That is a great question and her is the answer that I use to tell our clients on a daily basis.
Colic refers to abdominal pain, and in this case sand is what causes the abdominal pain.
It noramlly affects horses in areas that have sandy soils, horses that live on dry lots, etc. Living in Arizona we highly qualify.

We don't have much pasture and the majority of horses are on dry lots. No matter how hard you try to keep your horses hay and feed up off the ground they always manage to get it on the ground. Plus they are forever rumaging for tidbits off the ground. Even your hay will have dirt/sand in it when it is baled. So what happens is as they pick up the bits of hay or feed off the ground with their mouths they ingest sand/dirt. As this makes its way through the intestines some will pass it out the other end but some stays behind settling in the colon. As time goes on more and more accumulates in the intestines. You normally don't know your horse has a problem until they start showing signs like mild colic episodes, where the horse may just eat a little or not eat and may just lay quietly for hours. Also some horses will have bouts of loose manure. The sand/dirt is irritating to the intestines and causes inflammation. If left long enough it can rupture the intestine. My friend adopted a horse and he began having regular bouts of colic and loose stools. Long story short they ended up taking him to surgery and removed 40lbs of sand/dirt. He is doing great now and is a pistol most days.
There are many ideas out there on what gets rid of the sand, but the only one that works is Psyillium (A fiber). The clinic that I use did a study on different products and the only on that clear sand was psyillium.
So it is easy to check and see if you horse has sand. Get a gallon ziplock (don't use a bucket or jar to hard to see how much is there). Find a fresh pile of manure, make sure that the horse hasn't kicked dirt on it (best time is when you have them tied on concrete, like at the wash rack). Invert the bag and Take a good size handful off the top. Then fill with water and close bag. Break up the manure balls completely and Tie the bag so the sand/dirt will fall into a corner and let sit for 20 minutes to let the sand settle. After 20 minutes check to see if there is any visable sand. A few grains is not bad, but if you see sand even a small amount, It may not seem like alot but if you figure that much sand is in every handful of manure then you could be looking at a problem. Vets will also listen to the lowest spot on the belly, IF a horse has a lot of sand it almost sounds like the ocean.
In areas where you might be concerned a little you can purchase some Psyillium at he feed store and just follow the directions. Most say you feed the enclosed scoop once to twice a day for one week out of each month. In areas (Like where I am) you can feed it more often I tend to but a 40 lb container and feed it daily until it is gone. It normally last a couple weeks with all my horses and then I will wait a month or so and do it again. They are now also recommending that along with the Psyillium you should feed some mineral oil to help things move along and to keep them from getting stopped up. So I think I covered most of it, hope this helps.