It’s the bogeyman in every horse owner’s closet, the 3 A.M cold sweat, the tentacled monster lurking under the bed.

This nightmare looms large in the horseman’s mind for good reason. As the leading cause of death in domestic horses, colic is nothing to scoff at.

As monsters go, colic is a shape-shifter, and for many people their understanding of colic depends on the shape they’ve experienced. Let’s say we have a horse that looks somewhat painful. He lies down and gets up again, circles, paws at his hay. Two different owners respond to the same scene in polar opposite ways.

OWNER A: “Eh, just a belly ache. He’ll be fine in the morning.”
OWNER B: “Oh no, my horse is colicking! He’s going to DIEEEEEEEE!”

Is Owner A irresponsible or is Owner B histrionic? Both. Neither. It’s complicated.

Colic has a PR problem. It’s the Hamlet of equine diseases – everybody’s heard of it, but they can’t tell you what happens, though they’re fairly certain everyone dies at the end.

As with the Capulets and Montagues (yes, I switched plays; roll with it), the problem for colic lies in the name. It is neither disease, nor diagnosis, nor any other part of thee. Colic, instead, is just a general term meaning abdominal pain.

Just like a belly ache in humans can be caused by everything from a bad Brussels sprout to a ruptured appendix, colic in the horse can range from “a little gas” to fatally twisted intestine.

And, just as some humans can walk around for days with an appendix on the cusp of going supernova while others suffering a touch of indigestion writhe about the bathroom tile bemoaning their imminent doom, horses vary in response to abdominal pain.

I have seen horses with fairly mild gas distension sweat, paw, and fling themselves about the landscape with the dramatic flair of an over-caffeinated Nicholas Cage. I once necropsied a mare after three days of severe physiological deterioration to find two complete (360 degree) twists in her colon and yards of blackened intestine – she had still been standing and nibbling (albeit half-heartedly) at some grass when I euthanized her.

You’ve probably noticed that the average horse is a substantial creature with a proportionately significant belly. Pinpointing a specific problem within the vast chasm of the equine abdomen can be tricky at best. Whereas you can toss a cat or dog on the X-ray table and get an image of the whole critter (Note: this is literary hyperbole. One should never “toss” cats or dogs), even the high-powered X-ray machines at university teaching hospitals have trouble getting clear pictures of the horse gut.

Ultrasound has the same limitations. As technology improves, we can scan more of the horse’s abdomen than ever before, but the larger the horse, the more challenging it is to get an image.

Does this mean diagnosis is hopeless? If my horse acts colicky should I just throw in the towel, save my money and figure he’ll either live or die?

No.

While behaving like Owner B won’t help anyone, let alone the horse (abject, decapitated-fowl panic is rarely useful), Owner A’s nonchalance is deceptively dangerous.

Because (much to everyone’s disappointment) horses don’t present with labels identifying the source of illness, and because even a seemingly benign cause of colic – like “a little gas” – can progress to something life-threatening, a prompt exam and close medical monitoring are the best ways to keep the bit of a belly-ache from morphing into disaster.

I’m including some ways of guarding against and identifying the colic monster.

TIPS FOR PREVENTING COMMON CAUSES OF COLIC IN HORSES

• Feed a consistent diet, ideally pasture grazing or small, frequent meals of mostly hay. Horses are designed to graze.
• Avoid feeding on bare dirt. Sand particles from the ground can accumulate in the intestine, damaging the intestinal lining, and causing obstruction.
• Talk to your veterinarian about a parasite prevention program. Parasites can cause intestinal damage and obstruction.
• Talk with your veterinarian before administering anti-inflammatory (NSAID) drugs like “Bute” or Banamine. NSAIDs are extremely useful for treating certain conditions, but they can increase the risk of stomach ulcer formation in horses.
• Provide free access to fresh water at all times. Monitor water intake particularly in winter when waterers may freeze or horses may not feel as thirsty.
• Have your veterinarian perform a thorough dental examination yearly. Dental abnormalities, especially in older horses, may lead to incomplete chewing of feed which can cause intestinal obstruction.

RED FLAGS: SIGNS OF COLIC IN A HORSE

Note: a colicky horse may show all, some, or none of these signs.

• Elevated resting heart rate. Average “normal” heart rate for a horse is 24-40 beats/minute. Ask your veterinarian how to check your horse’s heart rate and do so regularly since each horse may have a different definition of normal.
• Sweating (in the absence of exercise or extreme heat)
• Pacing
• Pawing at the ground
• Lying down and getting up repeatedly
• Circling
• Rolling
• Standing with head down
• Lack of interest in food
• Looking at or biting sides
• Flared nostrils, rapid breathing
• Grinding teeth
• Excessive salivation

While many cases of colic resolve with minimal medical intervention, distinguishing the sort-of-bad from the epically disastrous can be tricky. If you notice any combination of the above signs, or even just have a vague sense that your horse is what we call ADR (this official-looking acronym stands for “ain’t doin’ right,” as in “What’s wrong with Trigger?” “Well, Doc, he just ain’t doin’ right.”), it’s a good idea to call your veterinarian sooner rather than later.

How soon is “sooner?” In the case of suspected colic, I define soon as the time it takes you to walk from the barn to the house or to find your cell phone and dial the digits. Those tentacular clues to your horse’s colic might belong to a harmless squid, but it’s better to call in help in case Cthulu is lurking instead.