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.
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.
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.
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.