Colic: the signs and what to do

Colic means pain in the abdomen. It isn't one disease but a sign of many different problems, most of them in the stomach or intestines. The pain can be mild or severe, and it can come and go or be constant. The British Horse Society (BHS) describes colic as the most common emergency in horses and a leading cause of death, and warns that it can get worse quickly, so treat it as an emergency.

Spot it: think REACT

The BHS and the University of Nottingham group the signs of colic under the word REACT:

The signs that are easy to miss

Not every horse with colic rolls and thrashes. The BHS says some horses seem quieter than normal and show only subtle signs, and that how a horse behaves may not reflect how much pain it is in. World Horse Welfare lists early signs that are easy to overlook:

• lying down more than usual
• eating less
• passing fewer droppings than normal.

A horse that colicked overnight or out of sight may have left clues. World Horse Welfare suggests looking for a horse that is muddier than usual, which may mean it has been rolling, and for cuts or grazes on the head or bony parts of the body, which are common after violent rolling.

Know what's normal for your horse

You'll notice a change sooner if you know your horse's usual behaviour, droppings, eating and drinking. The BHS also suggests recording your horse's normal temperature, pulse and breathing rate. A pulse and breathing rate above your horse's normal range may mean it is in pain, which could be colic. A raised temperature is more likely to mean illness or infection than early colic. Only take these readings if it is safe to do so; otherwise, wait for the vet.

World Horse Welfare gives these normal ranges for a healthy adult horse at rest:

Daily care explains how to work out your own horse's normal values.

What to do

While you wait for the vet:

• Keep yourself safe. A horse in severe pain can be dangerous to handle and may not notice you. Don't put yourself or anyone else at risk.
• Help the vet find you. If your vet doesn't know your yard, give them a precise location, such as a what3words address or a live location, and a phone number.
• Don't give any medicine. World Horse Welfare says only a vet should give pain relief, and medicine given beforehand can make it harder for the vet to assess your horse.
• Follow your vet's advice on feed and water. World Horse Welfare says this usually means water but no feed.
• Give your horse a safe space. World Horse Welfare suggests a well-bedded stable, and bringing a horse in from the field, especially in the dark, so you can watch it. The BHS advises removing anything the horse could hurt itself on, such as hay nets, buckets and equipment.
• Rolling. The BHS says letting your horse lie down or roll if it wants to won't make the colic worse.
• Walking. Ask your vet first. World Horse Welfare says only walk your horse if your vet recommends it, and never to the point of exhaustion. The BHS suggests that gentle walking may help, ideally on a lunge line, with a riding hat, gloves and suitable footwear; don't force it, and don't walk for more than 30 minutes unless your vet says so.
• Keep watching. Note what your horse does, so you can tell the vet.

What the vet will do

The vet will ask about your horse's history and any recent changes, then examine it: usually the heart rate and breathing, gum colour, hydration and gut sounds. According to the BHS and the University of Nottingham, the tests used most are a rectal examination and passing a tube up the nose into the stomach (a nasogastric tube), which can also release fluid from the stomach. The vet may take a sample of fluid from the belly, and give pain relief, muscle relaxants and fluids. If your horse is in a lot of pain or hard to handle, the vet may sedate it to keep everyone safe. If you're not comfortable holding your horse, tell the vet.

Many cases can be treated at the yard. Some need treatment or surgery at an equine hospital. The BHS gives an average cost for colic surgery in 2023 of £8,690, with a range of £4,764 to £20,343, not counting care before and after the referral. World Horse Welfare points out that referral isn't always possible: the horse may be too ill to travel, or the cost may be too high or beyond your insurance. Think about this before an emergency, and keep your insurance details and transport plans in your emergency plan. If surgery isn't an option and the pain can't be controlled, euthanasia may need to be considered; see end of life.

Types of colic

The vet may tell you what kind of colic your horse has. The BHS and World Horse Welfare describe these types:

• Spasmodic: spasms of the gut, with bouts of sharp pain that come and go. The gut can be noisy.
• Gas: gas builds up and stretches the gut. The horse can look bloated. The BHS says it is often linked to eating new grass.
• Impaction: a blockage, usually of food. Droppings are fewer or drier and the pain is low-grade but lasts, so the signs can be subtle. The BHS links it to a drier diet or box rest.
• Sand: sand and soil build up in the gut. You may see sand in the droppings.
• Displacement: part of the gut moves into the wrong position.
• Strangulating: part of the gut loses its blood supply, for example when it twists. This is the most dangerous type. It usually causes severe, constant pain, though some horses are very dull instead.

Gastric ulcers and inflammation of the gut (enteritis or colitis, often with diarrhoea) can also cause colic. In many cases the exact cause is never found.

Lowering the risk

Not every case can be prevented, but the BHS and World Horse Welfare agree on the basics:

• Feed a forage-based diet: grass, hay or haylage. See forage first.
• Change slowly. Make any change to diet over at least 10–14 days, and change routines such as stabling and exercise gradually too.
• Keep concentrates small: low in starch and sugar, and split into as many small feeds as you can. Soak feeds such as sugar beet as instructed.
• Never feed grass cuttings, garden waste or human food.
• Always provide fresh, clean water, and check it often in hot weather and when it may freeze.
• Manage grazing. Limit lush grass with strip grazing or a grazing muzzle. Avoid overgrazed, sandy fields and feed hay off the ground on sandy soil.
• Look after teeth and worm control. Have teeth checked every 6–12 months, and follow a worm control plan agreed with your vet.
• Keep carers few and well briefed. Horses with many carers, and horses suddenly put on box rest, are at higher risk, says the BHS. A written daily care plan helps everyone know the horse's normal habits.
• Watch after travelling. Travel raises the risk, especially if water was held back. See travelling safely.