Changes

===Clinical signs===

===Clinical signs===

Ingestion of sand without impaction may lead to clinical signs pertaining to a physical colitis due to the abrasive nature of sand. These may include diarrhoea, If sufficient sand has been ingested to cause an impaction, the clinical signs are generally dependent on the anatomical site affected. Horses affected by a pelvic flexure impaction often present with signs of mild abdominal pain and generally respond well to conservative treatment. Impaction of the transverse colon is often associated with more severe abdominal pain due to the build up of gas in the the colon proximal to the obstruction.  

Ingestion of sand without impaction may lead to clinical signs pertaining to a physical colitis due its abrasive nature. These may include diarrhoea, If sufficient sand has been ingested to cause an impaction, the clinical signs are generally dependent on the anatomical site affected. Horses affected by a pelvic flexure impaction often present with signs of mild abdominal pain and generally respond well to conservative treatment. Impaction of the transverse colon is often associated with more severe abdominal pain due to the build up of gas in the the colon proximal to the obstruction.  

===Diagnosis===

===Diagnosis===

===Treatment===

===Treatment===

Bulk laxatives such as Psyllium are widely used to assist in the movement of sand. Psyllium is administered directly into the stomach via a nasogastric tube and the sand becomes incorporated into the laxative. Some authors however have described no benefical effects of Psyllium and adovate restriction to access to sand as the main component of treatment. This treament is continued for up to a week until all sand is fully removed from the colon.

Bulk laxatives such as Psyllium are widely used to assist in the movement of sand. A mixture of Psyllium mucilloid and water is administered directly into the stomach via a nasogastric tube . Some authors however have described no benefical effects of Psyllium and adovate restriction to access to sand as the main component of treatment. This treament is continued for up to a week until all sand is fully removed from the colon.

If the impaction is large or non-responsive to medical treatment, surgery may be indicated.  

If the impaction is large or non-responsive to medical treatment, surgery may be indicated.