the first step in the digestion process, which involves mechanically breaking down the food. Sharp points or uneven grinding surfaces on the teeth can prevent adequate chewing and reduce overall intake. A reduction in forage intake and partially digested food can reduce GI motility, increasing the risk for colic.  

Internal parasites are linked to impaction and spasmodic colic. A fecal egg count can be performed to identify and determine the number of parasites. Most horses should be dewormed twice yearly, once in the spring and once in the fall; however, horses in moderate or high shedding categories (200+ eggs per gram) may need extra deworming treatments. Owners can work with veterinarians to determine the shedding category and frequency of deworming to prevent colic and maintain health.

Broodmares in the late stages of gestation or post-partum are at a higher risk for colic than geldings or mares who are not pregnant. In most cases, this colic cannot be prevented, but knowing your horse's normal vital signs and behavior can help identify when something is wrong and help you get medical intervention sooner.

Horses that display stereotypic behaviors are at a higher risk for colic. Stereotypic behaviors include cribbing, wind-sucking, stall walking, weaving, self-mutilation, and pawing. Extra precautions and added enrichment to the horse’s environment can be used to reduce the prevalence of stereotypic behaviors.

Management

Multiple research studies have shown that stalled horses are more likely to colic than pasture-housed horses. A preventative measure can be to provide as much time in the pasture or dry lot as possible to reduce the time stalled. Full pasture access is not always an option, depending on the housing location, like at a boarding or training facility. Still, some things can be done to reduce stress and boredom while the horse is in the stall. A horse should be stalled where it can see other horses, and access to hay or toys in the stall can help reduce stress.

Stressful events can trigger a colic episode. Stressful events can be changing housing facilities, frequent trips, changing herds, etc. Make transitions slowly to reduce stress. When trailering, a hay bag can provide forage and distraction. On long trailer rides, stopping every few hours to offer water can also be helpful.

Other Diseases Causing Colic Signs

There are multiple diseases or chronic issues that can cause colic-like signs. One of the most common conditions is gastric ulcers. Ulcers are lesions within the digestive tract, typically in the stomach, where the stomach/intestinal lining has been damaged. This is painful and irritating to the horse, and outward signs are similar to colic. There are many other conditions or illnesses that can cause colic signs, such as infections, a moving fetus, or tying up episodes.

Planning Ahead for Colic Emergencies

The treatment plan for a severe colic can be costly, especially if surgery and hospitalization are required. When buying a horse, the owner needs to start planning for emergencies. If the horse is stabled, the owner needs to have their emergency contact information, the veterinarian of choice, and the services that can be provided if they cannot be reached or present at the event. This information should be given to the facility owner or manager with instructions on what to do during your horse's emergency. An owner needs to have a predetermined amount they can afford to spend. Colic treatment is variable depending on the severity, but can range from a few hundred dollars for home treatments to more than $10,000 after surgery and hospitalization. Owners can get insurance plans to help alleviate the costs of surgical procedures, but they likely will not cover all the expenses.

Outside of cost, there also needs to be a plan for getting the horse to an equine hospital for treatment. If you do not own or have access to a trailer, a plan must be made to get the horse to the treatment facility. An option can be having someone else haul the horse or borrowing a trailer.

Unfortunately, colic can be fatal. After-life plans should be considered when making an emergency plan for your horse. Emergencies can be difficult to think about, but it is easier to plan ahead of time. A few things to consider would be disposal of the remains, such as burial, cremation, or composting, moving the horse to the final resting place, and access to machinery, if needed.

Conclusion

Colic is an emergency that is often unpreventable. Knowing your horse's normal vital signs and behaviors is essential to determining if there is a problem. If you think something is wrong, always consult a veterinarian.

References

Escalona EE, Okell CN, Archer DC. Prevalence of and risk factors for colic in horses that display crib-biting behaviour. BMC Vet Res. 2014;10 Suppl 1(Suppl 1):S3. doi: 10.1186/1746-6148-10-S1-S3. Epub 2014 Jul 7. PMID: 25238292; PMCID: PMC4123051.

Hewetson, Michael. (2006). Investigation of false colic in the horse. In Practice. 28. 10.1136/inpract.28.6.326.