Clinical Signs of Colic in the Horse: Book Excerpt

Clinical signs of colic are those changes in behavior or activity that indicate abdominal pain. Although these signs are relatively universal, individual horses may exhibit slightly different cues and different intensities to the same causes of colic. For instance, a colicky foal often rolls onto its back with its feet in the air. Some older horses and perhaps certain breeds may be more stoic than others.

Such horses may experience abdominal pain and show few obvious signs of this pain other than depression or unwillingness to move. Overall, no one knows when a horse is behaving abnormally better than an owner who is well acquainted with his/her horse's normal behavior. Such individuals may pick up on early or subtle behavioral changes that could indicate a problem. Changes that owners often recognize early may include increased recumbency, failure to finish grain or hay, reduced activity either in the stall or in the pasture, increased time spent lying down, abnormal stance, increased time required for feed consumption, reduced fecal production, dry or loose feces, poor hair coat, and weight loss.

These changes are important to share with your veterinarian, who does not have the benefit of seeing these day-to-day changes in your horse.  Therefore, the owner serves as the eyes and ears to the episodes that have prompted veterinary intervention. Your veterinarian can use this information to help evaluate your horse.  As important as this information is, you, as the owner, need to realize that these subtle changes in your horse are not specific to any one condition.  Therefore, these signs do not necessarily mean that your horse is experiencing colic.

Your veterinarian will perform a complete examination that may seem to include things that do not focus on the intestinal system.  This is the correct approach since these signs can indicate problem(s) in areas other than the intestinal tract. During the examination your veterinarian will also look for evidence of previous colic episodes such as skin abrasions, swollen and reddened skin around the eyes and over the hips (from trauma due to rolling), presence or absence of feces in the stall, scrapes left in the stall floor bedding (from pawing), and scrapes or hair found on the walls of the stall that may be left from a horse that has been cast or otherwise trying to alleviate discomfort. 

Most horses will manifest abdominal pain clinically with some important signs.  Very mild abdominal pain might only be apparent in the behavioral changes suggested above. However, horses with mild abdominal pain often show one or more of the following clinical signs:
• pawing at the ground with a forelimb
• stretching out
• reaching around with the head to the flank
• increased amount of time lying down
• poor appetite
• playing in the water bucket
• continual shifting of weight on the hind limbs
• standing against a wall and moving infrequently

If abdominal pain continues or if the condition causes more than simply mild abdominal pain, the signs of more intense (moderate) abdominal pain may become evident.  The signs include the following actions:
• persistent movement (even in the stall)
• frequently pawing at the ground with a forelimb
• repetitively lying down and then getting back up
• rolling after lying down
• grunting
• kicking at the belly
• frequently turning the head to the flank

Clinical manifestations of severe abdominal pain may include the following signs or behaviors:
• profuse sweating
• continuous rolling
• persistent movement
• getting up and down violently

These lists are only general guidelines for gauging the severity of pain. Indeed, individual horses might display other manifestations of pain. Furthermore, the signs of colic displayed by any horse do not neatly divide into the three levels of pain presented here. For any colicky horse several signs from any of the above lists may be present, or there may be few or none if the horse is particularly stoic.

With more advanced progression of colic or with certain types of colic, horses might become more depressed than painful. Depression is generally believed to occur as blood flow decreases to the intestine and leads to segmental death of intestinal tissue and endotoxemia, dehydration, and other poor blood perfusion of the body tissues that can be associated with poor oxygen delivery to the same tissues. Many types of inflammatory diseases of the intestine produce more depression than pain.  Anterior enteritis, colitis, and peritonitis may be more likely to cause greater depression than abdominal pain without necessarily being associated with death of the intestine.

Other than in the instances noted above, greater abdominal pain (colic) is generally associated with more severe disease. Therefore, strangulation of a segment of intestine that leads to loss of blood supply and intestinal death causes more pain than an impaction that causes intestinal obstruction. However, gas distension of any segment of intestine can be extremely painful due to continuous stretching and tension on the intestine and its attachment to the body wall (the mesentery). If severe abdominal pain that has been evident gives way to acute relief and comfort, the astute veterinarian is usually considering the possibility of a rupture of a distended segment of intestine (stomach or intestinal rupture).

Editor's Note: This is an excerpt from Understanding Equine Colic by Bradford G. Bentz, VMD, MS. This book is available from

About the Author

Bradford G. Bentz, VMD, MS, Dipl. ACVIM, ABVP (equine)

Brad Bentz, VMD, Dipl. ACVIM, ABVP, ACVECC, owns Bluegrass Equine Performance and Internal Medicine in Lexington, Ky., where he specializes in advanced internal medicine and critical care focused on helping equine patients recuperate at home. He’s authored numerous books, articles, and papers about horse health and currently serves as commission veterinarian for the Kentucky State Racing Commission.

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