Colic Lessons Learned

The more you know about colic, the better prepared you can be when it strikes. ‘Go to school’ with these real-life stories.

Carol Hamilton/

I saw her when I looked out my office window to the field outside. My beautiful mare was down on the ground, thrashing around with her 4-month-old foal standing by her side. A quick assessment was all it took for me to know that she was colicking—severely. I loaded her up and headed to the nearby surgical referral hospital within minutes. And then she died. Before we could even get her on the table. Just like that.

Did I expect it? No way. She was fine in the morning and dead six hours later. Yet if there’s anything I’ve learned in 20-plus years of treating colics, it’s to expect the unexpected. And every time something doesn’t quite go as planned, I add another lesson to the list of possibilities.

I’m going to tell you what to expect when your horse colics, and how to handle the unexpected. I’ll start by outlining the three most common categories of colic episodes I encounter in my practice. Then I’ll share some stories of horses that didn’t fit the mold—those lessons that’ve taught me that when it comes to colic, almost anything is possible.

The Colic Pyramid
Tier 1: Self-limiting

Your horse usually has gut sounds, sometimes louder or more frequent than normal because of hypermotility, or overactive intestines. His heart rate may be elevated, but usually isn’t faster than 60 beats per minute. His gum color is healthy pink, and he’s not dehydrated. He may be very painful—thrashing and rolling when you try to take him for a walk. The good news is that his symptoms often resolve on their own, with just a little bit of walking or a trailer ride. At worst, he responds immediately to a dose of pain-relieving medication, and his signs don’t reappear.

Tier 2: Requires treatment
Your horse is painful, he has diminished gut sounds and may be slightly dehydrated. His heart rate might be elevated above 60, but his gums are healthy pink. He doesn’t get better after an hour of walking. Your vet treats him with pain-relieving medications, tubes him with a laxative, and may even administer intravenous fluids. You stay in constant communication with your vet, and your horse slowly improves. He’s back to normal after a day or two.

Tier 3: 911
Your horse is very painful, with a heart rate as high as 80 beats per minute. He has little or no gut sounds, and his gums may be dark pink or red. His colic symptoms don’t improve with pain-relieving medication, and before you know it, you’re loaded up and headed down the road to a surgical facility where your horse will undergo life-saving colic surgery.

In many situations, I can tell from the initial phone call where your horse is likely to be on this colic pyramid—especially if you’re able to accurately report his condition (heart rate, gut sounds, degree of pain, and how long he’s been showing signs). But every once in a while, I meet a horse that breaks the mold. Let me introduce you to some lesson-teaching colic victims I’ve met in my years of practice.

Lucky Larry
His story: Larry was a 10-year-old Thoroughbred gelding, living in a pasture behind his owner’s house. He’d been showing severe colic symptoms for several hours when the owner called, and at the time of my exam was still extremely painful—throwing himself to the ground even when anyone tried to take him for a walk. His signs improved a bit following a dose of Banamine, but he required heavy sedation before he became comfortable. When I performed a rectal examination, I could feel multiple loops of gas-filled intestines. Given the severity of Larry’s signs, and the abnormal rectal exam that made me think he might have a loop of intestine out of place, I recommended that his owners haul him to a surgical facility.

Sadly, Larry’s owners didn’t have the means to afford surgery, and weren’t able to take him to the referral hospital. When I left the farm, I instructed them to call me back if he continued to be painful—fully expecting I’d be back to perform humane euthanasia within a period of hours. The next morning I got a welcome call. “Larry’s feeling fine,” they said. “Can we feed him breakfast?”

Lesson learned: A simple gas colic can cause more severe pain than almost any other type of colic—even one that requires surgery to correct. And, “never say never.” Even if your horse is severely painful, his colic episode might resolve without aggressive treatment or surgery.

Bad-Luck Bart
His story: Bart was a 16-year-old Appaloosa gelding who worked as a school horse at a local stable. His owner called me when he started showing mild colic symptoms. She could hear gut sounds, and he just seemed a little bit uncomfortable. She’d given him a full dose of Banamine 30 minutes earlier and was trying to avoid the expense of a vet call. She just wanted me to know what was going on in case his signs got worse.

Bart seemed quite comfortable after his Banamine, so the stable owner went home for the night. But things didn’t turn out quite the way she’d planned. When she arrived at the barn the following morning, Bart was dead in his stall.

Lesson learned: Banamine can mask severe colic signs and should be used with caution. If you call your vet to ask whether you should give your horse a dose of this pain-relieving medication, make sure you can accurately assess his condition first. And to avoid masking important symptoms, a half-dose is generally safer than a full dose. Finally, if your horse is showing colic symptoms in the evening, make a point of checking on him several times throughout the night, even if he’s feeling better initially.

Sneaky Sally
Her story: Sally was a 10-year-old Paint mare who’d started showing mild signs of colic pain several hours before her owners called. They decided to haul her to my clinic for evaluation, and when they arrived she seemed to be feeling just fine. Her vital signs were normal and her symptoms had abated. I was concerned that her GI sounds were just a little quieter than normal, and went ahead with the rectal exam that’s a routine part of my colic evaluation. To my surprise, I could palpate a gas-filled loop of intestine that felt out of place.

Even though Sally was interested in food and didn’t appear painful during her exam, her owners were the “better safe than sorry” type, and they decided to haul her to our local surgical facility for observation because of her abnormal rectal exam. Two hours later, her colic symptoms returned and she underwent life-saving colic surgery.

Lesson learned: A full examination, including rectal palpation, can mean the difference between life and death for all but the simplest colic cases. And some horses are either tougher than others or simply don’t experience that much pain even with serious colic. Pay attention to your horse’s subtle signs, and request an examination by your veterinarian if you have any question about your horse’s condition. A thorough exam just might save your horse’s life.

Persistent Pete
His story: Pete was an 18-year-old Quarter Horse gelding, whose owner called me as soon as he started showing very mild colic symptoms. When I examined Pete, I could feel a very large segment of impacted feed within his large intestine. I administered laxatives through a nasogastric tube and started intravenous fluids to help loosen up the impaction. I warned his owner that although most impaction colics respond to fluid therapy, some difficult cases will require surgery to relieve the blockage. She informed me that surgery was absolutely not an option for her horse: If he didn’t respond to the fluids, Pete would be euthanized.

After 24 hours, Pete was still reasonably comfortable, but he hadn’t passed any manure, and the impaction felt as hard as ever. Once again, I warned his owner that surgery might be necessary to save his life, and she reiterated that surgery wouldn’t be an option.

Every 24 hours for five straight days we repeated our conversation—and Pete’s owner stuck to her story that surgery wasn’t an option for this horse. In spite of aggressive oral and intravenous fluids, the impaction wasn’t moving. Finally, on Day 6, Pete started showing signs of severe abdominal pain and it became absolutely clear that surgery would be necessary to save his life. Suddenly, Pete’s owner changed her mind and rushed her horse off to the referral hospital. Pete survived the surgery, but barely. He had to have several feet of intestine removed that suffered serious damage during the time he was impacted.

Lesson learned: Pete’s owner was the one who learned a lesson that day. She wished she’d thought about the options more carefully and known ahead of time that she’d actually consent to surgery if it became a question of life or death. Delaying surgery when it’s needed can significantly affect your horse’s recovery, and may even compromise his chances for survival. I learned to recommend that my clients have a colic plan in place, so they won’t be surprised, and already know what decisions they’d make if their horse suffers a serious colic episode.

Fortunate Fred
His story: Fred was a 10-year-old pony who suddenly started showing severe colic signs. He was fine at breakfast time and throwing himself on the ground not more than an hour later. Fred’s family called me immediately, and before I even made it to the farm, I knew it would be bad. I also knew that things had been tough for this family in recent months; they’d just sent their oldest daughter off to college, and Dad had been laid off at work.

Sure enough, when I arrived at their farm, Fred was in bad shape. His heart rate was over 80 beats per minute, and his pain was uncontrollable even with multiple doses of pain-relieving medication. With a heavy heart, I told them Fred probably would need surgery to survive. Much to my surprise, they were instantly loaded up and headed down the road—with their major medical insurance policy in hand. Due to their quick response (and prior planning), Fred made it through surgery in good condition. Their insurance paid all the expenses except a minimal deductible.

Lesson learned: Major medical/surgical insurance is the best deal in horses. If you have a limited budget for emergencies, knowing that you have insurance will eliminate much of the financial stress that can make a bad situation even worse. To be eligible for major medical insurance, you’ll have to purchase a mortality policy—typically at a rate of around 3 percent of your horse’s value. With that in place, you often can get $10,000, or even more, in medical coverage at a cost as low as $200 per year.

Colic 101
Colic is defined as “abdominal pain,” and is a common horse emergency. You’ll know your horse is colicky if he refuses to eat, starts to paw or roll, kicks at his belly, looks back at his sides, or just generally acts uncomfortable. Although abdominal pain can be caused by a wide variety of different conditions, the following is a rundown of the five most common types of colic.

Spasmodic colic: Hypermotility, or spasms of the intestines, cause intense pain. Typically, this type of colic, which can sometimes be caused by a sudden change in diet, has a sudden onset, and the horse is very painful. It can also stop just as quickly as it starts and often requires no more treatment than a dose of pain-relieving medication.

Gas: A bubble of gas, sometimes caused by a diet change or lack of exercise, accumulates in the large intestine, causing the intestinal walls to stretch and become uncomfortable. The majority of gas colics resolve once the gas moves through the intestine. Pain-relieving medications are often the only necessary treatment. Rarely, a gas bubble can cause an intestinal loop to move out of its normal position, resulting in a displacement or torsion colic (see below).

Impaction: An accumulation of feed material, sometimes the result of inadequate water consumption, poor-quality feed, or dental problems that hinder the horse’s ability to chew, causes a blockage in the intestine. The pain from this type of colic is typically mild—only becoming more severe if an impaction persists for several days. Impaction colics may require administration of laxatives through a nasogastric tube, or intravenous fluid to help soften the blockage so it can be passed. Rarely, an impaction colic will require surgery to resolve.

Displacement: A loop of intestine moves to an abnormal position within your horse’s abdomen; sometimes this results when gas accumulation causes the intestine to move out of place. The abnormally positioned intestine can become blocked, accumulate large amounts of gas, or lose blood supply—all resulting in serious colic symptoms. The majority of displacements require surgery to correct, and the sooner the better to keep the intestines healthy.

Torsion: This is the scariest type of colic of all. For reasons unknown, and sometimes associated with changes in gut movement and/or gas accumulation, your horse’s intestine twists around itself, causing a complete blockage. The intestine rapidly loses its blood supply, and your horse’s pain will be intense. Immediate surgery is necessary to correct a torsion colic. 

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