Administering Foal Enemas

With a newborn foal, you observe a checklist of progressive behaviors: Regular breaths, ears up, standing, and nursing. Once the foal has survived these adjustments to life after birth, you're tempted to sigh with relief (and go back to bed!).

But to thrive, the foal's digestive system must function in both ingestion and excretion. A newborn can appear normal, yet in his first hours he could suffer a serious problem. The foal could be a candidate for impaction colic due to retained meconium.

The foal, like other mammals, is born with meconium waste in his bowel. The Oxford English Dictionary defines this as a "dark excrementitious substance." These feces develop in the intestinal tract during the foal's fetal period, produced from cell debris and other wastes ingested during gestation. At birth, the gastrointestinal system is ready to function, and the first bowel movement begins the discharge of the material through the colon and out through the rectum.

In a recent article, Noah Cohen, VMD, PhD, Diplomate ACVIM, and M. Keith Chaffin, DVM, of Texas A&M University, noted, "An onset of clinical signs at or just after birth indicates the possibility of a congenital problem. Colic caused by retained meconium must be considered because of the high prevalence of the condition."

The foal's digestive tract must begin functioning immediately after birth. The nursing foal will ingest from 20-25% of his weight daily in mare's milk. To survive, his system must function like an adult's--gastrointestinal motility (spontaneous movement) processes nutrients and eliminates waste. You can observe this function by the amount of waste the foal evacuates in his first hours.

The dam's first milk, colostrum, produces a laxative effect that helps purge the foal's system. Shortly after he begins nursing, the foal should pass the black feces of meconium. After his system moves this waste from his bowel, he then produces the soft, yellow bowel movements normal in a nursing foal. However, a substantial percentage of foals suffer fecal impaction, or a mechanical obstruction of retained meconium.

These first feces can be of a hard and dry consistency. The affected foal begins to show signs of abdominal pain hours after birth. He will seem sluggish and might stop nursing. The foal might raise a hind foot and switch his tail rapidly. He arches his back and crouches as he strains to defecate with no result. Straining stresses the fragile newborn, and some authorities believe it can lead to an umbilical hernia.

The foal usually passes meconium in the first two hours of life, or as long as four to 12 hours after birth. Unless you constantly observe his behavior, you won't be sure he has defecated.

To prevent obstruction, discomfort, and possible colic, many breeders routinely perform enemas on foals as a standard practice. An enema distends the rectum and helps stimulate the intestinal tract to promote evacuation.

This simple precaution can forestall a serious problem in the newborn foal.

"Retained meconium is probably the most common cause of G.I. upset in newborn foals," explained Jim Hamilton, DVM, of "Ask the Vet" on the World Wide Web's Horse Country site. "The enema causes distention of the distal colon, which is a stimulus for (increase in) gut motility. Secondly, the enema fluid adds moisture to the rather dry meconium balls and makes passing them easier."

For this treatment, many equine practitioners recommend using the pre-mixed enema liquid, sold in a plastic squeeze bottle.

"The commercially available, disposable, phosphate-based Fleet enema or something similar are the safest for the lay person to use," said Nancy Aronoff, DVM, and Fairfield Bain, DVM, Diplomate ACVIM, Diplomate American College of Veterinary Pathologists, of the Hagyard-Davidson-McGee Medicine Hospital near Lexington, Ky.

This brand is available in two laxatives: either a saline solution of sodium phosphate (a sodium salt of phosphoric acid), or a mineral oil solution. The bottle includes an attached, lubricated tip for easy insertion, and a valve helps control the flow. Due to the bottle's design, you can insert the tip only a short, safe distance into the rectum.

The foal should be standing for the treatment. An assistant should restrain the foal during the process. With a newborn, an adult can embrace the foal, wrapping one hand around his chest, just below the neck, and the other around the foal's buttocks or just above the hocks. Some handlers grasp the dock of the foal's tail and raise it up.

To administer the enema, gently insert the tip of the bottle into the foal's anus. Use a side to side movement to slide it in place, without applying force.

Slowly squeeze the bottle to expel the solution into the rectum. Allow time for the bowel wall to expand to hold the fluid, and then slide the tip out.

The bottle's design prevents reflux, or a flowing back of the fluid. The laxative solution should stimulate evacuation, so watch for relief of the obstruction.

Using the bottle is the simplest method. You can buy the pre-mixed enemas at any drugstore. They're marketed for human use, but they are completely acceptable for young equines.

Horsemen used to mix their own enema solutions, using a mild soap and water. The usual recipe was a tablespoon of mineral oil, glycerin, or a mild soap like Ivory mixed into a quart of warm water.

If you're familiar with the treatment, you can assemble your own enema tools in place of the pre-mixed bottle. "A soft tube like a stallion catheter may also be used," said Aronoff and Bain. "Great care, lubrication of the tube, and proper restraint of the foal are critical in preventing trauma or tearing to the rectal lining."

For the tubing, you can use a length of three-eighths-inch rubber or plastic surgical tubing and a large funnel. Moisten the soft tip of the tubing with petroleum jelly. With an assistant restraining the foal, insert the tubing an inch or two into the anus. Be careful, as it is possible to cause a ruptured rectum.

Fit the tip of the funnel into the other end of the tubing and hold it higher than the foal's back. Pour the solution into the funnel, to allow the enema to flow in through gravity. When you remove the tube, the fluid will pour out.

Whichever tool you choose, watch for the foal to pass the meconium upon completion of the process. If you see no result, repeat the treatment in an hour.

Administer enemas judiciously, and don't over-treat the foal. Ted Fischer, DVM, of the Chino Valley (California) Equine Hospital said, "We see a lot of foals come in to us that can't defecate because they've had so many enemas. This can cause swelling of the rectal mucosa, especially with water enemas, which causes a hypotonic condition."

A foal's condition can deteriorate rapidly, so don't delay treatment if your foal appears sick. The symptoms and pain should be alleviated soon after you perform the enema. If meconium does not appear following the second enema, the foal probably shows signs of acute colic. He'll appear to be in severe abdominal pain and possibly show distention of the abdomen. A foal which hasn't passed feces in the first 24 hours requires emergency treatment from an equine practitioner.

A veterinarian will want to know what treatment you administered to the foal. Keep track of the times you administered enemas, and any response you observed. The veterinarian will examine the foal's abdominal distention, and he might externally palpate the abdomen to feel for rectal impaction. Using ultrasound, he can see meconium impactions as masses in the large or small colon.

The veterinarian will determine if the foal has either a medical or surgical condition. He might apply therapeutic intervention such as administering fluid or alleviating pain. The foal could require surgery, either to remove the retained meconium or to correct a congenital condition.

Occasionally an enema might be necessary on a foal older than a newborn. If the foal develops and is treated for diarrhea, he could become constipated as a result. To re-establish a normal gastrointestinal function, consult your equine practitioner about this treatment.

Every owner should be prepared to administer an enema. When assembling a foaling kit, stock at least one bottle of pre-mixed enema solution.

Hamilton advised, "Because a foal is so fragile, I think it is wise to be 'proactive' in your standard foaling procedures. Take nothing for granted!"

About the Author

Charlene Strickland

Award-winning writer Charlene Strickland lives in Bosque Farms, N.M. She has published 8 books and over 600 magazine articles, and is a member of the International Alliance of Equestrian Journalists.

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