Colic Emergency Signs: What to Do While You Wait for the Vet

Colic kills more horses than any other medical condition. That sentence should get your attention, because the difference between a horse that walks out of the hospital and one that doesn't often comes down to how fast the owner recognized the signs and picked up the phone.

Quick Answer: If your horse shows persistent rolling, elevated heart rate above 60 bpm, absent gut sounds, or violent thrashing, treat it as a surgical emergency and call your vet immediately. While waiting, keep the horse walking gently and remove all feed.

Here's the first thing you need to understand: colic is not a disease. It's a symptom. The word literally just means abdominal pain. A horse with gas cramps and a horse with a twisted intestine are both "colicking," but one might resolve in twenty minutes and the other needs emergency surgery within hours or it's dead. Knowing which scenario you're facing, or at least which direction things are trending, is a skill every horse owner must develop.

Types of Colic (Because It's Not All the Same)

Gas Colic

The most common and usually the least dangerous. Gas builds up in the intestines, stretches the gut wall, and causes pain. The horse is uncomfortable, maybe pawing or looking at its flank, but vital signs stay relatively normal. Most gas colics resolve with hand-walking and a dose of Banamine from the vet. Some pass on their own. I've seen horses go from rolling in distress to munching hay within thirty minutes once the gas moves through. Bodies are weird like that.

Spasmodic Colic

Similar to gas colic but driven by abnormal intestinal contractions. The gut essentially cramps. Pain tends to come in waves, with the horse looking fairly normal between episodes and then suddenly agitated again. Spasmodic colic responds well to antispasmodic drugs like buscopan. Weather changes, stress, and sudden temperature drops seem to trigger it in some horses, though the mechanism isn't entirely clear.

Impaction Colic

Feed material or sand accumulates at a narrow point in the intestine, usually the pelvic flexure of the large colon. The blockage creates a backup. The horse stops passing manure, gets progressively more uncomfortable, and the gut sounds go quiet in the affected area. Impactions often respond to IV fluids and mineral oil via nasogastric tube, but severe cases can require surgery. Horses that don't drink enough water, especially in winter when troughs freeze, are prime candidates. Understanding the anatomy of the hindgut helps you visualize exactly where these blockages form and why certain flexure points are so vulnerable.

Displacement Colic

The large colon shifts out of its normal position. Think of it like a garden hose that's gotten twisted or folded. The horse's colon is surprisingly mobile (it's not firmly attached in the abdomen), so it can slide around, flip over the nephrosplenic ligament, or fold back on itself. Displacements cause moderate to severe pain and often need surgical correction. Nephrosplenic entrapment, where the colon gets trapped over the ligament between the spleen and the left kidney, sometimes resolves with a specific protocol: phenylephrine to shrink the spleen, followed by jogging or rolling the horse under anesthesia. Sometimes. Not always.

Torsion (Volvulus)

This is the one that terrifies every horse owner and every equine vet. The intestine rotates on its axis, cutting off blood supply. Tissue starts dying within hours. Pain is severe and unrelenting. Without surgery, it's fatal. With surgery, survival depends on how much bowel is compromised and how quickly the horse gets on the table. A 360-degree large colon volvulus with compromised tissue carries a survival rate that drops precipitously with every hour of delay. Time is the only currency that matters here.

Enteritis and Colitis

Inflammation of the small intestine (enteritis) or large colon (colitis) causes colic signs too, but the picture looks different. These horses often have fever, diarrhea, and signs of endotoxemia. Salmonella, Clostridium, and Potomac horse fever are common culprits. The colic pain here comes from inflamed, swollen gut walls rather than mechanical obstruction. Treatment focuses on aggressive IV fluid therapy, anti-endotoxin treatment, and managing the secondary complications.

What Are the Colic Emergency Signs You Cannot Miss?

Mild colic can look like a horse having a bad day. Severe colic looks like an emergency. Here's how to tell the difference.

Mild to Moderate Signs

• Pawing the ground intermittently
• Looking at or nipping at the flank
• Lying down and getting up repeatedly
• Decreased appetite or refusing grain
• Reduced or absent manure production
• Mild restlessness, shifting weight, general "off" behavior
• Stretching out as if to urinate but not producing urine

Emergency Signs (Call the Vet NOW)

• Heart rate above 60 beats per minute. Normal resting heart rate is 28 to 44. A colicking horse at 50 is concerning. Above 60 means the pain is severe or cardiovascular compromise is starting. Above 80, you're running out of time.
• Absent gut sounds. Press your ear (or a stethoscope) to the horse's flank in four quadrants: upper right, lower right, upper left, lower left. You should hear gurgling, rumbling, and occasional rushing sounds. Silence in any quadrant is a red flag. Complete silence across the abdomen is an emergency.
• Violent rolling. A horse that goes down, thrashes, rolls onto its back, and can't seem to get comfortable is in serious distress. This level of pain usually indicates something mechanical, like a displacement or torsion.
• Sweating without exercise. A horse standing in its stall covered in sweat is in pain. Period.
• Pale or purple gums. Lift the lip. Healthy gums are salmon pink. Pale gums indicate shock. Dark red or purple gums mean toxins are entering the bloodstream from dying bowel. Capillary refill time (press the gum, release, count until the color returns) should be under 2 seconds. Over 3 seconds is trouble.
• No response to Banamine. If the horse gets a dose of flunixin and shows zero improvement in 30 to 45 minutes, the pain source is beyond what anti-inflammatories can touch.
• Depression replacing agitation. A horse that was thrashing and suddenly becomes quiet, standing with its head low, eyes dull, seemingly "resigned," may be entering endotoxic shock. This is not improvement. This is deterioration wearing a calm mask.

Trust your gut about your horse's gut. If something feels seriously wrong, it probably is. A false alarm costs you a farm call. Waiting too long costs you the horse.

What Should You Do While Waiting for the Vet During a Colic Episode?

You've called the vet. They're 20 minutes away, or 45, or an hour if you're rural. Here's what to do in the meantime.

• Remove all feed. Hay, grain, everything out of reach. If there's a blockage, more feed makes it worse.
• Hand-walk if the horse will cooperate. Gentle walking can help move gas through the intestines and provides mild pain distraction. Don't exhaust the horse. If it wants to stop, let it stop.
• Do NOT let the horse eat grass while walking. I know it seems like it would help. It won't.
• Allow the horse to lie down if it's doing so quietly. Resting comfortably on its side is fine. Thrashing violently is not. If the horse is throwing itself around, keep it up and walking to prevent self-injury.
• Take vital signs and write them down. Heart rate, respiratory rate, gum color, capillary refill time, rectal temperature if you're comfortable doing so. Note the time. This information is incredibly valuable for your vet. Read our colic first aid guide for a detailed walkthrough.
• Note the last time the horse passed manure and what it looked like. Dry, mucus-coated, diarrhea, normal. All of it matters.
• Do NOT administer medications unless directed by your vet. Banamine can mask pain severity that the vet needs to assess. If you already gave it, tell them the dose and time.

When Mild Discomfort Becomes an Emergency

Gas colic typically follows a pattern: the horse is uncomfortable, pawing, maybe lying down once or twice, then 30 to 60 minutes later (especially after Banamine and hand-walking) it starts eating again, passes gas or manure, and acts normal. That's the best-case scenario.

Escalation looks like this:

• Pain that returns after medication wears off
• Pain that intensifies despite medication
• Heart rate climbing instead of stabilizing
• Horse becoming increasingly agitated or, worse, becoming depressed and withdrawn (this can indicate severe systemic compromise)
• Nasogastric reflux (your vet passes a tube and gets back liters of fluid, meaning the stomach can't empty because something downstream is blocked)

Any of these patterns warrant escalation. If your primary vet suggests referral to a surgical facility, go. Don't hesitate. Don't decide to "wait and see for another hour." The survival rate for surgical colic drops significantly with every hour of delay.

The Surgery Decision

Nobody wants to hear "your horse needs surgery." The cost is significant (often $7,000 to $15,000 or more), the recovery is long, and the outcome isn't guaranteed. But delaying that decision is almost always worse than the alternative.

Your vet will consider several factors when recommending surgery: pain severity and response to medication, heart rate trends, nasogastric reflux volume, rectal exam findings, abdominal ultrasound results, and peritoneal fluid analysis if performed. Not every colic that doesn't respond to medical management needs surgery, but every colic that does need surgery needs it soon. The horses that do best after surgical colic are the ones that arrive at the referral hospital before the gut has been compromised for hours.

If you have colic surgery insurance, know the details before you need them. If you don't, have a candid conversation with yourself about your financial limits and your horse's value to you. These are terrible decisions to make at midnight with a suffering animal. Having thought about it in advance, even briefly, helps enormously.

Prevention: Stacking the Odds

You can't prevent every colic episode. Some happen despite doing everything right. But you can dramatically reduce frequency with basic management:

• Constant access to clean water. Dehydration is the number one predisposing factor for impaction colic. Horses drink 5 to 12 gallons daily. In winter, warm the water. Horses reduce intake by up to 40% when water is near freezing.
• Forage first, always. The equine gut was designed for continuous forage intake. Long gaps between meals allow gastric acid to accumulate and alter gut motility. Feed hay before grain. Use slow feeders to extend eating time.
• Make feed changes gradually. New hay, new grain, different pasture: introduce over 7 to 14 days minimum. Abrupt changes disrupt the hindgut microbiome and invite trouble.
• Maintain a parasite control program. Heavy parasite loads damage the intestinal lining and blood supply to the gut. Work with your vet on fecal egg counts and targeted deworming.
• Regular dental care. A horse that can't chew properly sends large, poorly processed feed particles into a system designed for finely ground material. Impaction risk goes up.
• Consistent exercise. Movement promotes gut motility. Stall-bound horses colic more frequently than horses with regular turnout and exercise.
• Sand management. Horses in sandy regions ingest sand with every mouthful of grass. Over time it accumulates in the large colon. Psyllium supplementation on a regular schedule (typically one week per month) can help move sand through, and feeding hay off the ground using mats or feeders reduces intake.

Colic is the emergency every horse owner will face eventually. Knowing what to look for, what to measure, and when to escalate can save your horse's life. Keep your vet's emergency number in your phone, not buried in a drawer. Use our Symptom Advisor to review common colic presentations, and bookmark this article somewhere you can find it at 2 AM when you need it.

Last reviewed: March 2026

Frequently Asked Questions

What heart rate indicates a colic emergency in horses?

A resting heart rate above 60 beats per minute during a colic episode signals severe pain or cardiovascular compromise. Normal resting heart rate for horses is 28 to 44 bpm. At 50 bpm during colic, you should be concerned. Above 80 bpm, the situation is critical and the horse needs emergency veterinary intervention immediately.

How long can you wait before colic becomes fatal?

For surgical colic like a torsion (volvulus), intestinal tissue starts dying within hours once blood supply is cut off. Survival rates drop significantly with every hour of delay in getting the horse to surgery. If your vet recommends referral to a surgical facility, transport immediately. A false alarm and an unnecessary trailer ride cost far less than a delayed decision.

Should you let a colicking horse roll?

Quiet lying down is fine. A horse resting on its side is not dangerous. However, violent thrashing and repeated rolling can cause self-injury and, in rare cases, may contribute to intestinal displacement. If the horse is throwing itself around, keep it up and walking gently to prevent injury. If it lies down calmly, let it rest.

How much does colic surgery cost?

Colic surgery typically costs $7,000 to $15,000 or more, depending on the facility, the type of lesion, and the length of hospitalization. Recovery takes weeks. If you have major medical or surgical insurance on your horse, review the policy details before an emergency happens so you know your coverage limits and any exclusions.

What is the most common type of colic?

Gas colic is the most common and usually the least dangerous. Gas builds up in the intestines, stretches the gut wall, and causes pain. Most gas colics resolve with hand-walking and a dose of Banamine from the vet, often within 30 to 60 minutes. Impaction colic is the next most common, especially in winter when horses reduce water intake by up to 40% because of cold water temperatures.

Sources

• Texas A&M College of Veterinary Medicine & Biomedical Sciences. "Colic in Horses." vetmed.tamu.edu
• AAEP. "Colic in Horses: Signs, Causes, and Treatment." aaep.org
• Cornell University College of Veterinary Medicine. "Colic: A Cause for Concern." vet.cornell.edu
• Merck Veterinary Manual. "Colic in Horses." merckvetmanual.com
• UC Davis School of Veterinary Medicine. "Colic in Horses." ceh.vetmed.ucdavis.edu