Horse colic: the first response while you wait for the vet

Quick answer

A horse that goes down and stays down when it would normally be on its feet is often the first thing an owner actually notices.

Phone the vet before you do anything else, then take a heart rate. Those two actions decide more about the outcome than everything else you can do at the yard.

Colic is not a diagnosis. It is abdominal pain, and it covers everything from a gas bubble that will pass in an hour to a twisted intestine that is dying inside the horse. You cannot tell which one you have from the outside, and the ones that kill do so on a timescale of hours.

• Remove all feed and hay immediately. Do not give any drug unless the vet has told you to.
• Take heart rate, gum colour, capillary refill and gut sounds, then take them again in twenty minutes. The trend is what matters.
• Walking gently is fine if it settles the horse. Walking a horse to exhaustion is harmful and does not prevent a twist.
• Rolling does not cause a twist. It is a response to pain, not a cause of it.
• Have the horse's identification documents ready. In the UK and EU, the medicines declaration in the passport decides which drugs the vet is legally allowed to use.

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Do not give flunixin, phenylbutazone or any other painkiller before the vet has examined the horse, unless the vet has specifically instructed it on the phone.

These drugs suppress pain and lower the heart rate without treating the cause. A horse with a strangulating lesion that has been given flunixin can look deceptively comfortable for hours, and that is exactly how a surgical case is missed until it is too late to survive surgery.

Injecting flunixin into muscle carries a separate risk of clostridial myositis, a rapidly fatal infection. If a vet does instruct you to give it, ask about the route.
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Decide in 60 seconds

Why the horse gut fails the way it does

No escape valve at the front.

The equine oesophagus enters the stomach at a sharp angle and the sphincter there is unusually strong. Combined with a stomach that sits deep under the ribcage, this makes vomiting effectively impossible.

The consequence is that anything which backs up has nowhere to go. Fluid accumulating from a small intestinal obstruction fills the stomach until the wall gives way, and gastric rupture is not survivable. Decompressing the stomach through a nasogastric tube is therefore one of the first things a vet will do, and the volume of fluid that comes back is one of the most important pieces of information in the whole examination.

A colon that is not tied down.

The ascending colon is enormous and, over much of its length, is not anchored to the body wall. It folds back on itself at the pelvic flexure, where the diameter narrows abruptly, then widens again.

That geometry produces two failure modes. Firm ingesta lodges where the tube narrows, which is an impaction. Or a gas-filled, mobile section shifts out of position and can rotate on its own axis, which is a volvulus and cuts off its own blood supply.

Two ends in the same place.

The caecum takes in and empties out near its top. Material has to travel upward to leave, which makes the caecum vulnerable to impaction when gut motility or hydration falls.

Why the clock is short.

In a strangulating lesion, blood supply to a section of intestine is cut off. That tissue begins dying immediately. Endotoxin crosses the damaged wall into the circulation, and the horse goes into shock.

Survival after surgery depends heavily on how much gut is still viable when the abdomen is opened. Every hour of delay reduces that. This is why the honest advice is to call early and be wrong sometimes, rather than to wait and be right once.

Take the numbers

Lift the lip and press the gum: colour and refill time tell you about circulation, which is the part of colic that kills.

Write every reading down with the time next to it. A single set of numbers is worth something; two sets twenty minutes apart is worth far more.

Heart rate.

Place a stethoscope on the left side just behind and above the elbow, or feel the artery under the jaw. Count for fifteen seconds and multiply by four.

Commonly quoted resting values for an adult horse sit around 28–44 beats per minute, but the number that matters most is this horse's own resting rate, which is why it is worth taking a few times when everything is normal. A rate that stays high, or climbs between checks, indicates either uncontrolled pain or failing circulation.

Mucous membranes and capillary refill.

Lift the upper lip. Healthy gums are moist and pale pink. Press a thumb firmly on the gum, release, and count how long the white patch takes to refill; under about two seconds is normal.

Pale gums suggest poor perfusion. Brick red, dark red or purple gums, or a dark line at the gum margin, suggest endotoxaemia and are a serious finding. Tacky, dry gums indicate dehydration.

Gut sounds.

Listen in four places: high and low on each flank. Normal gut produces gurgling and rumbling with occasional loud rushes.

Silence is significant and means motility has stopped. Very loud, constant, fluid sounds can indicate diarrhoea developing or hypermotility. In sandy regions, a sound like waves washing over a beach, low down on the right or left ventral abdomen, points to sand in the colon.

Temperature and breathing.

Take the rectal temperature. Reference figures commonly given for adult horses are roughly 37.2–38.3°C, with resting respiration around 8–16 breaths per minute.

A fever alongside colic signs shifts the likely diagnosis towards inflammation or infection of the gut, such as colitis or proximal enteritis, rather than a simple obstruction. That changes the treatment plan entirely, so the reading is genuinely useful even though it is not the most urgent one.

Digital pulses and feet.

Feel the pulse at the back of the fetlock on each foot. A strong, bounding digital pulse suggests laminitis, which can either mimic colic or follow from the endotoxaemia that colic produces.

What to do while you wait

Have the kit, the light, the water and a second person organised before the vet arrives, not after.

Walking, properly understood.

Gentle walking in hand can help a gassy or spasmodic colic by encouraging gut movement, and it gives you something to do that keeps the horse from throwing itself down in a dangerous place.

What it does not do is prevent a twist. The belief that continuous walking stops the gut turning is folklore, and acting on it causes real harm: a horse walked for hours arrives at surgery dehydrated and exhausted, which worsens the anaesthetic risk in an already high-risk procedure.

If the horse wants to stand quietly, let it stand quietly. If it wants to lie down and is lying calmly, that is not an emergency in itself.

Rolling.

Rolling is a horse responding to pain. It is not the mechanism that creates a volvulus, and preventing it does not prevent one.

The reason to manage rolling is human and equine safety. A horse going down suddenly in a stable can trap you against a wall, and can injure its own head and hips. Never position yourself where you cannot get out.

Your own safety.

A horse in severe colic is genuinely dangerous and is not in control of where it puts itself. Stay out of corners, keep the door behind you, and if the pain is uncontrollable, accept that the safest option may be to leave the horse in a safe space and observe from outside until the vet arrives.

What else it could be

Colic signs are not specific to the intestine, and several look-alikes change the response entirely.

Tying up, or exertional rhabdomyolysis.

Stiffness, reluctance to move, sweating, hard and painful hindquarter muscles, and dark red or brown urine, usually shortly after exercise. Do not force this horse to walk. Movement worsens muscle damage.

Choke, meaning oesophageal obstruction.

Food and saliva at the nostrils, retching movements of the neck, coughing, distress, but the horse is often still interested in food. Remove all feed and call the vet; do not attempt to flush anything into the mouth.

Laminitis.

Weight shifted onto the heels, reluctance to walk, strong digital pulses, heat in the hooves. A horse that will not move can be misread as a horse with abdominal pain.

Foaling problems in a mare.

Straining, restlessness and rolling near term can be dystocia or uterine torsion rather than gut colic. Say the mare's pregnancy status when you phone. It changes who the vet sends and how fast.

Foal-specific causes.

A newborn straining and rolling onto its back is usually meconium impaction. A colt foal a couple of days old, straining and becoming progressively duller, may have a ruptured bladder. Both need a vet rather than home enemas.

Grass sickness, in regions where it occurs.

Equine dysautonomia is reported particularly in the UK and northern Europe and parts of South America. It presents with colic signs, muscle tremors, drooping eyelids, difficulty swallowing and patchy sweating. Mention the region and the pattern when you call.

Atypical myopathy.

Seen where sycamore grows in Europe and box elder in North America, seasonally, in horses on bare autumn or spring pasture with seeds or seedlings present. Weakness, stiffness, dark urine and depression can be mistaken for colic and it is rapidly fatal.

Sand enteropathy.

In sandy paddocks, on short grazing, or where hay is fed on bare ground. Suspect it regionally rather than universally, and mention it if it applies, because it changes the treatment.

Getting the history straight before the vet arrives

The examination will be faster and better if you can answer these without going to look.

When did you last see the horse normal, and when did the signs start. What the horse has eaten in the last day and whether anything about the feed, hay batch, bedding or grazing changed.

When droppings were last passed, how many, and whether they were normal, dry, loose or reduced. Whether water intake has changed, which matters a great deal in cold weather when horses drink less.

Recent worming, when and with what, and whether faecal egg counts are done. A large worm burden treated abruptly is a recognised trigger.

Recent dental work and when. Poor dentition produces poorly chewed forage and is a genuine impaction risk in older horses.

Whether the horse cribs or windsucks, because that behaviour is associated with a specific strangulating lesion at the epiploic foramen.

Age matters. Strangulating lipomas, which are fatty masses on a stalk that wrap around intestine, are a classic cause in older horses and are essentially a surgical problem.

Any medication given, by anyone, and at what time. If a painkiller was given before the vet arrived, say so immediately rather than letting them examine a masked horse.

The decision you should make before you ever need it

Colic surgery is expensive, time-critical and not always the right choice. The worst time to think about it for the first time is standing in a stable at midnight with a vet waiting for an answer.

Work out in advance whether you would pursue referral, what your insurance actually covers and whether there is a per-condition limit, how far the nearest surgical hospital is, and how long transport would realistically take.

Also decide who is authorised to make the decision if you cannot be reached, and make sure that person's name and number are on the yard.

In the UK and EU, the horse passport contains a declaration about whether the animal is intended for human consumption. That declaration determines which medicines can legally be given. If it is not signed correctly, some treatments are unavailable, so find the passport now rather than during the emergency.

What never to do

Do not give any painkiller, sedative, muscle relaxant or "colic drench" without veterinary instruction.

Do not pass a stomach tube, give an enema to an adult horse, or attempt any rectal procedure yourself. Rectal tears in horses are catastrophic and are caused by exactly this.

Do not offer feed to see whether the horse will eat as a test of recovery. Eating during an obstruction adds to the material that has to be cleared.

Do not walk a horse to exhaustion, and do not walk a horse that is stiff and sweating with dark urine.

Do not assume that a horse that has settled is fixed. Improvement after a period of severe pain, with a heart rate that has not come down, can mean the gut has died rather than recovered.

Do not delay the call because it is out of hours, because you are not sure, or because the last one turned out to be gas.

When to get help

Recovery means comfortable behaviour and a heart rate that has come back down, and droppings that start again.

Call immediately, and say the words "colic" and "emergency" when you book, for any of these:

• Any repeated pain behaviour: pawing, flank watching, repeated getting up and down, curling the upper lip, stretching out
• Violent or uncontrollable pain
• A heart rate that is above this horse's normal and rising
• Dark, brick red, purple or muddy gums, or capillary refill over about two seconds
• Absent gut sounds
• A visibly distended abdomen
• Any fluid or food material at the nostrils
• No droppings passed for an unusually long period for that horse
• A pregnant or recently foaled mare with any of the above
• A foal of any age showing straining, rolling or dullness

Tell the vet on the phone: the time signs started, all the vitals you have taken with their times, what has been eaten and when, when droppings were last passed, anything you have given, and the horse's age, sex and pregnancy status.

Then say how far you are from a surgical referral centre and whether transport is available, because that shapes the plan the vet makes before they have even left.