Ileocecal Valve Syndrome by Sue Kira

by rod

Problems with the Ileocecal valve (ICV)

by Sue Kira, Naturopath & Clinical Nutritionist

What is the ileocecal valve?

The ileocecal valve, also known simply as the ICV, is a sphincter muscle valve that joins the small intestine to the large intestine, or to be more anatomically correct, this valve joins the ilium to the caecum. The ilium is the last part of the small intestine and the caecum is the first part of the large intestine.

What is the function of the ileocecal valve?

The valve has two main functions.  The first is to control the flow between these two areas (ilium to caecum) to prevent the bacteria laden contents of the large bowel regurgitating or backing up and contaminating the small intestine. The second function is to keep the contents in the small intestine long enough for the remaining digestive processes to be completed before being passed into the large intestine for water reabsorption and removal of solid waste.

What is ileocecal valve syndrome (ICVS)?

The term syndrome suggests a group of symptoms that occur together and with ICVS there is usually a cluster of symptoms that can arise. There are two types of ICVS – open and closed.

In the open ICVS, the valve is stuck open, allowing a regurgitation of colon contents into the small intestine, and a rapid flow of matter from the small intestine to large intestine before it has been properly digested. As a result this leads to undigested food in the stool, loose stools and nutrient deficiencies. Open ICVS usually causes diarrhea.

In the closed or spastic ICVS, the valve is stuck shut for extended periods of time. This causes material to be held back and unable to pass from the ileum (end of small intestine) to the colon (large intestine). Closed ICVS usually leads to constipation.

What controls the opening and closing of the ileocecal valve?

Normally when there is a pressure gradient change between the ilium and the caecum, that  signals the small intestine contents are ready to transfer into the large intestine, and the valve knows to open to allow this flow.

The signal is governed by a nerve called the Vagus Nerve, which is a long nerve fibre all the way from the cranium. It is also called the 10th cranial nerve and is the longest and most important nerve controlling the digestive system and many other vital organs. You could say that this nerve connects the gut to the brain and vice versa.

What causes problems with the ileocecal valve opening and closing signals?

There are many factors that can influence the valves ability to open and close. Because the valve opening signals come from our nervous system, things that effect our nervous system will have the potential to influence the proper function. We can break these dysfunctions into three groups – Structural, Chemical and Mental/Emotional.

1. Structural/physical
Every part of our spine has nerves that connect to various organs and play a role in controlling certain functions. If there is any spinal misalignment we can have faulty signalling to the body part that the vertebrae connects to via nerves.

The reverse can also happen where an inflamed organ can then inflame the nerve that runs to the spine and you may get a back ache. This is called referred pain and explains why some of the symptoms you may experience with ICVS includes shoulder pain and neck stiffness, even though these areas are a long way from the ileocecal valve. Inflammation of the appendix, which is very close to the ICV is another physical cause of valve disruption.

2. Chemical
This group can be divided into two sections. The first is where a chemical affects the nerve control. A chemical toxin can be anything from food additives, pesticide residue, fertiliser residue, heavy metals and other environmental toxins. These types of chemicals affect the nerves.

The second is a more physical aspect where a chemical physically affects the ICV function from  food chemicals such as those that arise from a food allergy or intolerance. The body reacts by producing mucus to protect the area, making the valve sticky and unable to open and shut easily. Other physical chemical assaults come from pathogens such as parasites and the wrong types of bacteria and fungi such as candida.

3. Mental/Emotional
Our nervous system is divided into our sympathetic nervous system (SNS) and our our parasympathetic nervous system (PSNS) which is our ventral and portal nervous system.

Our sympathetic nervous system controls our ‘fight or flight’ response (stress) i.e. the movement side of the nervous system where the majority of our blood is shunted to the organs and muscles that move us such as the arms, legs, heart and lungs, robbing blood from the other areas of the body.

The parasympathetic nervous system controls digestion, assimilation and elimination. Here we have a good deal of our blood in the digestive organs.

In SNS dominance we have a release of adrenaline, also called epinephrine or hyper-adrenal (overactive) activity. This is why stress can not only rob blood from our digestive system and shut its function down, but also close the ileocecal valve to prevent the release of waste during stressful events like running away from a hungry lion.

Long term (chronic) stress fatigues the adrenal glands causing hypo (low) adrenal function and a higher risk of the ICV being stuck open and releasing the bowel contents too fast.

Symptoms of Ileocecal Valve Syndrome

The obvious signs of a sticking closed valve is constipation as waste is held back in the small intestine. Then only when the small intestine is so full that it forces the valve to open do you get the waste flowing through the large intestine. There will usually be associated bloating and abdominal distension, pains, cramps and spasms. This form of constipation doesn’t always create hard stools (but it is common).

On the flip side, if the valve is staying open then the passage of undigested waste will flow through the colon faster than it should, giving rise to looser stools often with undigested food present. There will also be some flushing back or regurgitation of the contents and its bacteria from the large intestine into the small intestine giving rise to SIBO – Small Intestinal Bacterial Overgrowth. Symptoms of SIBO include bloating, cramps and changes in bowel consistency depending on the type of bacteria growing.

There can also be liver problems, creating pain under the ribs, with nausea and sometimes even vomiting. Other symptoms of an open ICV can include heart palpitations (a feeling of the heart fluttering), chest pain with activity, migraine headache, right shoulder pain like bursitis, neck stiffness, mid-afternoon dizziness, tinnitus, nausea, faintness, sinus, sudden thirst, dark circles under eyes and general achiness. Many of these symptoms relate to the impact on the Vagus nerve and other areas this nerve helps to control.

Many of the symptoms are similar for an ICV staying open or sticking, except for the difference between hard and soft stools.

But the main differing feature is the time of day that the symptoms arise. With an ICV that is stuck open the symptoms are often worse in the afternoon. The closed ICV symptoms occur more often in the morning rather than the afternoon and generally ease with movement. Activity also helps to improve headaches and other symptoms, but can be much worse from sleeping-in.

One of the causes of ICVS (whether open or shut) can be the reactions to different foods eaten.  There can also be variations in symptoms according to the times of day certain foods are eaten. In these situations problems with the valve opening or closing can be short-term, depending on the food eaten.

In clinic I have noticed that wheat (but also many other grains), dairy products (especially cheese), sugar and chocolate seem to be the biggest culprits to make the valve physically sticky.

How to remedy ICVS

To treat ICVS you first need to establish the cause. An in-depth consultation with an experienced naturopath is a great place to start and in particular to investigate the structural, chemical and mental/emotional aspects mentioned previously.

Other factors to consider include: food allergies and intolerances; vagal nerve problems; gut inflammation and it’s drivers; SIBO (small intestine bacterial overgrowth) which can be a chicken and egg situation where an open ICV can create SIBO and SIBO can create sticky ICV; and mineral imbalances – an imbalance in the ratio between calcium, magnesium and potassium can have a huge influence.

There is also a massage technique used by osteopaths to help open or close a stuck ICV, but you still need to work on the causes of the valve sticking.



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35 thoughts on “Ileocecal Valve Syndrome by Sue Kira

Susan 2 December 2019 - 1:20 pm

I have been diagnosed many years ago. I went to an orthopedist with shoulder pain I could barely dress myself and there was nothing visually wrong with the structure (had an MRI). Went to my chiropractor when visiting my mother and referred me to one in NYC. He did some muscle testing told me I had an incompetent ICV. He did the manuever and there was had immediate relief of pain! I had darkened eyes and other symptoms as well. After a month of a non fibrous diet , no problem after except after a colonoscopy.

Carrie 25 June 2019 - 8:10 pm

I was was thinking I had endometriosis or an ovary gone bad. A very painful ultrasound later and it checks out ok. I have no bowel issues just a constant feeling of sharp pain, back pain and a feeling of menstrual cramps for three months. It went away with an occasional small flare ups but tolerable. I read about massage and decided to try. This brought on a full force event like I had three months ago. I am miserable. Bloated, sharp pain and low back pain. I did start eating healthy around the same time this all started. Could this be my ileocecal valve?

Barb 4 November 2019 - 12:35 am

I think if massaging is worsening then you have an open valve and try liquid chlorophyll as one suggested above. If it’s closed the massage helps. The fact it makes you worse suggests yo me that it is open.

Lisa 7 December 2018 - 9:00 am

Is nausea and frequent vomiting related to ICVS? I’ve had an endoscopy and colonoscopy recently and a small bowel follow through scheduled tomorrow (at my request through research on the internet). I’ve had tons of blood work and stool samples taken with no results. I’m vomiting 2-3 times a week and becoming more and more disheartened everyday.

sue 24 January 2019 - 3:54 pm

I haven’t heard of ICVS causing nausea and frequent vomiting. Sounds terrible, hope you find out what causes it.

sue 25 January 2019 - 10:30 am

Have you looked into Gall bladder issues, as the GB can cause nausea and vomiting as can the liver too but more often the GB

Jill 30 April 2020 - 8:00 am

I went into the ER today with excruciating pain in my right lower quadrant & extreme nausea. I found out, after a CT Scan that ruled out an appendicitis, that my ileocecal valve is inflamed. So I would definitely say vomiting could possibly be a symptom.

sue 30 April 2020 - 12:00 pm

Thanks for adding the symptoms of nausea and vomiting to the list of possibilities with ICV issues. Hope your inflammation settles soon. With love, Sue

Kathy 17 September 2018 - 2:27 am

Has hidradenitis superativa cysts ever been associated with ICVS?

sue 30 November 2018 - 4:32 pm

Not that I’m aware of.

Joy 11 August 2018 - 7:58 am

My ileocecal valve was removed when I had surgery for colon cancer. I have SIBO. I have taken a couple of rounds of Xifaxan and felt some better although I am on pain meds. Do I even have a hope of getting well?

Laurel Ablett 21 March 2018 - 12:12 pm

I was 14 when I was taken into hospital with suspected appendicitis and sent home a few days later after being told it was not that at all and given no more information. Now, after asking at least eight doctors to find the cause of the frequent sharp pain in my side, it was finally my chiropractor who told me it was the ileocecal valve that was the cause of my pain. I was 78 years old by this time !!! It was frequently closing and also, of course, causing constipation and the bad pain in my left hand side. I also had right shoulder pain and could not open top cupboards, very occasional sharp carpel tunnel pain, and lower back pain, not acute, but always there, struggled with bed making, gardening and housework. Best way to cope is the massage and find a diet to follow that is very important.

robin 1 October 2018 - 12:00 am

Laurel, you sound like me! 25 years ago, out of the blue, I developed what I called diarrhea (but have since heard called “pencil stool) and VERY bad pain in the area of my appendix. Every morning I’d be doubled-over until I had a bowel movement. After two weeks I started getting terrible headaches, which would last for one to three weeks, non-stop, separated by a couple of days without a headache.
I went to a doctor at that point, thinking that I had a brain tumor. Long story short, I saw at least seven doctors over the course of a year, and went to the emergency room twice when I was so sick that I thought I was dying. No doctor ran any tests, except for one blood test, and all told me it was stress, and recommended getting a hobby or getting away from the kids – I had a 5yo I was homeschooling, a 3 1/2yo, and 2yo twins.
Anyway, after a year of doctor-hopping, a chiropractor told me that my IV might be inflamed, and not to eat anything raw for two to three weeks. I was better within a day or two! I only had flare-ups when I ate a lot of almonds or watermelon.
Fast forward to three days ago – lots of organic low-fat popcorn and sprouted organic almonds and stress over an ill beloved pet, and I now have stabbing pains in my pelvic area. Not sure if it’s another flare-up, or diverticulitis/diverticulosis, since the pain is all the way across, not just on the right side.
But, in either event, it’s back to a LOW fiber diet for awhile!

sue 30 November 2018 - 4:28 pm

Hi Robin, also get your pancreas and gall bladder checked. Love sue x

Cynthia Mason 3 December 2017 - 4:12 am

Can ICV be an underlying cause of SIBO?

sue 5 December 2017 - 7:44 am

Yes definitely, as an open ICV will allow the flush back of bacteria that should only be in the one zone it came from

Cynthia Mason 3 December 2017 - 4:11 am

Can ICV be an underlying cause of SIBO? I was diagnosed through breath test to have SIBO methane.

Camelia 26 August 2017 - 11:58 am

Just wonder if with the colonic irrigation it won’t introduce the toxic fecal matter back into the small intestine hence exacerbating the symptoms for the people with closed IVS. Can you please elaborate?

sue 27 August 2017 - 1:25 pm

Basically it is all being flushed out anyway, but refluxing of bacteria into the small intestine with someone with a stuck open ICV could be dangerous

Lisa Heiser 14 December 2018 - 2:10 am

How would you know if the contents from your large intestine had reflexes into your small intestine?

sue 24 January 2019 - 3:52 pm

You would most likely have SIBO (small intestinal bacterial overgrowth), but some chiropractors and osteopaths can test for this.

Peter 25 April 2017 - 10:11 pm

I learned about the ileocecal valve in 1980 from a prominent chiropractor in NE Ohio. If my IV was open or closed my back would go out and I would need adjustments to restore straightness. I especially found that when I would eat nuts, popcorn,or drink to much caffeine or alcohol my digestive system would bloat and the IV would be effected. Stress is a big culprit. I was a salesman on the road rushing and eating wrong which triggered the symptoms. He would have me massage the valve and use chlorophyll tablets to sooth the valve. The adjustments on the lower mid back also relieved the valve. I learned here that diet and adrenal activity and blood flow are all integrated in managing IVS. Thanks for info!

Zippy 16 March 2017 - 11:26 am

If you have a closed pain will you have pain in the area or an irritable feeling? I have had constipation and an irritated feeling in that area for a year and a half. If I eat highly fermentable foods it is much worse and if I just eat protein and fat I can avoid it though that causes constipation.
Its been a nightmare for me as every night when I lie down I have dull pain and irritation and pain killers don’t really stop the feeling.
I am desperate for an answer

Zippy 16 March 2017 - 11:27 am

Sorry I mean closed valve

K 25 December 2017 - 2:38 am

Hi I feel like you’re describing my symptoms too! Zippy have you tried a low FODMAP diet? It has helped reduce the pain for me significantly. I think my valve tends to be closed and eating any high FODMAPS increases the gas in the gut which then becomes trapped and causes pain. I also avoid gluten and my allergens

Cassandra Gill 12 March 2017 - 3:54 pm

My daughter had her ileocecal valve removed at 36 days old due to damage caused by necrotising enterocolitis she is now 15 months old and finally went for stomal reversal surgery a fortnight ago and now has an ileous of her small bowel so we have had 2 contrast studies up and down would like to know if there are anymore option we can try without getting another double barrel ileostomy. Thankyou concerned mum

Susie Grace 10 January 2017 - 12:02 am

I recall being diagnosed by a chiropractor many years ago with a closed ICV and it has been a recurring problem throughout my life Initially I was instructed to massage the valve area downward several times a day and eat more roughage. Now I may do a colonic cleanse and massage, better nutrition and pray that will get my digestive system and everything else back on track. What do others think about the use of castor oil as a remedy? I wonder why most medical doctors do not acknowledge the importance of Ileocecal valve function when it seems to be vital to life itself. That to me is a mystery of life.

Sam 9 August 2019 - 5:00 am

Yes it does!….seem vital to me too! My thought exactly

Penka Ivanova 4 January 2017 - 10:24 am

i need information for enlarges sigmoid colon,thank,s you

Teresa 10 December 2016 - 12:28 pm

Thank you for this informative article. I am being seen by a chiropractor for valve problems. I am always looking for other options. What is your treatment?

Catherine McKay 24 November 2016 - 4:00 am

I found this article very interesting as I do suffer from abdominal pain a find it difficult to digest food. I had a radical hysterectomy and radiotherapy 30 years ago and have suffered with my digestion ever since. Could this have caused my ICV to malfunction?

sue 9 December 2016 - 7:59 am

maybe, it’s hard to say

Kristen Fairman 24 July 2016 - 3:34 pm

I have neurobechet’s disease. I have had extreme upper stomach pain and bloating on and off for a few weeks now. This article made me feel like I was being described perfectly ! I think I’m suffering from the closed one. My baby girl chihuahua Dot passed away suddenly a month ago. She was my heart and soul. My emotions have NEVER been this intense and terrible. I’m also suffering with constipation, and I sore neck. Thank you for this article. I’m wondering what I should do next ??

physician assistant 9 June 2010 - 4:59 pm

What a great resource!

tijjani yusuf 28 May 2010 - 7:02 pm

Dear sir,

my sister have been diagnosed with ICV and she is considering going for operation.according to the doctor the valve has eroded and does not close properly is it advisable to undergo operation or try and manage it.