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If you provide care for equines, you likely already know that colic is a major concern when considering the health of equine residents. If you are considering rescuing or providing sanctuary to equines, learning about this health concern is vital. Knowing how to identify signs of colic and how to respond can save resident lives. Colic is the leading cause of death in horses (and fatal for many donkeys and mules too) across the world. Here we will cover the general signs and types of colic for equines, diagnosis and treatment, causes and prevention, and supplies to have on hand. Then we can discuss some particular things to look out for in donkeys, mules, and miniature horses. 

What Is Colic?

Colic isn’t a particular disease, but the symptom of abdominal pain. Colic is a serious issue (even fatal) among equines and quick action is vital if you suspect colic. Always call a veterinarian if you suspect colic. There are many causes of colic. When colic strikes, the intestines and/or the stomach may be inflamed, the intestinal walls may be distended, the motility of the intestines may be altered, and/or the intestines may be experiencing a loss of blood supply due to torsion. Various types of colic may present differently, and they are often assessed on the basis of the equine’s history, presence of pain, heart rate, respiratory rate, gut sounds (the presence/absence of), frequency, and moisture level of stools, and other exam findings. While some cases of colic are mild and resolve, other cases can be fatal, and all cases should be treated seriously.

Colic can be a broken down into broad categories (This is just one example of how types of colic are broken into categories):

• Spasmodic Colic
  • Spasmodic colic can be caused by sudden changes in diet or nervousness, among other things.
• Impaction Colic
  • Large amounts of food that has larger pieces of unchewed forage that reach the intestines can cause an impaction, as can a lack of water, and ingesting foreign objects, including sand. 
• Displacement/Torsion Colic 
  • This can happen if a loop of the intestines becomes trapped or twisted. If twisted, this can result in a loss of blood supply.
• Excessive Fermentation Colic (Gassy Colic)
  • This can happen from eating too much grain that ferments in the equine’s stomach faster than it can eliminate it.

Is Sand A Problem?
One way to help determine if sand colic is a concern for residents is to put a couple “cups” of fecal stool into a sealable plastic bag, add water, and shake it up, causing the stool to dissolve. Once the stool is dissolved, hold the bag at an angle, allowing one corner to hang lowest. Any sand should start to slide to the lower corner. More than half a teaspoon and you should consider them at risk. This can also be done regularly if you have residents who are prone to sand colic. Checking their stools this way allows you to get ahead of things before they get worse.

Symptoms Of Colic

• Depression  
• Not interested in eating
• Not drinking much
• Pawing
• Looking or biting at the flank  
• Lying down more than usual or at unusual times
• Lying down, getting up, circling, and laying down again repeatedly
• Curling/lifting the upper lip
• Kicking up at the abdomen with hind legs
• Rolling around
• Standing stretched out
• Sitting with hind legs on the ground (like a dog)
• Groaning
• Sweating
• Tacky gums
• Abnormal capillary refill time
• Bright red or purple mucus membranes 
• Absent or reduced gut sounds
• Increased heart rate (normal is 28–44 beats per minute)
• Abdominal distention (appearance of being bloated)
• Less-than-normal to no feces production
• Smaller-than-normal fecal balls
• Diarrhea
• Slimy, mucus-covered stools
• Foals may roll up on their backs or grind their teeth and salivate excessively

If you suspect a resident is colicking, regardless of the severity,  call your veterinarian immediately. Be ready with your resident’s vitals, including temperature, if possible. If you aren’t completely sure of your residents health history, be sure to pull their records to have on hand in order to answer any question your veterinarian might have. 

Colic In Donkeys

The “stoic” nature of a donkey may mean the only signs of colic you observe are “dullness” and an unwillingness to eat. You might see a donkey stretch themselves out in a standing position if they are extremely uncomfortable. It is important to take small changes in behavior very seriously with donkeys. There are physiological differences between donkeys (and mules) and horses. You may notice a different dosage of the same medication recommended for donkeys and horses. Donkeys are also more efficient in water conservation and can digest fiber more efficiently, having slower gut transit times. These elements can affect the risk of certain types of colic and recommended treatment.

Symptoms Of Colic In Donkeys

• Dullness – most commonly the first sign
• Lack of appetite or refusing to eat
• Self-isolation
• Rolling and pawing at the ground (rare in donkeys, if seen indicates very serious problems)
• Standing with the body stretched out
• Fast breathing, raised heart rate
• Excessive sweating
• Color of gums or inside eyelid – brick red color is a poor sign
• Lack of, or a reduction in the normal quantity of droppings
• Head down
• Ears drooping backwards or sideways

Colic In Mules

Mules are the offspring of a male donkey and a female horse. As you might expect, they often lie somewhere in the middle of the Donkey-Horses spectrum in a number of areas. Colic is no different. They are generally more likely to show signs of pain than a donkey might but less than a horse might. There are physiological differences between mules (and donkeys) and horses. You may notice a different dosage of the same medication recommended for mules and horses of a size. Mules are also more efficient in water conservation and can digest fiber more efficiently, having slower gut transit times. These elements can affect the risk of certain types of colic and recommended treatment.

Colic In Miniature Horses

While all horses are at risk of colic and should be carefully observed for any signs of distress, miniature horses seem to be particularly vulnerable to certain forms of colic. Miniature horses are susceptible to food impactions resulting in fecaliths (stone-like balls of feces). They are also susceptible to enteroliths and sand impaction. The ingestion of foreign bodies can cause enteroliths. Enteroliths (stone-like masses) are when the body starts forming a coating around a foreign body in the intestinal tract. This results in hard mineral masses, sometimes referred to as intestinal stones. Possible reasons for their susceptibility to food impaction are poor dental formation (and a subsequent inability to properly grind down food) and a disproportionately small intestine.

You’ve Called The Vet, Now What?

Okay, so you’ve noticed some concerning signs in one of your residents. Call your veterinarian immediately. While you wait for the veterinarian to arrive, monitor your resident’s vital signs and note any further signs of discomfort. Be sure you are trained to listen to gut sounds (or the absence of) with a stethoscope. If possible, get a rectal temperature. Have the residents’ history and records on hand for the vet to look over so you aren’t struggling to locate them when your veterinarian arrives. Remove food from the area. If the colic seems to be a more mild case at that moment, you can hand walk your resident, which may help or simply distract them. However, if the equine shows signs of discomfort while walking, stop. You don’t want to push them. If possible, make sure your resident is in a safe space where they won’t injure themselves if they are rolling around. If they prefer to lay quietly and comfortably, do not force them to get up and walk. If it is hot and sunny, try to get them to some shade. If they are severely incapacitated and aren’t rising, you can construct a makeshift shade/shelter with tarps or blankets and poles or simply buy a camping shelter. In fact, it is good to have one of these on hand for a number of your residents. If you can do so safely, try to relocate the resident to a barn or structure that can provide better lighting and protection from the elements before your veterinarian arrives. This will help your veterinarian to better assess your resident and provide immediate and effective care. Some veterinarians may also request a pail of warm water and a power supply/extension cord. Having these on hand and ready to go and safe precious time.

When The Vet Arrives

When the veterinarian arrives, they will perform an examination in order to accurately diagnose the issue.

Getting A History

 First thing, they will want a history. Have the answers to these questions:

• What is their diet?
• Have there been any changes recently to their diet?
• Have you started any new supplements or medications? When did they start them? What is the dosage?
• Have they recently had a vaccination?
• Have they recently been dewormed?
• Have they recently had their teeth floated?
• Have they recently been seen or treated for another malady?
• How long do they spend inside (in spaces where their movement is limited) each day?
• Have you changed their living spaces/routine recently?
• Have they traveled recently?
• What signs/symptoms have you observed that make you concerned they have colic? 
• Have you noticed any signs in your other residents?
• Have they had colic before? How recent? What was the treatment?
• What is the rest of their medical history?

The Physical Exam

These are common aspects of an physical exam:

• Checking vitals
• Getting a rectal temperature
• Listening for gut sounds (or the absence of)
• Checking the color and capillary refill of mucous membranes
• Examining their mouth and teeth
• Checking skin elasticity “skin tent”
• Checking the digital pulse in the hooves
• Checking for abdominal distention

The Diagnostic Testing

After they have performed the basic exam, depending on what the find, they may carry out more diagnostic testing:

• Check for reflux (place a nasogastric tube)
• Blood work
• Carry out a sand sediment test 
• Do an ultrasound of the abdomen
• Do a rectal exam
• Perform a fecal egg count
• Obtain a fluid sample from the area around the intestines (abdominocentesis)
• Check for ulcers in the stomach (gastroscopy)
• Take radiographs (to look for impactions)

The Treatment

Treatment can vary depending on the findings of the examination. The veterinarian may decide to:

• Place a nasogastric tube (if not already in place for diagnosis) to provide fluids
• Administer fluids on a drip (IV through large veins in their neck)
• Prescribe antibiotics 
• Provide non-steroidal anti-inflammatories or painkillers when appropriate (though you must use caution because some can mask symptoms and some can cause gastric ulcers)
• Give them mineral oil (though the usefulness is debated)
• Administer magnesium sulfate (epsom salt) orally or through an IV to encourage fluid to the bowel.
• WARNING: A veterinarian may prescribe/administer DSS (dioctyl sodium sulfosuccinate) as a stool softener. However, if used improperly, it can cause serious, possibly fatal, side effects.
• Provide doses of psyllium (or epsom salt) through nasogastric tubing for a number of days
• Prescribe alpha-agonists (detomidine and xylazine) for intestinal pain
• Administer an antispasmodic and anticholinergic (buscopoan) to reduce intestinal spasms as well as sedate the individual to prevent continued distress and rolling.
• Hospitalize them
• Recommend surgery 
• Recommend euthanasia 

Possible Causes And Preventative Measures For Colic

Diet

• Make any dietary changes gradually over at least a week, ideally 2-4 weeks. Feed good quality forage and equine specific foods.
• Avoid grain and cereals. Feed a diet high in forage. Rich food, particularly those that are high in starch and sugar, can cause laminitis and colic.
• Do not feed moldy food.
• If using sugar beet, be sure to soak them thoroughly. 
• Ensure regular feeding: small amounts and often, especially if the animal is supposed to be eating extra calories.
• Avoid access to too much rich spring grass, which can lead to problems with laminitis and colic.
• Never feed grass clippings!
• Avoid feeding hay on sandy ground.
• Avoid feeding especially tough and/or old hay.
• Look through hay to ensure it isn’t moldy and does not contain bailing twine or blister beetles.
• Remove seeds/pits from fruits and go easy on the treats, choosing only horse-safe treats.

Water Supply

• Check troughs throughout the day: self-fill auto-waterers can become blocked or the water supply can fail.
• Clean dirty water containers. Many equines will not drink dirty water.
• Check that the water is not frozen or too cold. Equines are less likely to drink cold water, especially in the winter.
• Offer several sources of water.
• Ensure they have access to water at all times.

Cribbing

• Provide a dynamic, enriching environment. 
• Be sure they live with companions.
• Avoid small, uninteresting living spaces.
• Provide access to plenty to forage.
• Avoid grains and cereals.
• Treat gastric ulcers.
• Provide plenty of enriching outdoor space so they can move about.
• Place orally manipulatable toys in their living spaces.
• Offer engaging activities and positive reinforcement learning. 
• Mix up their environment with different sights, sounds, smells, and textures (In a way that the resident finds enriching. If they are afraid or indifferent, then it isn’t enriching.)

Hardware Disease

• Ensure residents cannot access areas where there are tools, random papers, baling twine, food bags, where construction is taking place, and other materials they shouldn’t have access to.
• Walk through living spaces and ensure there aren’t dropped items, old construction materials, or trash that has blown in.
• Avoid placing hay on sandy ground.
• Watch out for residents eating their bedding.

Toxic Plants And Substances

• Know about the poisonous plants and trees that could be present at your sanctuary and prevent your residents from accessing them
• Check pasture and boundary fences and hedgerows frequently and remove any poisonous plants.
• Fence off trees during fruiting to prevent overeating.
• Check hay for signs of mold and blister beetles.
• Ensure they don’t have access to cleaning products or medications or sprays.

Sandy Soil

• Avoid grazing on sandy soil pasture.
• Discuss possible supplementation with your veterinarian that may help eliminate sand from the intestines if ingested by a resident.

Stress

• Make changes to routines gradually. 
• Work on comfort walking into a trailer gradually (using gentle positive reinforcement) before it is needed. 
• Prepare in advance when you know bad weather is coming. Have emergency sheltering and evacuation plans prepared and practiced before there is a need.
• Be sure to introduce new residents to a social group gradually and observe for any confrontations.
• Ensure social species/individuals have access to a buddy.
• Avoid yelling, playing really loud music (planned music for enrichment can be provided in certain circumstances and actually reduce stress), and construction in the area they live in.
• Keep beloved companions as close as possible when one has to be separated temporarily.
• Do not break up bonded pairs for adoptions or when creating new social groups.
• Keep lavender essential oil on hand and allow them to smell it (not touch it) when they are having their hooves trimmed, being treated, traveling, or anything else the individual finds stressful, as it has been shown to reduce heart rate.
• Only use gentle handling/teaching techniques.
• Keep a close eye on them and treat any injuries or illnesses immediately.
• Provide enrichment.

Dental Health

• Ensure a resident’s teeth are checked at least annually (ideally every 6 months) by a qualified equine dental technician or veterinarian .
• Follow a dental care program, which includes having their teeth floated during their dental exams.
• Avoid feeding particularly rough, long-stemmed forage that could injure their mouth.
• Dental disease is more common in older populations. Suspect teeth problems if equine residents are ‘quidding’ (dropping partially-chewed food) or drooling or not eating.

Parasites

• Regularly perform fecal worm egg counts.
• Talk to your vet and follow a dewormingThe act of medicating an animal to reduce or eliminate internal parasites, either prophylactically or in response to illness. schedule.
• Pick up manure from living areas frequently.
• Follow quarantine and other biosecurity measures. 

Stomach Ulcers

• Reduce stress and ensure that you ‘trickle feed’. 
• Talk to your veterinarian about the use of NSAIDs, avoiding when appropriate.
• Feed a diet high in quality forage and avoid grains and cereals, using them only as a supplement when advised by your veterinarian.
• Provide an enriching daily life to avoid stereotypic behaviors like cribbing.

Gastrointestinal Diseases And Pancreatitis

• Treat the underlying disease with your veterinarian.

Tumors

• Ask your veterinarian about this during routine health checks.
• If a tumor is the cause, surgical intervention may be necessary.

Torsion

• If the intestines are twisted, surgical intervention may be necessary.
• It is possible an equine that is already colicking or has a history of colic may get a twisted gut by excessive rolling. Talk with your veterinarian about preventative measures.

Cold Weather Colic
While an equine can colic any time of the year, winter can present particular challenges if you live in an area with cold weather. Impaction colic is usually the biggest threat, though gassy colic can also be a problem. The main issues with cold weather colic are 1) Lack of access to warm, unfrozen water, 2) Reduced time to spend outside moving their bodies, and 3) Lack of access to grazing pastures. 

1) Equines often will not drink if the water is too cold, leading to dehydration and impact colic as there isn’t enough moisture for the needed digestive processes. It is vital that residents have access to warm, clean, and fresh water throughout the cold season. Heated water tanks and warming tools can help keep fresh, warm water available, but will need to be checked daily to ensure they are working properly. 

2) Often residents spend less time outdoors and more time in indoor living spaces where movement is significantly limited. Keeping the body moving helps keep the digestive system functioning properly. When possible, provide as much access as is safe, encouraging movement through strategically placing forage and enrichment throughout the outdoor living spaceThe indoor or outdoor area where an animal resident lives, eats, and rests..

3) Equines who have access to decent pasture are moving and consuming grass with a higher moisture content than the forage they generally receive during cold weather, increasing their need for moisture. Particularly dry and coarse roughage can also cause sores in the mouth, affecting the way a resident chews. This may lead to larger bits of food that can lead to impaction colic.

4) Additionally, equines may lose weight in the winter and humans may try to help them keep on weight by adding grain and concentrates to their diet. Unless specifically told by a veterinarian, equines should receive more forage before considering adding grain and concentrates to their diet. 

Supplies To Keep On Hand For Colic

Keeping certain supplies on hand can allow your veterinarian to walk you through important, potentially life-saving treatments and can also ensure they have the supplies they may need when working with one of your residents. However, you must be trained and experienced, and act under the supervision of a veterinarian. 

ALWAYS CONSULT YOUR VETERINARIAN
This list of supplies is not an invitation for you to diagnose and treat your residents yourself. Do not administer medications or place a nasogastric tube without training, experience, and veterinary supervision. To do so can cause worsening of symptoms, even proving fatal. As always, read our disclaimer and note that we are not your veterinarian!

• Banamine (flunixin) 
• Bute (phenylbutazone)
• Mineral oil
• Magnesium sulfate
• Psyllium
• Thermometer 
• Stethoscope
• Tubing
• Oral syringe 

That’s all for now!

That was a lot of information to process and this isn’t even intended to be an exhaustive resource! If you care for equine residents, you must reach out to your veterinarian and learn from and become trained by them before any issues arise. To not do so could lead to a heartbreaking outcome. While this resource cannot offer veterinary advice, we hope this gives you some useful information to better understand colic, how it can affect your equine residents, and steps you can take to prevent it. Your residents will thank you!

Infographic

Copy of Colic by Amber D Barnes

SOURCES:

Colic | Stillwater Equine Veterinary Clinic

12 Miniature Horse Health Risks | American Association Of Equine Practitioners 

Gastrointestinal Disorders Of Donkeys And Mules | The Veterinary Clinics Of North America 

Colic In Horses | American Association Of Veterinary Surgeons 

Common Veterinary Tests Used To Diagnose Conditions Causing Colic (CCC’s)  | Thal Equine Regional Equine Hospital

How To Diagnose And Treat Colic In Horses | Veterinary Practice News

Enteroliths In Horses | Equinews: Kentucky Equine Research (Non-Compassionate Source)

Prevalence Of And Risk Factors For Colic In Horses That Display Crib-Biting Behaviour | BMC Veterinary Research (Non-Compassionate Source)

The Working Equid Veterinary Manual Chapter 11 | The Brooke (Non-Compassionate Source)

Cold Weather Colic In Horses | Texas A&M College of Veterinary Medicine & Biomedical Sciences (Non-Compassionate Source)

Winter Can Increase Colic Risk In Horses | Kentucky Equine Research (Non-Compassionate Source)

Non-Compassionate Source?
If a source includes the (Non-Compassionate Source) tag, it means that we do not endorse that particular source’s views about animals, even if some of their insights are valuable from a care perspective. See a more detailed explanation here.