From the Ileocecal Valve to the Sigmoid Colon
VISCERAL STRESS MANAGEMENT
Howard Loomis
Article 10 of 12
THIS SERIES OF ARTICLES HAS BEEN DEVOTED TO DISCUSSING WHEN VISCERAL DYSFUNCTIONS CAUSE INVOLUNTARY MUSCLE CONTRACTIONS THAT ARE FOUND BOTH AT THE SPINE, WHERE THE INVOLVED ORGAN RECEIVES ITS NERVE SUPPLY, AND IN THE PERIPHERY IN THOSE MUSCLES THAT SHARE INNERVATION WITH THE INVOLVED ORGAN OR TISSUE. I HAVE PREVIOUSLY DESCRIBED THE 60-SECOND CHIROPRACTIC SCREENING TEST AND HAVE SUGGESTED THAT BEFORE THE PATIENT LEAVES THE TREATMENT ROOM, YOU ASK HIM OR HER TO BE SEATED AND THEN YOU PERFORM THIS PROCEDURE. THE PURPOSE OF THIS SCREENING IS TO IDENTIFY IF STRESS, FROM EITHER A STRUCTURAL OR VISCERAL SOURCE, REMAINS AFTER AN ADJUSTMENT. No DOUBT, THE STRUCTURAL PROBLEMS HAVE BEEN RELIEVED, IF NOT REMOVED, AND WHAT PROBABLY REMAINS IS INVOLUNTARY MUSCLE CONTRACTION FROM A VISCERAL SOURCE.
The Unlevel (Hemipelvis) Pelvis
I described this test (really just an observation) and its meaning in article two of this series. While the patient is still seated, slide your hands down to the top of the iliac crests and determine if the hips are level. Of course, we all know that a pelvis that
is not level may be caused by a wallet in a hip pocket. Nevertheless, this may be the cause of recurring back pain and is occasionally overlooked. Be aware that a short (asymmetrical) ilium occurs in 20 to 30% of the population and is caused by pelvic rotation, and is invariably found in patients suffering from restless legs syndrome (RLS).
While the structural misalignment can come from the spine or lower extremities, don’t forget that the involuntary muscle contractions involved here might be coming from dysfunction of organs in the lower abdomen. It is worthwhile to point out that stress, in and of itself, reduces peristalsis in the large intestine, as well as digestive secretions and contraction of the pyloric and ileocecal valves. With that in mind, we need to stop and discuss something vitally important to chiropractors.
The Abdominal Cavity
The abdominal cavity contains some organs that ai e wrapped in the peritoneum (intraperitoneal) and others that aie not included in the peritoneum (retroperitoneal).
The peritoneum is composed of a layer of mesothelium supported by a thin layer of connective tissue. It is a pliable, mesh-like tissue with a fluid matrix that functions to cushion and protect body organs, and serves as a conduit for their blood vessels, lymph vessels, and nerves.
This is important because unspecialized “loose” connective tissue forms an anatomical network throughout the body and functions as a body-wide mechanosensitive signaling network. Such connective tissue signaling is affected by changes in movement and posture, such as, for example, involuntary muscle contractions produced by an organ or through connective tissue signaling by the normal or pathological function of other organ systems. Demonstrating the existence of a connective signaling network therefore may profoundly influence our understanding of health and disease.
With that understanding, here is a list of intraperitoneal structures that are not fixed in place, but are generally mobile and generate widespread mechanosensitive signals to other tissues:
• The stomach
• First five centimeters of the duodenum
• The tail of the pancreas
• The jejunum and ileum
• The cecum and appendix
• Transverse colon
• Sigmoid colon and upper third of the rectum
• The liver and spleen
• In women: the ovaries, fallopian tubes, and uterus
So let’s take that information and move forward.
Autonomic Innervation of the Colon
Innervation of the colon originates from LÍ and L2 or L3. Sympathetic fibers from the spinal cord lead to the celiac, superior mesenteric ganglia as well as the inferior mesenteric ganglia, and reduce motility.
What is more interesting to us regarding involuntary muscle contraction is that parasympathetic innervation from the vagus nerve (tenth cranial) reaches all the way to the midpoint of the transverse colon. Pelvic innervation increases motility and secretions in the descending and sigmoid colon and rectum, as well as relaxation of the internal anal sphincter.
Ascending Colon
The ascending colon runs through the abdominal cavity, upward toward the transverse colon for approximately eight inches, and is not suspended in the peritoneum. As we stated previously, one of the main functions of the colon is to remove the water and other key nutrients from waste material and recycle it back into the body. Waste material exits the small intestine into the cecum and then to the ascending colon where this process of extracting starts, and peristalsis moves the waste material upward toward the transverse section of the colon.
Dysfunction here will produce involuntary muscle contraction in the right lower quadrant of the abdomen. In that regard, it is interesting to note that cancers form more frequently further along the large intestine as the contents become more solid (water is removed) in order to form feces.
Pain emanating from the ileum, cecum, and ascending colon ai e usually felt in the lower right quadrant. Poor protein digestion, evidenced by a high urinary indican level and abdominal muscular weakness, is first evidenced in the lower right abdominal quadrant accompanied by the ileocecal valve trigger point.
We mentioned acute appendicitis previously. It usually begins with epigastric or periumbilical pain and may be accompanied by nausea and vomiting. Several hours later, the pain shifts to the lower right quadrant when fever and leukocytosis become evident.
Transverse Colon
The transverse colon begins at the hepatic flexure and begins to be supported by the peritoneum, which actually hangs off
the stomach attached to it by a wide band of tissue called the greater omentum. Because it is mobile (intraperitoneal), this suggests that dysfunction in this part of the colon can easily be responsible for involuntary muscle contractions in other areas of the peritoneum, even reaching to the upper cervical spine because of its vagal innervation. On the posterior side, the transverse colon is connected to the posterior abdominal wall by a mesentery (double layer of peritoneum) known as the transverse mesocolon. After reaching the splenic flexure, it leaves the peritoneum.
Descending Colon
The descending colon is the part of the colon from the splenic flexure to the beginning of the sigmoid colon. The function of the descending colon in the digestive system is to store feces that will be emptied into the rectum. It is not included in the peritoneum in two-thirds of humans. In the other third, it has a short mesentery to support it.
Obviously, dysfunction here will produce involuntary muscle confracti on in the lower left abdominal quadrant. Pain from the transverse and descending colon is typically located in the lower left quadrant. Because the sigmoid colon is most frequently the site of diverticula, the pain of acute diverticulitis is located in the lower left quadrant. The clinical picture has been likened to “left-side appendicitis.” Previous history of similar attacks, deranged bowel habits, and the absence of epigastric or periumbilical pain favor the diagnosis of diverticulitis.
Sigmoid Colon
The word sigmoid means S-shaped. Its walls aie muscular and contract to increase the pressure inside the colon, thus causing the stool to move into the rectum.
The Rectum
The rectum receives afferent nerves through the parasympathetic rami from S2 to S4 and inferior mesenteric ganglion. The rectum follows the shape of the sacrum and passes through the pelvic floor muscles.
In the next articles, I will discuss abdominal palpation and relating it to structural problems.
Dr. Howard Loomis has an extensive background in enzymes and enzyme supplements. He is the founder and president of Enzyme Formulations®, Inc. His knowledge of physiology, biochemistry, and enzymology has made him a sought-after speaker and a prolific writer. Dr Loomis published ENZYMES: The Key to Health in 1999. Contact info: 6421 Enterprise Lane, Madison, WI53719, customerservice@ loomisinstitute.com
