Is this an unidentified painful area in your endo life? Poke here, on your right side, about halfway between your hip bone and belly button. Meet your ileocecal valve (ICV)! Your ICV exists where your small intestine flows into your large intestine.

Because they are such radical different microbiomes (the large intestine holds the majority of bacteria within the intestinal tract, whereas the small intestine has much much less, I talk about this in my book), it’s important to keep the two worlds apart. To do so, there is a delicate little flap (called the ICV) that works kind of like a toilet—it’s sealed shut until the small intestine “toilet” is ready to be flushed into the large, where the ICV flaps open then quickly shut. Done!

The problem with the ICV lies, perhaps, in how delicate it is. This is no strong porcelain toilet! The delicate little flap depends on an ecosystem free from inflammation, infection, and dysbiosis in order to behave properly. When the ecosystem becomes skewed, the ICV itself can become inflamed, which means the proverbial “toilet'“ may get clogged or, worse yet, backflow.

This causes pain! You may even notice swelling. In my own journey pain and swelling here were common symptoms. You may notice it flairs up more often with certain food choices (like alcohol, sugar, eggs, etc), or you may feel it more during the week before your period as progesterone rises to create more constipation-based issues (which also trigger the poor ICV).

Wait, isn’t that my ovary?

In the endo world, I sometimes see women confuse this area with their right ovary as they tell me they have terrible endo pain here. Some of them actually do, but often the ICV is a big culprit.

How to tell the difference? Anatomically, your ovary is about an inch (or more) lower than the ICV, and if you poke and prod in this area on both sides you may notice you only feel the tenderness on the right side and nothing on the left (even though you may have endo + cysts on both sides). You may also hear a “squish” noise when you press here firmly, like fluid moving around, or feel it inflame after eating something you react to, like dairy, gluten, alcohol, etc. You may not even have realized it until now, that this is your ICV responding rather than your right ovary. Take the next week to pay attention, see if you can differentiate some patterns.

Here below are two pictures to help you tease out the location of your pain:

Why Does My ICV Feel so Tender?

Because it’s inflamed, and maybe because it’s malfunctioning (two different issues, one or both may be at play). Your ICV bears the brunt of distress from everything above it - the stomach, pancreas, gallbladder, small intestine, and even your mouth! It may be reacting to rancid food particles from improper digestion, pathogenic bacteria or yeast overgrowths, or food allergies. A celiac friend of mine had named this spot her “Gluten Spot” in college since it would become incredibly painful whenever she ate something contaminated with gluten. This little area is also known for holding infections.

When the ICV faces this kind of inflammation for a long time, it can stop functioning correctly - if at all. Basically, the flap can get stuck open, losing the proper seal that keeps the two microbiomes apart. Insert toilet sewage backup. This allows contents of your large intestine to back up into your small intestine, basically fecal matter lodging itself in your very sensitive small intestine. This is why ICV issues are also a potential root cause of SIBO (Small Intestinal Bacterial Overgrowth) since copious amounts of bacteria can more easily migrate to the small intestine, where they shouldn’t be.

How to help your ileocecal valve

Like any area in your body the ICV can be rehabbed! To do so, there’s a two-pronged approach to help your ICV:

1) you must remove the inflammatory triggers from upstream

Just like you must remove a splinter from the finger for the infected area to heal, so too much you remove the triggers from above the ICV for it to cool its jets. That means eliminating any triggers unique to you, such as foods you may be reacting to, pathogens, and improperly digested foods. I highly recommend my best selling book, Heal Endo, for about 1,000 tips on how to digest better, as well as Heal Endo which dives deep into the importance of food to lower intestinal (and endo) inflammation. Here are some quick ideas in the meantime:

Try a month of just cutting out gluten, alcohol, and dairy, see if the ICV pain subsides.
Add in digestive enzymes, and ALWAYS chew and salivate with your meals. Be conscious about it, see any shift in pain?
Always brush your teeth after every meal. Not for dental reasons, it’s actually important for supporting gut microbiome health.
If you have more severe digestive issues, try a low FODMAP diet for a month. Notice any shifts?

All of this can take a while, but it’s fun to use this spot as a “barometer” of healing, as in watch at you remove certain foods and realize the pain or tenderness is much less within 24-48 hours.

2) rehabilitate your icv through a Manually flush

The second thing to do simultaneously throughout your whole endo-belly healing process is to massage this area in a certain way to help to start rehabilitating it.

To do, lay down and find your ICV, that tender little spot. Using a firm pressure of the fingertips from both hands, aim an inch below that ICV spot, press firmly into your abdomen, and pull directly up (towards your head) as you follow the line of your large intestine.

Take your fingers off, replace them at starting, and pull up again. Do it one more time for a total of 3x.

Last, place both your thumbs together about an inch above your ICV. Push into your abdomen firmly, and drag down. Here you are clossssssing your ICV.

So three long and firm pulls up to help empty the toilet. One small but firm push to close the ICV.

You may be tempted to dig in this area in rotations to “massage,” but don’t do that as it can just push even more fecal matter into your small intestine. Three up, one down. Done. Toilet flushed. Do once per day.

Note: If you have severe pain here, please DO NOT force yourself to massage this area at all. There’s a difference between tenderness and genuine pain. If your pain is significant in this area, it could be a sign of an infection (as this area often becomes a pathogenic bacteria breeding ground when it’s been sick for a long time), a cyst from your ovary that you don’t want to rupture, or IBD. If this is you, get thee to the gyno for an ultrasound to double-check. If no cysts or adhesions are present, get thee to a functional doc or gastroenterologist who can help you investigate further if you have damage here.