I work in partnership with Naturopathic and Functional Medicine Physicians who are helping people recover from small intestinal bacterial overgrowth (SIBO). Physicians typically address SIBO through a variety of herbal, antibiotic and nutritional protocols.

My job as a practitioner trained abdominal therapies is to help improve gut motility and improve intestinal sphincter function through manual therapy. Slow motility can lead to SIBO, a difficult recovery, and SIBO relapses.

I sometimes find dysfunction with the ileocecal valve (IC Valve) with clients who have SIBO. The IC Valve connects the small intestine to the Cecum (the first part of the large intestine). Peristalsis of the small and large intestine should keep things flowing in the right direction. The IC Valve also plays a role in keeping contents from the cecum back flowing into the small intestine. Dysfunction in the IC valve can lead to bacteria migrating from the large intestine to the small intestine where it shouldn’t be. There are specific Visceral Manipulation™ techniques that improve the ileocecal valve function. These manual therapy techniques may include working with the ileocecal valve, cecum and/or surrounding structures.

Practitioners who are trained in Visceral Manipulation™ may also work to improve motility of the small and large intestine as well as the liver or stomach. Low stomach acid is another cause of SIBO. Stomach acid is the bodies first line of defense, it’s part of our immune response, it kills bacteria in our food before it get’s to the small intestine. If the stomach acid is low, harmful bacteria gets to the small intestine. So think twice before popping the antacids. We need acid! I wrote about how low stomach acid can actually CAUSE heartburn here.

A Visceral Manipulation™ practitioner doesn’t follow one set protocol when working with someone with SIBO (or anyone else). The body guides us. That’s why we start the session with a “listening” with our hands. A listening is a way the body guides us to lesions or restrictions in the body. Restrictions may be adhesions, but not always. I wrote about my approach to working with abdominal adhesions here.

No one area of the body works in isolation. Working with the belly can be like working with a ball of string. You pull on one area and you feel it somewhere else. The intestines can definitely work in this way. There may be a dysfunction at the upper sphincters and once they’re corrected, the lower sphincters also correct. Or if you improve the motility of one organ, you improve the motility of the surrounding organs. They are all connected and snuggled up to each other. Typically follow-up appointments for Visceral Manipulation™ are once every 3 weeks until symptoms resolve. In between appointments my clients may incorporate the following homework.


  • Repair the gut-brain axis through vagal nerve stimulation. Do these exercises daily.
  • Gargle vigorously until you have tears running down your cheeks. Do this at least twice a day for a minute or more each time.
  • Tongue scraping to induce the gagging reflex.
  • Sing your heart out. Singing stimulates the vagal nerve pathway.
  • Smell your food to stimulate saliva. The cephalic phase of digestion (brain phase) is triggered by the sight, smell, and memory of food. The sight, smell and memory of food signals the brain to send messages to the gastrointestinal tract via the vagus nerve. This reflex stimulates peristalsis and gastric juices.
  • Chew your food. Each phase of digestion only works as well as the phase that came before. Chewing stimulates enzymes that break down food and signals the rest of the digestive system that food is incoming.
  • Don’t talk politics while you eat or eat on the run. When you eat on the run, your body registers you as being in motion, and this slows down the digestive process. Digestive juices are inhibited by emotions of anger, fear, and anxiety. Limit your dinner conversations to pleasant dialogue or better yet eat in silence.
  • Don’t wear restrictive clothing around your waist, or habitually suck your belly in.
  • I also give them self-care massage instructions. Doing self-abdominal massage can stimulate the wave-like peristaltic movement of the intestines and stimulates digestive juices. You can even hear the gut gurgling when abdominal massage is applied. It’s like the gut is saying, “Yeah, baby! Let’s do this!”
  • I’ve developed an online class for working with your abdominal adhesions and scars.

Abdominal Adhesions Course


Recommended reading:

Chew Challenge http://alignmentmonkey.nurturance.net/2017/chew-challenge/

Digestive Tips Part 1: http://alignmentmonkey.nurturance.net/2011/digestive-health-part-1/

Digestive Tips Part 2: http://alignmentmonkey.nurturance.net/2012/digestive-health-part-2-alignment-and-digestion/

Constipation: http://alignmentmonkey.nurturance.net/2014/constipation-aka-log-jam/

Adhesions: http://alignmentmonkey.nurturance.net/2016/abdominal-adhesions/

SIBO Info: https://www.siboinfo.com/

Sucking your belly in: http://alignmentmonkey.nurturance.net/2015/where-organs-go-when-sucking-in/

Dr Mariotti’s lecture (video) Neuorplasticity, the Gut, and the Role of Visceral Manipulation in the Osteopathic Practice

To Find a practitioner trained in Visceral Manipulation™ visit the Barral Institute’s website.

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