Colic is a medical emergency for your horse, both because of the pain it causes him and because it can be life threatening. Your veterinarian will want to listen via stethoscope to your horses intestinal sounds, as this can provide important clues.

Simply put, colic in your horse means that he’s experiencing some type of abdominal pain.

Problems with any of the organs in the abdomen—liver, spleen, urinary tract, reproductive organs, or intestines—can cause abdominal pain. While most colics are caused by problems in the intestinal tract, only a veterinary exam can tell you for sure what’s causing the problem.

While colic may be simple to describe, you shouldn’t ever consider it to be a simple problem. Colic represents a medical emergency for your horse, both because of the pain it causes him and because it can develop into a life-threatening situation.

Recognizing the symptoms of colic and treating them as quickly as possible generally improves the chances of a favorable outcome for your horse. You should suspect colic immediately if you see changes in these three areas/aspects of your horse: posture, body language, and vital signs.

Crucial Clues
Posture. If your horse is experiencing only mild pain—or is in between bouts of pain—all you may see is that he looks droopy, tired, or depressed. You’ll usually see him standing with his head down and eyes half shut. This posture can easily be mistaken for a napping, relaxed horse—except that you’ll notice several other peculiarities. If your horse is in a group pasture situation at the time, he’ll likely have isolated himself from the other horses. If he’s alone in a stall, he may be standing with his head facing the back wall.

Horses with mild to moderate abdominal pain will often lay down, either fully flat on their side or sitting on their sternum—and you’ll often see them switch back and forth between the two positions. If you notice that your horse has been lying down more than usual or at an unusual time of the day—like during feeding time—be suspicious.

If your horse is standing while in moderate to severe pain, he’ll likely be standing in a stretched-out position as if to urinate. This is often called a "sawhorse stance" because of the similarities in appearance. If your horse is male, his penis often will be at least partially dropped. You may also notice that he might pace, circle, or get up and down frequently.

Horses in severe pain will often roll on the ground, sometimes violently as the pain escalates.

Body language. Who says horses don’t talk? More often, it’s that we don’t know when, how, or where to listen. For your horse’s well-being, you must learn to become a keen listener to what your horse says with his body language.

A classic sign of abdominal pain in your horse is when he frequently turns his head back to look at, nudge, or even bite at his flank. If you see him kicking at his belly, make sure flies aren’t bothering him. This is a fairly specific sign. Another sign of pain is if you see your horse pawing at the ground. Horses with abdominal pain, or those in shock, may even begin to tremble.

You may notice your horse has become somewhat more vocal, making grunting or groaning sounds. You’re more likely to hear these noises when he’s lying down, which might prompt you to notice other clues. Keep an eye open for your horse exhibiting any lip lifting or rolling (Flehmen response). He may even audibly grind his teeth.

In addition to observing your horse’s body language, examine the ground or stall around him for signs of unobserved pain. Does it look like he might recently have been pawing (bedding pushed aside, holes in dirt) or rolling (flattened grass or bedding, dirt or bedding in the coat and mane)?

Vital signs. Your horse’s pulse and respiratory rate are important clues to the severity of his pain and also to shock status or other metabolic problems. When evaluating your horse, it helps to know what his pulse and respiratory rate normally are since a resting pulse will run anywhere from 28 to 40 beats per minute and still be normal, depending on the individual.

That said, as a rule of thumb, a pulse rate between 40 to 50 bpm is mildly elevated, 50 to 60 is moderately elevated, and above 60 is severely elevated. The respiratory rate tends to change parallel with the pulse rate, so horses experiencing severe pain or metabolic problems breathe the most rapidly.

You should also take your horse’s temperature. In cases where the cause of colic is infectious—such as with Potomac Horse Fever, Clostridia, or Salmonella—you may see fever. Conversely, if your horse is going into shock, the temperature may be abnormally low.

Finally, keep an eye on the feel and color of your horse’s gums and the capillary refill time (see "Big Red Flags" below). These are valuable clues to your horse’s metabolic condition and whether dehydration is developing.

Your veterinarian may pass a stomach tube to check for build up of fluid in the stomach. This occurs commonly with colic problems that involve the small intestine and may even be found with serious large intestinal disorders.

Other Clues
If you (or your horse’s caretakers) are observant, you will have noticed other signs, as well, to indicate that your horse isn’t feeling well. He may not be eating or at least not eating well, you may notice reduced water intake, or you may have seen changes in the amount and consistency of his manure. These are very important observations because they will help your veterinarian to make a diagnosis.

For example, not eating well can come from any source of pain, so it’s not terribly specific for diagnosis. But knowing how long your horse has been off feed can help narrow down the possibilities. A horse whose appetite has been declining slowly—or you may have noticed that it was on and off—may have something that builds slowly to the crisis stage, like an impaction or an enterolith. Loss of appetite that developed suddenly and at the same time as other signs is more likely to be from an acute problem.

If your horse has had an obvious change in manure, this certainly points to the digestive tract. However, abdominal pain does not necessarily mean it’s coming from the intestinal tract, so no change in manure amount or consistency can lead your veterinarian to explore other causes.

Other possible diagnoses include problems such as urinary tract stones, pancreatitis, a ruptured ovarian artery in a mare who has foaled recently, a ruptured bladder in a foal, a ruptured spleen or fractured rib from a kick, a leaking abdominal abscess, a bile duct infection, a testicular torsion in a stallion, or a uterine torsion in a pregnant mare. The list can be exhaustive!

Colic Look-Alikes
The signs of colic are usually fairly straightforward, but there are a few other conditions that may be mistaken for colic based on some symptoms alone. A horse experiencing an attack of hyperkalemic periodic paralysis (HYPP) can be mistaken for colic because of distress, trembling, weakness, and possibly lying down.

Tying-up syndrome also can look like colic, but the onset during exercise and the development of hard muscles of the legs and body make colic unlikely.

Acute laminitis may also mimic colic, with the parked-out stance and obvious pain. However, the laminitic horse will be very reluctant to move, obviously lame when he does move, and his hooves will be hot to the touch with elevated pulses in the arteries feeding the foot.

Pleuritis is a very painful inflammation of the lining of the chest that can develop in a horse with pneumonia or an abscess in his chest. These horses are depressed and breathing rapidly.

Missing from all of these look-alike conditions will be any change in manure, changes on rectal exam, or changes in gums. Appetite will have been normal up until the time of the "attack."

What to Do
The first thing you should do if you suspect your horse may be experiencing a colic episode—regardless of severity—is to contact your veterinarian. Never just decide on your own that it’s not serious enough to call the doctor. Even if your vet does ultimately decide you don’t need a farm call yet, at least he/she will have been alerted to the problem. Often, they can suggest steps you could take to help the situation, and they also can let you know who is on call for emergencies if you need help outside of regular hours.

Don't Give Up on Impactions

Horses with impaction colics may have severe abdominal pain that causes them a good bit of distress—with pawing, rolling, agitation, and sweating. However, pulse rate typically never gets into the danger zone and the color of their gums stays good. Medical treatments for impaction involve intravenous fluids, oral fluids by stomach tube, enemas, and pain-relieving drugs. Impactions often can take up to a week to resolve, so don’t let the ongoing pain your horse may be experiencing fool you into giving up too soon. Slowly, over time, with medical management, impactions resolve themselves.

You should never give any drugs or even non-drug "remedies" to a horse with colic without talking to your veterinarian first. Your vet may want to examine the horse before anything is given that may change the signs. Giving a medication without your vet’s knowledge could also end up limiting the treatment options he/she has available.

How Bad Is It?
This is, no doubt, one of the first questions you’ll have once your veterinarian arrives, but it isn’t always easy to answer. As an owner, you will understandably be focused on your horse’s pain, but the level of pain isn’t always a good indicator of how life threatening the colic may be.

Horses with impaction colic may have severe pain, but they can be successfully treated medically and don’t develop the ominous changes in their gums that indicate dehydration and metabolic involvement. Conversely, horses with only moderate pain may have a twisted or entrapped section of intestine that can become necrotic because of lack of adequate blood supply and cause a life-threatening leak of bacteria into the abdomen. Horses also vary widely in their pain tolerance. Stoic individuals may fool you, while the more sensitive horses react badly to minor gas. So, you really need your veterinarian’s input to answer this question.

The rectal examination your veterinarian does is extremely important. It is not always 100% successful in establishing a diagnosis, but without a doubt it provides information you cannot get any other way. Cases that require surgery usually will have obvious loops of dilated and/or fluid-filled bowel that can be felt on rectal examination.

The horse’s intestinal sounds heard by stethoscope provide important clues. Your veterinarian may also pass a stomach tube to check for build up of fluid in the stomach. This occurs commonly with problems that involve the small intestine and may even be found with serious large intestinal disorders.

After putting together all the information, your veterinarian will give you a list of possible causes of your horse’s colic and suggestions for how to proceed.