Donkeys with colic may have subtle clinical signs of pain that delay detection, so a methodical clinical examination is needed to make a diagnosis. Using donkey-specific pain scoring can be helpful in monitoring progress and responses to analgesia. Hyperlipaemia is often secondary to the underlying disease process, and will reduce the prognosis for successful treatment, so assessing triglycerides and treating any elevation alongside other required blood testing is necessary. Ultrasound evaluation is helpful in donkeys which are too small for safe palpation per-rectum, and serum and peritoneal lactate values may be useful in guiding prognosis. Surgical treatment of colic in donkeys has a poorer success rate that in the horse, largely due to delays in diagnosis and referral as a result of the lack of overt pain signs, postoperative complications and hyperlipaemia. Preventative care is often lacking in donkeys, so provision of regular routine dental management, routine parasite monitoring and control (including appropriate use of anthelmintics and dietary management to ensure a healthy body weight) are areas that veterinarians and nurses can assist with. Donkeys cope poorly with stress, so when undergoing treatment, any bonded companion should be kept close by.