Background and Aim: Colic is among the common health issues in equine health management. Gastrointestinal (GI) disorders are the most frequent causes of colic, but dysfunction of other organs and systems inside the abdominal cavity may also contribute. Therefore, it is crucial to identify risk factors for colic of specific etiologies. This study aimed to examine the incidence, risk factors, and best therapeutic management practices for horses with colic.Materials and Methods: A cohort of 256 horses living in Lamongan, East Java, Indonesia, was randomly recruited based on reports of colic symptoms by owners. Diagnosis and treatment were then conducted with the help of owners. Symptom profiles, risk factors, and therapeutic management strategies were analyzed by Chi-square tests. Results: Of 256 horses enrolled, 217 (84%) were diagnosed with colic, of which 172 (79.3%) were cases of spasmodic colic, 33 (15.2%) of impaction colic, and 12 (5.5%) of intestinal obstruction/displacement. Male sex (x2 = 16.27; p < 0.001), wheat bran feeding (x2 = 15.49; p < 0.001), concentrate feed intake >5 kg/day (x2 = 24.95; p < 0.001), no regular anthelmintic drug treatment (x2 = 67.24; p < 0.001), GI parasite infection (x2 = 65.11; p < 0.001), recurrent colic (x2 = 91.09; p < 0.001), poor body condition score (x2 = 71.81; p < 0.001), limited daily water access (x2 = 127.92; p < 0.001), and indications of dental disease (x2 = 9.03; p < 0.001) were identified as risk factors. The most effective therapies were gastric intubation (x2 = 153.54; p < 0.001), Vitamin B complex injection (x2 = 32.09; p < 0.001), fluid therapy (x2 = 42.59; p < 0.001), and non-steroidal anti-inflammatory drug injection (NSAID).Conclusion: Colic is highly prevalent among horses in Lamongan, East Java, Indonesia. Proper diet, workload management, regular access to clean drinking water, and dental care can reduce colic risk. Recommended therapies include NSAID injection without other analgesics or spasmolytics, fluid therapy, Vitamin B complex, and gastric intubation.