Equine colic is not a single disease but a collective term for any condition causing abdominal pain in a horse. It is one of the most common and potentially life-threatening medical emergencies in equine medicine. Colic can range from a brief episode of mild gas pain that resolves within an hour to a severe surgical emergency requiring immediate hospitalisation and intestinal surgery. Recognising colic early, understanding its many causes, and knowing when to call the vet are among the most critical skills any horse owner or yard manager can develop.
Other Names
- Abdominal pain in horses
- Belly ache (colloquial)
- Spasmodic colic, impaction colic, gas colic, sand colic (specific types)
- Surgical colic (when requiring surgical intervention)
What Is Equine Colic?
Colic describes any form of abdominal pain in a horse. The equine gastrointestinal tract is extraordinarily long and complex — spanning approximately 30 metres from oesophagus to rectum — and is uniquely vulnerable to a range of painful conditions. Unlike humans or dogs, horses cannot vomit, which means any obstruction, gas accumulation, or displacement of the gut can rapidly escalate in severity if not resolved.
The most common forms of colic include:
- Spasmodic (gas) colic: Painful intestinal spasm caused by gas accumulation. Often mild and self-resolving.
- Impaction colic: A blockage of ingested material (typically in the large colon) that fails to pass. Can be caused by dehydration, poor dental care, or dietary change.
- Large colon displacement: Sections of the large colon shift out of their normal position. May resolve with medical management or require surgery.
- Large colon volvulus (twist): The large colon twists on itself, cutting off blood supply. This is one of the most severe and rapidly fatal forms of colic — always a surgical emergency.
- Small intestinal strangulation: Causes include epiploic foramen entrapment, lipoma strangulation (particularly in older horses), and intussusception. All require urgent surgery.
- Sand colic: Sand ingested with grazing accumulates in the ventral colon, causing irritation and impaction.
- Right dorsal colitis: NSAID-related inflammation of the large colon.
Causes
The factors that predispose horses to colic are well established:
- Dietary factors: Abrupt changes in feed type or quantity, introduction to lush pasture, high-concentrate diets, feeding large single meals rather than multiple small feeds
- Water intake: Inadequate water consumption leads to dry, impacted ingesta — particularly relevant in cold weather when horses may drink less
- Dental disease: Poor dentition leads to inadequate chewing of forage, increasing impaction risk
- Parasite burden: Particularly migrating Strongylus vulgaris larvae (less common now with modern anthelmintics) and encysted cyathostomes
- Reduced gut motility: Prolonged box rest, post-operative, or associated with other illness
- Sand ingestion: Horses grazing on sandy soils or eating hay from bare ground
- Stabling: Horses in full-time stabling with limited movement have a higher colic risk than those with free pasture access
- Stress: Changes in management, transport, competition, and yard changes have all been associated with increased colic incidence
- Age: Older horses (over 10 years) are at higher risk of strangulating lipomas — benign fatty tumours that can wrap around the small intestine
- History of previous colic: Particularly previous colic surgery, which can lead to adhesion formation
Symptoms and Signs
The signs of colic range from subtle to dramatic. Severity does not always correlate with type — some horses with a colonic volvulus are initially only moderately distressed, whilst others with spasmodic colic show extreme pain. Common signs include:
- Pawing at the ground
- Looking at or biting at the flank
- Repeatedly lying down and getting up
- Rolling — mild rolling is common; violent or unrelenting rolling is more serious
- Inability or unwillingness to settle
- Sweating, particularly on the neck and flanks
- Elevated heart rate (above 48 bpm at rest is a concern; above 60 bpm indicates significant pain or compromise)
- Reduced or absent gut sounds on auscultation
- Reduced or absent faecal output
- Repeated posturing to urinate without producing urine
- Loss of appetite
- Abnormal mucous membrane colour (pale, dark red, or toxic purple/grey membranes indicate severe systemic compromise)
Diagnosis
Your vet will assess the horse using a combination of clinical examination findings and diagnostic tools to determine the type and severity of colic:
- Physical examination: Heart rate, respiratory rate, mucous membrane colour and capillary refill time, gut sounds on auscultation (all four quadrants), rectal temperature
- Rectal examination: Allows the vet to palpate sections of the large colon, small colon, caecum, and other accessible structures to detect impactions, displacements, and distension
- Nasogastric (stomach) tube: A tube passed through the nostril and down into the stomach to check for gastric reflux — a large volume of fluid refluxing back indicates small intestinal obstruction and is a significant finding
- Abdominal ultrasound: Increasingly used in the field to detect displaced bowel, distended small intestine, and free abdominal fluid
- Abdominocentesis (belly tap): Sampling of peritoneal fluid — cloudy, serosanguineous (blood-tinged), or elevated protein fluid indicates ischaemic gut wall damage and increases the urgency for surgery
- Blood tests: Haematology, biochemistry, lactate measurement — elevated lactate indicates poor tissue perfusion and is a strong predictor of the need for surgery
Treatment
Treatment depends on the type and severity of the colic:
Medical management (for the majority of colic cases):
- Analgesia — flunixin meglumine (Banamine) and/or butylscopolamine for spasmodic pain, sedation with detomidine or xylazine for severe pain
- IV fluid therapy — essential for impaction colic or dehydrated horses
- Oral fluids via nasogastric tube — water, electrolytes, and paraffin oil for impactions
- Walking — short periods of gentle walking can encourage gut motility in mild spasmodic colic. Do not walk a horse in severe pain — this is exhausting and rarely therapeutic.
- Dietary management — withhold grain; offer water and small amounts of good quality hay once pain is controlled
Surgical management (colic surgery — indicated for approximately 10–15% of colic cases):
- Large colon volvulus
- Small intestinal strangulation or obstruction
- Large colon displacement unresponsive to medical management
- Caecal impaction unresponsive to medical management
Surgery carries significant risk and cost but is life-saving in the right cases. Decision-making about referral for surgery should be made promptly — delaying surgery in a strangulating lesion dramatically worsens prognosis.
Prevention
Many colic cases are preventable with good management:
- Feed little and often — multiple small meals reduce the risk of hindgut overload
- Make all dietary changes gradually over 7–14 days minimum
- Ensure constant access to fresh, clean water
- Maintain good dental care — routine rasping by an equine dentist every 6–12 months
- Implement a strategic deworming programme based on faecal egg counts
- Maximise turnout — daily movement supports gut motility
- Minimise unnecessary changes in routine and management
- Feed hay before, not after, hard feed to slow gastric emptying
- Assess sand risk — use psyllium husks regularly if on sandy soil
Prognosis
The prognosis for colic ranges from excellent (spasmodic colic: over 95% resolve with minimal treatment) to grave (large colon volvulus with prolonged ischaemia). For medical colic cases, survival rates are very high. For surgical colic, overall survival to discharge from hospital is approximately 70–75%, with long-term survival at 1 year post-surgery of around 60–65% for most types. Early referral to a surgical facility is the most important factor influencing surgical outcome.
When to Call the Vet
Call your vet immediately — do not wait to see if the horse improves — if:
- The horse has been showing colic signs for more than 30 minutes
- Pain is severe or the horse is unable to be kept safe
- Heart rate is elevated above 52–60 bpm
- Gum colour is abnormal
- The horse has passed no faeces in several hours
- Colic signs return after brief initial improvement
- The horse has a history of colic surgery
Never administer phenylbutazone before the vet arrives — it can mask signs and complicate the clinical assessment. Flunixin meglumine (if prescribed and available) may be given based on your vet's standing instructions. For related conditions, see Equine Diarrhoea and Equine Laminitis (Founder), which can sometimes be triggered by or confused with colic. Our horse terminology guide on the equine digestive system provides essential background reading for understanding colic types and locations.
Frequently Asked Questions
Should I walk my horse during a colic episode?
Brief periods of gentle walking can help distract a mildly uncomfortable horse and may encourage gut motility in cases of spasmodic colic. However, walking does not "fix" colic and has no therapeutic benefit for serious conditions such as impaction, displacement, or volvulus. Do not exhaust a horse in severe pain by continuous walking — a horse in significant pain should be kept safe, quietly observed, and veterinary assistance sought promptly.
Can a horse with colic roll?
Mild rolling in a colicking horse is generally safe. The historical belief that rolling causes intestinal twists (volvulus) is not supported by evidence — it is far more likely that a horse with a volvulus rolls because of the pain the volvulus causes, rather than the rolling causing the volvulus. However, violent, uncontrolled rolling on hard surfaces can cause secondary trauma (head injuries, lacerations). If the horse can be kept safe and comfortable in a well-bedded stable, this is preferable to forcing a very painful horse to remain standing.
How do I know if my horse needs colic surgery?
Your vet will advise on this based on the clinical examination findings. Signs that increase the likelihood of requiring surgery include: persistent or worsening pain despite adequate analgesia, elevated heart rate that does not respond to treatment, abnormal mucous membranes, gastric reflux on nasogastric tubing, abnormal peritoneal fluid, distended small intestine on rectal examination or ultrasound, and elevated blood lactate. When in doubt, earlier referral to a surgical facility is always safer than waiting — delay significantly worsens outcomes for strangulating lesions.
How much does colic surgery cost?
Equine colic surgery is a major procedure. In the UK, costs typically range from approximately £4,000–£8,000 or more, depending on the type of surgery, duration of hospitalisation, and post-operative complications. Insurance is strongly recommended for horses at risk. Discuss payment options, insurance claims, and the surgical referral process with your vet before an emergency arises, so that decisions can be made quickly if needed.