Case Study: Chronic Severe Constipation Caused by Asymptomatic L3–4 Intervertebral Disc Syndrome and Closed Ileocecal Valve

by William M. Maykel, DC, DIBAK Presented at the International College of Applied Kinesiology-USA Annual Meeting, 2003–2004, p. 69–70

Abstract: The case of a thirteen year old boy who had never moved his bowels is discussed. Normalization of the bio-mechanics of his lumbosacral spine and ileocecal valve function corrected the case of a young man who had a once a week enema for all of his life. After his third visit he was moving his bowels daily.

Keywords: Applied Kinesiology, Ileocecal Valve, Challenge, Constipation

Introduction: As a result of a passing conversation with a mother of a thirteen year old boy, I found out that he had never begun to move his bowels since birth. He had extensive workups at many of the Worcester and Boston area hospitals to no avail. He had gone through a series of treatments which included repeated cycles of X-rays and mineral oil – none of which worked. For the better part of his life, his mother had given him a weekly enema. Constipation is defined as less than three bowel movements per week.1 Constipation is common and significantly impairs health-related quality of life.2, 3 The incidence range in the pediatric age is 0.3 to 8% and in 90–95% of cases it is functional, often due to an exclusively milky diet.

Discussion: Through my own past experience in treating people with closed ileocecal valves5 I thought he may have an asymptomatic low back problem that may be related to a dysfunctional gastrointestinal tract from a mechanical basis. Therefore I suggested that she bring him in.

Physical examination revealed that he in fact had a bilateral sacroiliac sprain/strain (right posterior externally rotated, left anterior) with a compression of the L3–4 intervertebral disc. Additionally L3 was anterior and there was a positive challenge suggestive of a closed ileocecal valve. Other findings included a lateral tarsal tunnel syndrome with laterally displaced talli and externally rotated tibias. The muscles relating to his stomach (pec major claviculars) were weak bilaterally suggestive of hypochlorlydria. There was also tenderness on palpation of the gallbladder so we suggested that he use beet greens.

They have a lipotrophic effect. After his second office visit, he had two small bowel movements on his own and after the fourth office visit, seven weeks from his first visit, he was moving his bowels on a daily basis. Treatment consisted of some lumbar intersegmental traction to the L3–4 disc along with corrective stretching exercises. He avoided several foods that he was found to be sensitive to using muscle testing. With a gustatory challenge, he was found to be sensitive to milk, corn, soy and wheat. We also gave him some nutritional advice to increase the water soluble fiber in his diet by incorporating the use of papaya and apples in his diet.

Conclusion: Normalization of the lumbosacral plexus outflow to the gastrointestinal tract specifically the ileocecal valve should be one of the first lines of approach to normalizing bowel function. It is both a non-invasive and cost effective (given the fact that poor quality of life is an important predicator of healthcare utilization in these patient types6) approach as well as represents a perfect example of the relationship between structure and visceral function. The tool of “challenge” utilizing applied kinesiology through muscle testing represents a technology which has awesome clinical applications that are unfortunately highly under utilized.

References:

  1. Cayaran S, Dorule E, et al. “The Assessment of constipation in monosymptomatic primary nocturnal enuresis.” Int Uro Nephrol 2001; 33(3): 513–6.
  2. Irvine EJ, Ferrazzi S, Pare P. “Health-equated quality of life in functional GI disorders: focus on constipation and resource utilization.” Am J Gastroenterol 2002 Aug; 97(8): 1986–93.
  3. Walter S, Hallbook O, et al. “A population-based study on bowel habits in a Swedish community: prevalence of faecal incontinence and constipation.” Scand J Gastroenterol 2002 Aug: 37 (8): 911–6.
  4. Dito L. “Constipation in Children.” Clin Ter 2002 Jul–Aug: 153 (4): 281–7
  5. Walther, David S DC, “Ileocecal Valve Syndrome: – Applied Kinesiology Synopsis- Second Ed. 1988, p. 494–500.
  6. Irvine EJ, Ferrazzi S, PareP “Health-equated quality of life in functional GI disorders: focus on constipation and resource utilization. Am J Gastroenterol 2002 Aug; 97 (8): 1986