The Ileocecal Valve – Lower gate of the small intestine

by Dr. Steven Sandberg-Lewis

The large intestine (colon) is designed to be a home for trillions of bacteria. Hundreds of species of beneficial colonic bacteria play a major role in many essential body functions including immunity, blood sugar regulation, hormonal balance and mood. The small intestine is designed to have low levels of bacteria and if these increase anywhere near that of the colon, irritable bowel syndrome manifests.

At the top of the small intestine, the entry of pancreatic enzymes, bile and stomach acid keep the growth of bacteria under control (the “upper gate” of the small intestine). At the very end of the small intestine is a ring of muscle called the ileocecal sphincter or valve (the “lower gate” of the small intestine).  The ileocecal sphincter is a one-way valve which prevents the abundant numbers of colonic bacteria from moving up into the small intestine. It normally stays closed at all times except when digested material leaves the small intestine to enter the colon. The word ileocecal is derived from ileo or ileum – the last portion of the small intestine- and cecal or cecum – the first portion of the large intestine.

If this ileocecal gatekeeper becomes too loose (“open ileocecal valve syndrome/open ICVS) and may cause diarrhea. If too tight (“closed ileocecal valve syndrome) it may cause constipation. Nausea or abdominal pain may also be experienced. Symptoms in body systems outside the digestive tract may include fatigue, ringing in the ears, neck or low back pain, joint pain, symptoms resembling carpal tunnel syndrome, flu-like aching, and bad breath.

During diagnostic colonoscopy, the scope is inserted into the anus and advanced through the colon to the ICV and then through the sphincter into the last portion of the small intestine which is called the terminal ileum. A close reading of colonoscopy reports with this in mind is important. On patient reports I have seen the following notes – “the ileocecal valve was open” and “the ileocecal valve was gaping” or “clear fluid was seen leaking through the ileocecal valve.”  These descriptions are associated with an open ileocecal valve and the scientific term is” low Ileocecal junction pressure”. Alternatively, the ICV may be so tight that the gastroenterologist is unable to move the scope through it and can only examine the colon. A device named wireless motility capsule evaluates pressure, pH, and temperature throughout the GI tract providing another test of ileocecal valve muscle function. Open ICV syndrome increases the risk of small intestine bacterial overgrowth/SIBO (Roland BC et al, 2014). Surgical removal of the ileocecal valve leads to reflux from the cecum (colon) into the ileum (small intestine) leading to SIBO (Gazet RJ, 1964).

Causes and treatment options:

A number of factors control the function of the ileocecal valve. Adequate calcium nutrition may be one of the most important. With dairy-free diets and the popularity of magnesium supplements over calcium supplements, a relative deficiency of calcium is possible. Supplementation of choline, huperzine A or other herbal extracts may improve ICV muscle tone in open ICVS. 

Distention (stretching due to excess fullness) or inflammation of the cecum or appendix increases the tightness of the ileocecal valve. The research shows this to be the case in appendicitis in humans and cecal distention in dogs (Kelly ML, 1966). The Western seated position toilet is a factor according to a 2018 journal article by Dr. Jonathan Isbet:

Like all primates, humans were designed to squat for bodily functions. The sitting position sabotages the natural biomechanics of defecation and forces one to use the Valsalva maneuver (holding the breath and straining to push out stool). How does this increase the risk of appendicitis? The cecum, instead of being squeezed empty by the right thigh when squatting, is actually inflated by the Valsalva maneuver. The increased pressure can push fecal matter into the appendiceal orifice. The back-pressure can also overwhelm the ileocecal valve, contaminating the small intestine.

Hormonal control over the valve is also important. The adrenal cortex produces two vital hormones called cortisol and dehydroepiandrosterone (DHEA). In general I have found that an imbalance between these allows ICVS to develop.

The sphincters and valves of the digestive tract are called smooth muscle. This means they are not under voluntary control as are the skeletal muscles such as those in the limbs, neck, back and trunk. One such voluntary skeletal muscle – the psoas- is found in the area of the cecum and ICV. When the psoas is very tight or in spasm, this can trigger a closed ICV. Certain acupressure and reflex points are used to help balance the psoas and kidney. These include Kidney 4, Bladder 58, and other reflex  points.

Certain foods are thought to trigger ICVS and the majority of the blame falls on popcorn. It is thought that the soft popped corn dissolves rapidly, but the sharp-edged, darker seed coat is not digested and makes it all the way down to irritate the ICV. Newer versions of popcorn (“Pipcorn”) have been developed to reduce this irritation. T

In my practice I have found that testing and treating hormonal imbalances, the use of visceral manipulation, acupressure techniques, dietary changes and nutritional supplements may normalize the function of the ileocecal valve. Restoring proper function of this important structure is an important step in prevention of a wide range of health problems.

Citations:

Roland BC et al, Low ileocecal valve pressure is significantly associated with small intestinal bacterial overgrowth (SIBO). Dig Dis Sci. 2014 Jun;59(6):1269-77.

Kelly ML et al. Pressure responses of canine ileocolonic junction zone to intestinal distention. Am J Physiol, 1966 Sep;211(3):614-8.

Isbit J. Preventing diseases of civilization. J Pediatr Surg. 2018 Jun;53(6):1261.

Gazet, RJ, Jarrett, The ileocecal-colic sphincter. Studies in vitro, in man, monkey, cat, and dog. Br J Surg 1964; 51:368-370.

Steven Sandberg-Lewis, ND, DHANP, has been in clinical practice since his 1978 graduation from NUNM. He has been a professor since 1985, teaching a variety of courses but primarily focusing on gastroenterology and GI physical medicine. He is the author of Let’s Be Real About Reflux - Getting to the Heart of Heartburn and the textbook CLINICAL GASTROENTEROLOGY, available on all online bookstores such as Powell’s.

Hive Mind Medicine blog posts are for educational purposes only and are not intended as medical advice. Please consult with your health care practitioner for personalized guidance.