Colic in Horses: Recognizing the Signs of the #1 Equine Emergency

Why Colic Is the Emergency Every Horse Owner Fears

In my years of equine practice, I have seen colic at every hour of the day and night. It is, without question, the condition that takes the most horses from us — more than any infectious disease, more than trauma, more than anything else. The word “colic” is not a diagnosis; it is a symptom. It means abdominal pain, and the cause behind that pain can range from a simple gas bubble that resolves in twenty minutes to a twisted intestine that will be fatal without surgery within hours. Your ability to assess which situation you are dealing with — and to communicate that clearly to your veterinarian — can be the difference between life and death for your horse.

The Four Major Types of Colic

Understanding the categories of colic helps you speak the same language as your vet and make better decisions in the moment.

Gas and Spasmodic Colic

This is the most common type and, thankfully, the most benign. Gas accumulates in the large colon, causing distension and pain. Gut sounds are often loud and rumbling. Horses may paw, look at their flank, and lie down briefly, but they are usually manageable. Most cases resolve with light walking and time. Pain tends to be intermittent rather than constant.

Impaction Colic

Feed material — most often at the pelvic flexure of the large colon — becomes dry and compacted, creating a blockage. This is very common in winter when horses drink less water and hay intake increases. Pain is typically moderate and persistent. Your horse may pass little or no manure. Medical treatment with fluids and lubricants resolves most impactions, but severe cases require referral.

Displacement Colic

Sections of the colon shift out of their normal position — the most infamous being a left dorsal displacement, sometimes called a “nephrosplenic entrapment,” where the colon becomes trapped over the nephrosplenic ligament between the left kidney and spleen. Pain ranges from moderate to severe. Some displacements resolve medically or with controlled exercise; others require surgery.

Strangulating Lesions

This is the category that kills horses quickly. A strangulating lesion cuts off blood supply to a section of bowel — examples include a small intestinal volvulus, large colon volvulus, or a small intestinal entrapment through a mesenteric tear. Pain is severe, constant, and unresponsive to pain medication. The horse deteriorates rapidly. Without surgical intervention, death occurs in hours. Time is absolutely critical.

The 4-Point Owner Exam

Before you call your veterinarian, do a rapid four-point assessment. This information will help your vet triage the case and decide whether to walk you through home management or get in the truck immediately.

1. Heart Rate

A normal resting heart rate is 28 to 44 beats per minute. Press a stethoscope or your fingers to the inside of the left elbow, or find the pulse beneath the jaw at the facial artery. A heart rate above 48 bpm is a significant warning sign. A heart rate above 60 bpm is an emergency. A heart rate above 80 bpm indicates severe cardiovascular compromise and the horse needs a surgeon, not a medical call. Heart rate is your single most reliable indicator of pain severity and gut compromise.

2. Gut Sounds

Listen in all four quadrants — upper and lower on both sides. You should hear gurgling, rumbling, and occasional “tinkling” sounds at least every 30 to 60 seconds per quadrant. Complete silence in one or more quadrants suggests ileus (gut shutdown) and is a red flag. Loud, high-pitched sounds can indicate gas distension. Absent sounds in all quadrants paired with a high heart rate means call immediately.

3. Mucous Membrane Color and Capillary Refill Time

Lift the upper lip and look at the gums. They should be pink and moist, and when you press a finger firmly and release, color should return within 1 to 2 seconds (capillary refill time, or CRT). Pale pink, white, or purple gums — or a CRT longer than 2 seconds — indicate shock or severe circulatory compromise. Tacky or dry gums suggest dehydration. Any abnormal color is grounds for an emergency call.

4. Pain Level and Behavior

Mild pain: the horse is uncomfortable, pawing, looking at the flank, but pauses to eat hay or drink water. Moderate pain: the horse is unwilling to stand still, goes down and gets up repeatedly, refuses feed. Severe pain: the horse throws itself down violently, rolls uncontrollably, sweats profusely, and cannot be distracted. Severe, unrelenting pain that does not respond to walking suggests a strangulating lesion until proven otherwise.

When to Call vs. When to Wait

Call your veterinarian immediately — do not wait — if any of the following are true: heart rate above 52 bpm; abnormal gum color or prolonged CRT; severe, uncontrollable pain; no manure passed in more than 4 hours; pain that does not improve after 30 minutes of walking; pain that was improving but has returned worse; distension visible in the flank; or any horse that has had a previous surgical colic.

You may monitor briefly at home if: the horse has a heart rate below 48 bpm, normal pink gums, audible gut sounds, only mild intermittent discomfort, and is still passing manure. Check every 15 to 20 minutes. If the situation is not clearly improving within 30 to 45 minutes, call.

A Critical Warning About Banamine

Flunixin meglumine (Banamine) is a powerful NSAID that many horse owners keep on hand, and it has a legitimate place in colic management. However, I must be direct with you: giving Banamine to a horse with a strangulating lesion can mask the severity of pain long enough for the horse to deteriorate past the surgical window. The pain returns when the drug wears off, but the bowel may be non-viable by then. Never give Banamine before your vet has assessed the horse unless you are instructed to by your veterinarian after a phone consultation. Always report any medications given before your vet arrives.

Medical vs. Surgical Colic

Your veterinarian will perform a rectal examination, pass a nasogastric tube to check for reflux, assess pain response to medication, and may recommend bloodwork and abdominal ultrasound. Referral to a surgical facility is recommended when there is nasogastric reflux (fluid accumulating in the stomach because the small intestine is obstructed), a heart rate that does not decrease after pain medication, ultrasonographic evidence of small intestinal distension or thickened loops, or pain that does not respond adequately to medical treatment. Survival rates for surgical colic at experienced facilities range from 70 to 85 percent for small intestinal cases and are even higher for large colon surgeries when horses are referred promptly.

Prevention Strategies That Actually Work

While not all colic is preventable, these practices significantly reduce risk: provide constant access to clean, fresh water, especially in winter (heated buckets or tank heaters are worth every penny); feed primarily forage and avoid large grain meals; make all diet changes gradually over 10 to 14 days; maintain a regular deworming program based on fecal egg counts; ensure regular dental care so horses chew properly; provide daily exercise and turnout; and establish a relationship with your veterinarian before an emergency happens so you know exactly who to call and when.

The horse that comes through colic is often the one whose owner caught it early, assessed it accurately, and made the call at the right time. Know your horse's normal. Trust your instincts. And never hesitate to call your vet — we would always rather talk you through a mild case than arrive too late for a surgical one.