How to identify signs of hindgut ulcers and how to treat them
The horse's hindgut is made up of the cecum & colon. It's the place where fibre is fermented to provide energy for the horse.
Ulcers in the hindgut can be extremely painful and indicate that the 'fermenter' is not working properly.
Signs of Hindgut Ulcers in Horses
Unlike gastric ulcers, hindgut ulcers cannot be diagnosed with a gastroscope. While there are techniques like ultrasound & blood work to diagnose hindgut ulcers, most vets rely on presumptive diagnosis.
Early signs of hindgut ulcers include non-specific indications of mild intermittent or recurring colic, lethargy and loss of appetite. However, as the condition worsens clinical signs may include:
- Sudden girthiness
- Sensitivity in the flank area
- Difficulty bending, collecting, and extending
- Blood in the manure
- Chewing wood
What are the causes of hindgut ulcers?
Bute & Banamine: Bute works by blocking two enzymes. One enzyme is responsible for pain and inflammation and that's the one we want to block for pain relief. Unfortunately, another enzyme is also blocked and it maintains a healthy gastrointestinal lining and also promotes proper blood clotting. This is why it's important not to use non-steroidal anti-inflammatories for longer than 5 - 7 days.
Too much grain: A build up of lactic acid kills off the 'good' bacteria and promotes the growth of pathogenic bacteria. This occurs when too much undigested grain reaches the hindgut. This is called hindgut acidosis.
Stress: When a horse is stressed, they release a hormone called cortisol which prevents the synthesis of prostaglandin. Prostaglandin is vital for mucous production which protect the digestive tract from acid.
Parasites: Parasites, in particular tapeworm and large strongyles can cause ulcers at the site where they attach to the intestinal wall.
How to Treat Hindgut Ulcers
Successful treatment is best achieved through lifestyle changes, diet modification and medication.
- Avoid the use of NSAIDs (especially Bute and Banamine),
- Implement methods to decrease stress. This includes access to grazing/turnout, providing company for your horse and minimising travel & competitions during treatment.
- Provide constant access to low-sugar forage and minimise grains or starchy feeds.
- Treat with sucralfate, which binds to the surface of ulcers allowing fast & effective ulcer healing.
Treating Hindgut Ulcers with Sucralfate
Treating hindgut ulcers is different from treating gastric ulcers.
Sucralfate is the best known treatment for hindgut ulcers. It is a sucrose and aluminium hydroxide complex that works by binding to the site of ulceration and forming a 'protective coating' over the lesion.
Once sucralfate binds to the lesion site, it also stimulates the production of prostaglandins – a protective chemical that enhances protection of the colon from further damage.