Horse Colic: When Is It an Emergency?

What Colic Actually Is

The word "colic" is not a diagnosis — it is a symptom. Colic simply means abdominal pain in a horse. The source of that pain can range from a mild gas buildup that resolves in 30 minutes to a twisted intestine that will kill the horse in hours without surgery. The challenge for every horse owner is knowing which type you are dealing with.

Roughly 80 to 90 percent of colic episodes are mild to moderate and resolve with basic treatment or on their own. The remaining 10 to 20 percent require veterinary intervention, and a subset of those require emergency surgery. Learning to assess your horse quickly and accurately can save its life.

Common Types of Colic

Spasmodic (Gas) Colic

The most common type. Caused by gas accumulation, intestinal spasms, or minor feed changes. Most horses recover within 1 to 3 hours with walking and sometimes antispasmodic medication. Pain is intermittent — the horse may show signs, then seem fine, then show signs again.

Impaction Colic

A blockage of feed material in the large colon, usually at natural narrowing points. Caused by inadequate water intake, coarse feed, or sand accumulation. Moderate to severe pain, no gut sounds on the right side, no manure production. Many impactions resolve with fluids and mineral oil administered by a vet; severe impactions may require surgery.

Displacement and Torsion

The large colon can move out of its normal position (displacement) or twist on itself (torsion/volvulus). Torsion is the most dangerous type of colic — the blood supply to the gut is compromised, and the horse deteriorates rapidly. This is always a surgical emergency. Pain is often severe and unrelenting. The horse will not respond to pain medication in a normal way.

Small Intestine Obstruction

Includes strangulating lipomas (fatty tumors that wrap around the small intestine), epiploic foramen entrapment, and other mechanical obstructions. These are surgical emergencies. Small intestine obstructions progress quickly to irreversible gut damage.

Sand Colic

Common in sandy-soil regions (Florida, parts of Texas and California). Horses graze close to the ground and ingest sand, which accumulates in the large colon. Signs include chronic low-grade colic, weight loss, and loose manure. Diagnosed by fecal sand test or radiographs. Managed with psyllium and in severe cases, surgery.

Signs of Colic: Mild vs. Severe

Sign	Mild/Moderate Colic	Severe / Emergency Colic
Pain behavior	Pawing, looking at flank, mild restlessness	Violent rolling, throwing body against walls, unable to stand
Heart rate	44 – 60 bpm (normal is 28–44 bpm)	Over 60–80 bpm; high HR that does not come down
Gut sounds	Normal or slightly reduced	Absent on one or both sides
Mucous membranes	Pink and moist	Pale, grey, tacky, or purple (toxic line)
Capillary refill time	Under 2 seconds	Over 2–3 seconds
Response to walking	Calms down somewhat	Unresponsive; continues violent behavior
Manure production	May have passed some manure	No manure for 6+ hours; significant gut distension

What to Do First: Your Initial Assessment

When you find a horse showing signs of colic, do the following before calling the vet:

1. Check heart rate. Use a stethoscope behind the left elbow. Count beats for 15 seconds and multiply by 4. Write it down.
2. Check gut sounds. Listen on both sides, both upper and lower quadrants. Note whether sounds are present, reduced, or absent.
3. Check gum color and capillary refill time. Press your thumb on the gum for 2 seconds and release. Color should return in under 2 seconds. Gums should be salmon-pink.
4. Note whether the horse has passed manure recently. Fresh manure in the stall or paddock is a reassuring sign. No manure for hours is concerning.
5. Assess pain level. Is the horse uncomfortable but controllable, or are they throwing themselves around and unable to be safely handled?

When to Call the Vet: The Rules

Call your vet immediately if:

• Heart rate is above 60 bpm and not coming down
• Pain is severe and unrelenting — the horse cannot be distracted or calmed
• Gums are pale, tacky, grey, or show a purple toxic line at the gum line
• No gut sounds in one or more quadrants
• No manure for 6 or more hours and visible distension of the abdomen
• The horse has been showing pain for more than 60 minutes without improvement
• The horse was given banamine (flunixin meglumine) and initially improved, but pain returned within 2 hours

When you call, have your assessment data ready: heart rate, gut sound status, gum color, time since onset, manure status, and what if any medication you have given. This data allows the vet to triage over the phone.

Banamine: Use Carefully

Flunixin meglumine (Banamine) is an NSAID that most horse owners have on hand for colic. It is a useful tool, but it has limitations and risks. Banamine can mask pain without addressing the underlying cause. A horse that appears to "improve" after Banamine and then gets worse quickly is a red flag for a serious lesion. Never give more than one dose before consulting your vet. Never give it intramuscularly — IV only, or as an oral paste. IM injections of Banamine cause severe muscle necrosis.

To Walk or Not to Walk

Light hand-walking can help with mild gas colic by stimulating gut motility and preventing the horse from rolling violently (which can cause intestinal displacement). However, there is no evidence that walking prevents a twist from happening. Do not exhaust a horse by walking it for hours. If walking is not calming the horse or if the horse is too painful to walk safely, stop and focus on getting veterinary attention.

After the Crisis: Preventing Recurrence

After a colic episode resolves, review the potential causes with your vet:

• Water access and intake (inadequate water is a primary driver of impaction colic)
• Hay quality and type (coarse, stemmy hay increases impaction risk; sudden feed changes cause spasmodic colic)
• Parasite load (some parasites directly damage the gut)
• Dental health (poor dentition leads to inadequate feed chewing and higher impaction risk)
• Exercise and turnout (horses that move freely have lower colic incidence than those that are stall-bound)