Colic: Symptoms, Types, Causes and Treatment

Colic is a term that often evokes concern, confusion, and even frustration for parents, caregivers, and patients alike. Whether it’s the inconsolable cries of a newborn or the severe abdominal pain in adults and animals, colic covers a spectrum of conditions that can be deeply distressing. Understanding colic—its symptoms, types, causes, and treatments—can be the first step toward better management and peace of mind. This comprehensive guide draws on the latest research to illuminate the core aspects of colic in both infants and adults.

Symptoms of Colic

Colic is recognized by a characteristic pattern of symptoms, though these can vary depending on the age group and underlying cause. For infants, colic typically presents as episodes of intense, often inconsolable crying, while in older children and adults, it manifests more as severe, intermittent abdominal pain.

Symptom	Description	Typical Age/Group	Reference
Persistent Crying	Prolonged, often inconsolable crying	Infants	1 8
Abdominal Pain	Intermittent, griping pain	Children/Adults	2 4
Leg Drawing	Pulling legs up toward the abdomen	Infants	1
Clenched Fists	Fist clenching during episodes	Infants	1
Rectal Gas	Passing gas, sometimes with pain	Infants	1
Body Stiffening	Stiff or straight posture	Infants	1
Feeding Changes	Wants to feed but refuses	Infants	1
Diarrhea/Bleeding	Loose stools, blood in stool	Adults (colitis)	4 3

Table 1: Key Symptoms of Colic

Understanding the Symptoms

Colic’s symptoms can be alarming, but they are the body’s way of signaling discomfort or distress.

Infant Colic

In infants, colic is most commonly identified by:

• Persistent crying: Episodes often peak in the late afternoon or evening and are difficult to soothe.
• Physical signs: Infants may clench their fists, draw up their legs, arch their backs, pass gas, or stiffen their bodies. These behaviors suggest abdominal discomfort.
• Inconsolability: Caregivers often report that typical soothing methods, like feeding or holding, offer little relief during colic episodes 1.

Nurses and doctors tend to look for specific patterns, such as crying for more than 4 hours in 24 hours or the infant wanting to feed but refusing to do so 1 8.

Adult and Animal Colic

In adults and animals, colic presents differently:

• Abdominal pain: The pain is often described as deep-seated, intermittent, and gripping. It can be severe enough to warrant medical attention 2.
• Gastrointestinal symptoms: In some types of colic, especially those related to inflammation (like colitis), symptoms may include diarrhea, rectal bleeding, and changes in bowel habits 3 4.
• Behavioral cues: In animals, signs include restlessness, rolling, or changes in feeding behavior 5.

Recognizing Patterns

It is important to recognize that symptoms may overlap with other conditions, and the intensity can vary. For infants, symptom diaries can help caregivers and clinicians identify colic and monitor progress 8.

Types of Colic

Colic is not a single disease but a set of symptoms that can arise from various causes. Different types are recognized based on age, organ system, or underlying mechanism.

Type	Population	Hallmark Feature	Reference
Infantile Colic	Infants (0-3 months)	Persistent crying	7 8 9
Renal Colic	Children/Adults	Flank pain, hematuria	2
Intestinal Colic	All ages	Abdominal pain	2 5
Ischemic Colitis	Older Adults	Sudden abdominal pain, rectal bleeding	3
Ulcerative Colitis	Adolescents/Adults	Chronic diarrhea, bleeding	4
Equine Colic	Horses	Abdominal pain, rolling	5

Table 2: Types of Colic

Infantile Colic

• Definition: Generally refers to otherwise healthy infants under 3 months old who cry excessively for more than three hours a day, more than three days a week, for at least three weeks—the so-called “rule of threes” 7 8.
• Unique aspects: Most cases are benign and resolve on their own.

Intestinal and Renal Colic

• Intestinal colic: Pain due to forcible contraction of intestinal muscles, often because of obstruction, inflammation, or infection 2 5.
• Renal colic: Severe flank pain caused by kidney stones or urinary tract obstruction 2.

Colitis-Associated Colic

• Ischemic colitis: Occurs in older adults, often with sudden onset of abdominal pain and rectal bleeding. Associated with vascular disease or certain medications 3.
• Ulcerative colitis: A chronic inflammatory condition of the colon, characterized by continuous inflammation, bleeding, and abdominal pain 4.

Colic in Animals

• Equine colic: The most common cause of death in horses, often associated with dietary changes, parasites, or management practices 5.

Why Classifying Colic Matters

Recognizing the type of colic is vital, as it determines the urgency, management, and prognosis. While infantile colic is usually self-limiting, types like ischemic or ulcerative colitis require targeted medical intervention.

Causes of Colic

The causes of colic are diverse and often multifactorial. In infants, both gastrointestinal and nongastrointestinal factors have been implicated. In older children, adults, and animals, causes range from dietary issues to underlying disease.

Cause	Description	Group Affected	Reference
Gastrointestinal	Food allergy, gut dysbiosis, motility	Infants/Adults	6 7 9
Behavioral	Parental stress, feeding practices	Infants	1 7 8
Vascular	Ischemia of the colon	Older Adults	3
Inflammatory	Autoimmune/infectious colitis	Adolescents/Adults	4 13 14
Environmental	Feeding changes, stabling, transport	Horses	5

Table 3: Major Causes of Colic

Gastrointestinal Causes

• Gut dysbiosis: Recent studies suggest that infants with colic have less diverse gut bacteria and higher levels of inflammation markers, such as fecal calprotectin. Certain bacteria like Klebsiella are more abundant in colicky infants, while beneficial species are reduced 6.
• Food protein allergy: Allergy or hypersensitivity to cow’s milk protein and other dietary components can trigger colic in infants 9.
• Abnormal motility: Excessive intestinal movement or spasm can lead to pain and discomfort 7.

Behavioral and Environmental Factors

• Parental and feeding dynamics: Maternal anxiety, feeding technique, and even maternal diet may play a role. Some believe that colic reflects a variant of normal crying behavior or a response to stress in the environment 1 7 8.
• Environmental stressors: In animals, sudden changes in diet, exercise, or environment (such as stabling or transport) can precipitate colic 5.

Vascular and Inflammatory Causes

• Ischemia: In older adults, colic can be caused by compromised blood supply to the colon, leading to ischemic colitis 3.
• Inflammation: Autoimmune or infectious processes, such as ulcerative colitis, result in chronic inflammation and colic-like symptoms 4 13 14.

Multifactorial Nature

Colic is rarely caused by a single factor. More commonly, it results from the interplay of biological, behavioral, and environmental contributors. Recognizing this complexity helps tailor effective management strategies 7 9.

Treatment of Colic

Treating colic depends greatly on its underlying cause and the affected population. For most infants, reassurance and supportive care are essential. In cases linked to gastrointestinal or inflammatory processes, more targeted therapies are available.

Treatment	Approach/Method	Target Group	Reference
Reassurance	Education, parental support	Infants	8
Hypoallergenic Diet	Elimination of certain proteins	Infants	10
Probiotics	Lactobacillus reuteri supplementation	Infants	11 12
Herbal Remedies	Herbal teas for symptom relief	Infants	10
Reduced Stimulation	Quiet, calm environment	Infants	10
Pharmacotherapy	Anti-inflammatories, immunosuppressants	Adults (colitis)	4 13 14
Surgery	For severe or complicated cases	Adults/Animals	3 5
Management Changes	Feed/environment adjustments	Horses	5

Table 4: Treatment Options for Colic

Infant Colic: Supportive Care and Diet

• Reassurance and education: For most cases of infantile colic, providing information and emotional support to parents is the cornerstone of management 8.
• Hypoallergenic diets: Switching to hypoallergenic or soy-based formulas can reduce symptoms in some infants, especially those with suspected food protein intolerance 10.
• Reduced stimulation: Calming the environment—lowering noise and activity levels—can help minimize episodes 10.
• Herbal teas: Limited evidence suggests herbal teas may offer short-term relief 10.

The Role of Probiotics

• Lactobacillus reuteri: Several randomized trials and systematic reviews indicate that supplementation with L. reuteri can significantly reduce crying and fussing times in breastfed infants with colic, with no reported adverse effects 11 12.
• Gut microbiota modulation: The benefit is thought to arise from restoring a healthy balance of intestinal bacteria and reducing gut inflammation 6 11 12.

Medical Therapy for Colitis-Associated Colic

• Pharmacologic treatment: For ulcerative colitis and other inflammatory causes, medications such as anti-inflammatories, immunosuppressants, and biologics are standard 4 13 14.
• Natural compounds: Certain plant-derived polysaccharides and flavonoids (e.g., kaempferol) are being researched for their ability to reduce inflammation and modulate the gut microbiota, offering potential adjunct therapies 13 14.

Surgical and Environmental Interventions

• Surgery: In severe cases—such as bowel obstruction, perforation, or refractory colitis—surgical intervention may be necessary 3 5.
• Environmental and management changes: In horses, adjusting feeding practices, ensuring regular exercise, and minimizing stress can help prevent or treat colic 5.

Choosing the Right Treatment

Treatment should always be individualized, based on the type of colic, its severity, and the needs of the patient or animal. Importantly, most cases of infant colic resolve with time and supportive care.

Conclusion

Colic is a complex, multifaceted syndrome with a wide range of symptoms, types, causes, and treatments. Whether affecting infants, adults, or animals, it is essential to approach each case with care, evidence-based understanding, and empathy.

Key Takeaways:

• Colic manifests with characteristic symptoms, most notably persistent crying in infants or severe abdominal pain in older individuals.
• There are multiple types of colic, including infantile, intestinal, renal, ischemic, and colitis-associated forms, as well as animal colic.
• Causes are diverse and often multifactorial, spanning gastrointestinal, behavioral, vascular, inflammatory, and environmental domains.
• Treatment strategies must be tailored to the underlying cause and patient, ranging from reassurance and dietary modifications to probiotics, medications, and surgery.
• Ongoing research into the gut microbiome, dietary influences, and novel therapies shows promise for more effective colic management in the future.

By understanding the nuances of colic, caregivers and clinicians can better support those affected—offering relief, reassurance, and hope.