Common Emergencies - Colic

Colic, a term for abdominal pain in the horse, covers numerous types of gastrointestinal distress.

This painful condition in horses can come on suddenly, seemingly out of nowhere, and while the vast majority of horses recover, it is a leading cause of death in equines.

What is it? What are the signs? What happens after the veterinarian arrives? And what are ways to prevent this all-too-common disorder?

Here are some general facts and tips on dealing with this condition.

Don't Miss the Signs
Feed	Goes off feed and shows little interest in grass
Facial distress	Curls lip, grinds teeth or shows other signs of mild distress
Daily manure	Doesn't pass manure in a normal time frame; passes hard, dry manure; has diarrhea
Pawing and stretching	Paws the ground or stands stretched out with legs parked out in front and behind
Checking, biting, kicking at pain	Repeatedly turns to look at flank; nips or kicks at belly
Getting up and going down, rolling	Lies down and gets up, tries to roll, sits on haunches like a dog
Violent rolling	Persistent rolling, which can be violent

Types of Colic

"Colic" is a catch-all term for belly pain from just about any cause. Here are some common and less common variations:

Gas colic

Discomfort brought on by excess gas in any part of the intestines. This is one of the most common forms of colic and the outlook for recovery with medical management is generally good.
Anterior enteritis

Inflammation in the section of the small intestine closest to the stomach. The cause isn't always clear. The small intestine stops working and becomes distended with fluid that backs up into the stomach. This is usually treated medically.
Impactions

Typically develop when an accumulation of undigested feed blocks the flow through the intestinal tract. Most impactions can be treated medically, but severe ones may require surgery.
Ileal Impactions

These occur in the last section of the small intestine, near the cecum. Two factors seem to be associated with blockage here – infestation with tapeworms and ingestion of coastal Bermuda grass hay, which is widely fed in the Southeast.
Sand colic

Develops when a horse takes in particles of sand or grit during grazing or while eating feed. The sand settles in the intestines, and over time it can irritate the intestinal linking or it may build up to create a blockage (sand impaction).
Enteroliths

Intestinal stones that form when minerals build up around something indigestible that the horse consumes. A single stone or multiple stones can form and may block the intestine. These are treated surgically.
Large colon displacement

Occurs when the large colon moves out of place. This type of event is fairly common because the majority of a horse's large colon can move freely in the abdomen.
Large colon volvulus

Occurs when the large colon twists on itself. This event is life threatening because the twist causes strangulation (cutting off the blood supply to) the affected section, and it requires immediate surgery.
Strangulated small intestines

This condition can develop in several ways. Older horses can develop fatty masses that can wrap around the small intestine and cut off the blood supply. Or a section of the small intestine may get trapped in a space between different organs in the abdomen (such as the liver and pancreas). Or a section of intestine can telescope into itself, causing an intussusception. Regardless of the specific cause of the strangulation, the result in all of these cases is a cutting off of the blood supply to the intestine, which requires surgical correction.

What You Can Do

Check Your Horse
Listen to your horse's abdomen	Invest in an inexpensive stethoscope. Listen on each side of the abdomen by placing the stethoscope (or, in a pinch, your ear) at the flank, in front of and below the point of the hip. Normally, you'll hear several gurgles a minute with a louder rumble every minute or two. Silence is not good; neither is excessive noise.
Check the heart rate	Move the stethoscope to the chest just above the left elbow to check the heart rate. Or, without a stethoscope, find your horse's pulse at the facial artery where it runs across the jaw. Using a watch with a second hand, count beats for 15 seconds and multiply by four to get the rate. A normal resting rate should be around 40 beats per minute.

What You Can Do
Keep watch	If your horse is mildly uncomfortable and quiet, keep watch. If there are any signs of greater pain or if discomfort persists after an hour or two, call your veterinarian. If signs take a turn for the worse or seem to improve but then return, call your veterinarian.
Walk	Walking your horse can encourage gastrointestinal motility. Incessant walking isn't a solution, though, and may exhaust your horse. Make sure to talk with your veterinarian.
Take food away	Impactions are a common cause of colic, and you don't want your horse to eat anything that might add to an obstruction.
Call your veterinarian	Don't wait to call the veterinarian if your horse does not improve in a couple of hours or if the signs worsen or return. If you find your horse sick or painful in the morning, call your veterinarian as the problem may have started some time overnight.

What to Expect When Your Veterinarian Arrives

The veterinarian will ask about your horse's history - how long the colic signs have been going on, when the last manure passed, when and what type of food was last eaten, and if there have been colic episodes in the past. An examination will be performed to determine the severity and cause of the colic. Besides vital signs and gut sounds, the examination will include:

Mucous membranes. Gums should be moist and healthy pink, not dry, dark or bright red or purple. A toxic line is a red line that appears above the teeth when toxic compounds build up in the blood. Prominent blood vessels in the gums or the sclera (whites of the eyes) are another sign.
Capillary refill time. Perform by pressing a finger on your horse's gum to briefly block blood flow and then watching to see how long it takes for color (blood flow) to return. Anything over two seconds suggests that your horse is dehydrated. Pinching a fold of skin on his neck to see how quickly it snaps back is another test for dehydration.
Rectal examination. A palpation of the abdomen via rectal exam may help the veterinarian figure out what's happening in your horse's abdomen. Common abnormalities include a displacement or an impaction in the large colon or areas that are distended with gas or fluid, for example.
Nasogastric intubation.The vet may pass a tube through your horse's nose and down the esophagus to the stomach to draw off the stomach contents. A large amount of gastric reflux (fluid and undigested food) suggests that whatever is causing the colic is preventing the stomach contents from passing through the digestive tract.
Ultrasound. Some practitioners use portable ultrasound units as part of the exam to look for abnormalities in the gastrointestinal tract.

If your horse's pain isn't severe, there is no dehydration and the exam doesn't turn up anything concerning, then the episode will likely be treated at home. Your veterinarian will give you instructions for your horse's care and might administer medications, either intravenously or via the nasogastric tube. It is likely that your horse will need to be watched closely until the colic signs subside.

Afterward, keep an eye on your horse for a day or so, making sure there are no more signs of discomfort, the horse's appetite returns, and normal manure is passed. Controlled hand walks and grazing can be included. Gradually return your horse to a regular diet and routine work. Always follow the direction of your veterinarian.

If You Need to Take Your Horse to the Clinic

If your horse is dehydrated, needs more intensive management or has severe signs that indicate surgery might be necessary, we recommend that you go to a referral clinic such as New Bolton Center where a clinical team can provide a higher level of care than your horse can receive at home.

The most telling sign is persistent pain, especially pain that persists after a medication such as xylazine or detomidine has been administered. A persistent heart rate above 60 can be telling in a horse that shows few other signs. A horse with large volumes of reflux or signs of dehydration usually needs fluids, and that's best done in a clinic.

Even if the signs aren't so clear, you may decide to take your horse in if you can't provide the care that is needed or if you live in an area where it is difficult to get veterinary help quickly.

At the clinic your horse can be closely monitored around the clock and get fluids through a continuous IV drip. At New Bolton Center, we have dual-boarded specialists, a large nursing staff and a critical care facility with a camera in each stall for constant monitoring. While some types of colic require medical management instead of surgery, if your horse takes a turn for the worse, a qualified equine surgeon, internist or critical-care specialist is on site 24 hours a day, seven days a week.

An Ounce of Prevention: Cutting the Risks
Control intestinal parasites	Strongyles and other parasites can damage your horse's intestines and be associated with various kinds of colic. Work with your veterinarian to set up a deworming and parasite-control program.
Ensure adequate water intake	Water not only keeps your horse hydrated, it also keeps food moving through the gastrointestinal tract. If your horse doesn't drink enough, there is an increased risk for an impaction. Ensuring continual access to clean water, offering a salt block, feeding mashes or soaked feed and warming water in cold weather are ways to increase water consumption.
Feed forage	Your horse's digestive system is set up to process high-fiber forage like hay and grass. Large amounts of grain may raise the risk of gas and impaction. Meet most of your horse's nutritional needs with forage, and divide his concentrates into several small feedings a day.
Avoid feed changes	Changes in concentrates or hay, or sudden access to pasture, can trigger colic. Gas production often increases as the beneficial microbes in your horse's gut adjust. When you do make a change, do it gradually over a period of several days.
Turn your horse out	Light exercise and constant grazing during turnout help keep the intestines in good working order.
Stick to a routine	Abrupt changes in lifestyle are linked to increased colic risk, so be as consistent as possible in work, feeding and turnout schedules. If there's a big change – stall rest, a move to a new barn, travel to a competition – be alert to the risks.
Don't rush meals	When your horse exercises, circulation sends blood away from the digestive tract to the horse's muscles. With exercise, your horse also loses fluid by sweating. Follow the one-hour rule – wait an hour after feeding before you ride, and wait an hour after riding before you feed.
Check the environment	Patrol for bits of plastic and baling twine or other debris your horse could accidentally ingest. Check for poisonous plants and signs that he's chewing fences or other objects.
Reduce sand intake	If your horse is fed in a sandy paddock, put hay in a rack with rubber mats below. Any feed buckets should have mats below them. If your horse is turned out in an area with sandy soil, consider feeding a psyllium supplement. Psyllium turns into a gel when wet and may help move sand through the gut.
Arrange a dental checkup	Regular dental floating can decrease the risk of colic in horses of all ages. Yearly dental examinations by a veterinarian are recommended. If your horse cannot chew feed properly, there is an increased risk for multiple gastrointestinal disorders, including choke and colic.

Please note that this information is general in nature and should not replace the advice of a veterinary professional. Colic is a serious medical condition and you should always contact your veterinarian or New Bolton Center as soon as you have any concerns and follow their advice.

If you need to contact us, we are available 24 hours/day, seven days a week, 365 days a year.
Call New Bolton Center at 610-444-5800.