Abstract—This letter introduces the concept that abdominal muscles play a vital role in digestion. They actively control the food flow between sequential intestinal processes, and importantly, they create and maintain a high-pressure environment, crucial for proper digestion. Our ability to consciously control those same muscles for body movements, also gives us the ability to intervene, alter and in some cases disrupt one or more of the automated, muscle controlled digestive processes. The results of such a change are today diagnosed as Irritable Bowel Syndrome – IBS. The only evidence supporting the proposed mechanism, besides its simplicity and its ability to fit and explain existing literature, is the fact that I had it going for 12 years.
Keywords—Irritable, Bowel, Syndrome, Constipation, Diarrhea, Abdominal, Muscle, Intestine, Flow, Pressure, Control
I. INTRODUCTION
Irritable bowel syndrome (IBS) is a chronic functional disorder of the gastrointestinal system, without definitive investigation, no biomarkers and no known cause [1]. The two major, state-of-the-art research directions for identifying the leading IBS cause are food related/triggered malfunctions, or psychological/mental health causes [2]. Here we show how IBS symptoms can arise due to a purely mechanical, abdominal muscle disorder, and the way psychology and food ingredients interact with it. The hypothesis is that fundamental role of abdominal muscles is to maintain constant intestinal pressure, which makes food move slower, and even stop.
II. FUNCTION
There is a misconception regarding digestion. It is visualized as a production line of many sequential processes, similar to a car making factory. We input metal and plastic (food) and get cars (stool). We think of the stomach as an hourglass, releasing bite after bite to go through the tunnel. The real process, however, involves a small number of sequential processes, which are vastly parallel and slow, similar to a cookie making factory. We input dough ingredients (food) to make a million cookies at once, which require three large and slow parallel steps. Mixing, baking, packaging. And in the end, we get a full container (stool). The difference is that the first visualization implies that food is continuously moving through the intestine, by the intestine. Meaning that the intestine walls are responsible for this movement. This visualization is inaccurate. Food moves only to change between the three sequential steps, but stays still for a huge amount of time at each of them. What ensures that it stays still is the constant abdominal pressure applied by the belly muscles, which is released only briefly, after mixing, baking or packaging are over.
Stage A : Chewing and stomach mixing with acid and enzymes (AE) is the first process, lasting 20-40 minutes. Abdominal pressure ensures food stays in stomach during that time and a brief relaxation (BR) releases the mix to stage B, when ready.
Stage B : Waiting to dissolve and reabsorb the AE is the next stage. Food is spread in a vast first portion of the intestine (maybe larger than 1/3 of the entire length), until AE act to dissolve the food ingredients. AE are also reabsorbed before the end of this stage for future reuse. Food is spread with mm thickness, like a long spaghetti. This way contact with intestinal walls is maximal. Abdominal muscle pressure (AMP) is crucial to achieve perfect thin spread, and clean separation between solid and gas ingredients. This allows early upward gas removal, which is the normal function. This stage lasts more than 2 hours, with food not moving at all the entire time. A BR releases the mix when ready.
Stage C : Waiting to absorb the useful food ingredients is the next stage. This process involves an equally large amount of intestine with stage B. Food is spread equally thin, and the intestine absorbs useful ingredients, remaining AE, and performs some dehydration. This stage lasts longer than 5 hours, and AMP ensures that food is not moving the entire time. A BR releases the mix when ready.
Stage D : Aggressive dehydration is the final stage. During stages B and C, food was soft enough, and AMP caused the spaghetti spread. Now it has become stiffer and harder to move. Thickness slowly increases and AMP helps in the final compression and forming of the stool in the large intestine, which lasts 10+ hours.
During the entire time, AMP is ensuring constant pressure and perfect spread, with BR for the food to move between the stages. It is possible that each stage has distinct limits, strategically placed under an abdominal muscle to allow for the flow control, as well as the ability to communicate its status to the brain and trigger a BR when ready. Stage B intestine includes AE sensors for proper AE release and absorbance control, as well as “regular” hunger sensors. Stage C intestine includes “deep” hunger sensors. It is also possible that the abdominal muscles are involved during stomach mixing and during the backpropagation of AE in the stomach.
III. DISFUNCTION
Before: Around the age of 22, I realized that I was developing Hourglass Syndrome (HS) habits (without being aware of the term) and decided to stop it. This decision not only made me to significantly reduce my AMP, but also made me misclassify a series of normal body functions, crucial for digestion, as HS habits. Someone might think that it is hard to intervene, but a couple of weeks of conscious interference can permanently change the muscle memory function, and in my case, invert it. In a month, my belly was expanding instead of contracting whenever a relevant signal was received, and I was maintaining almost zero AMP. Additionally, my breathing moved from the chest to the belly because it was a zero-resistance path. Within a year, I wasn’t even remembering that things had changed. And most importantly, I had no noticeable symptoms, especially digestive, for at least a couple of years after, which made me fully forget about the change.
Year 1-2: No symptoms. Some skin stretch marks, and some discomfort with tight clothes. The reduction of AMP is slowly allowing the intestine to work with larger diameter. This makes my stool slightly thicker for a few mm, which goes unnoticeable.
Year 3-4: Regular portions of food make me feel fuller than usual. Or at least briefly, because in general, hunger and food consumption are increased. This, intuitively, makes me further decrease my AMP, because if things press from the inside, you don’t consider pressing back. Stool become noticeably thicker, but not more than a few mm diameter. Coffee starts triggering a flash emptying of stage B process. However, the only symptom of that is hunger after coffee consumption. Bladder habits slightly change.
Year 5-6: Hemorrhoids and heartburns is the first reason I visit a doctor. He hints that some food might be the cause. At that point I am certain (wrongfully) that my problem, and what makes my stool bigger is constipation. With the doctor’s direction and some laxatives, I manage to break this large stool into a soft yellowish alternative, which however doesn’t improve the hemorrhoids issue at all, and restroom visits start to increase. I notice improvement during vacation. This indicates psychological-anxiety causes. However, first tests show that the vacation diet is what helps. I increase bread, which simply is harder to move, even with low AMP, and also increase milk. Despite quitting coffee, stage B failures return, but not as aggressive. This causes mostly AE distribution failures and heartburn, and at the same time milk significantly helps them go unnoticed. Bloating and gas increase. I probably have some gastritis amplified by my unhealthy habits.
Year 7-8: Within a year I am operating with consistent stage A, B, C and D failures, but extreme milk consumption significantly relieves the symptoms. Restroom visits exceed 5 per day, extreme amounts of downwards gas. Doctors investigations for diarrhea points to no known cause. I start a thorough food investigation, which will continue for the next years. I quit eggs, which instantly solves my hemorrhoids, and milk, which instantly eliminates 80% of the gasses. However, no significant restroom improvement. On the contrary, things become painful. Milk was actually helping.
Year 9-12: Continuous food investigations make me eliminate FODMAP, fat, alcohol, smoking. I feed on rice, potatoes and lean meat. Things are under control, restroom visits below 2, yet, it is still there. With effort, I manage to quantify the amount of illegal foods that I can “safely” consume, improve my diet without drawbacks, and things become a routine. However, the better I understand the food effects, the more apparent it becomes, that no food can fully predict results. There is another factor. I revisit the anxiety causes and detect an actual correlation. Heartburns come back, I consider it positive. I also consider BAM and test some PPI, both, anxiety and PPI seem to help. I quit breakfast, this also seems to help. But nothing helps consistently. My diet remains the same.
After: The quitting breakfast improvement seems to go away. This makes me think that it could be because hunger made me “suck my belly” (SMB), but as soon as I got used to hunger, I no longer do it. I recall a friend suggesting that SMB might help, and finally I remotely recall my HS habits. I realize that my weight is as low as 50 Kg, and my belly is still popping out. I realize that my belly is almost as far out as it goes. You should probably see the bones when you are 50 Kg. Next day, I wake up and just SMB all day. The day after, I have the first non-medically induced constipation in more than 5 years. I had a bacon burger, and another. All good. But besides that, I remained cautious. Muscle regeneration is tough, because my zero AMP habit eliminated my ability to apply any AMP. The stool results of the first two weeks fully correlated with my SMB capability. After two weeks, I am consistently and fully healthy. My brain remembered that there already exists a breathing control for chest breathing, which automatically triggers SMB. And then my brain started remembering all the details for what actually happened 12 years ago. Within a month, although I still don’t have the muscle capability to fully AMP, I have already reintroduced all foods and smoking. But the most important indication, is that my body is now recalling how we used to live.
IV. DISCUSSION
AMP: By now the role of AMP in digestion should be clear. Consistent reduction of AMP leads to larger intestine diameter during operation, which leads to poor wall contact and allows food portions to move when not supposed. At first, this can cause some AE malfunction (heartburn) and some food might reach the colon (hemorrhoids). Eventually, the stage flow controls fail, and entire stages collapse, starting from above. Counter-intuitively, early symptoms let food spend more time at the dehydration stage D, leading to constipation even though things move faster. Classic IBS symptoms are next. Gasses, bloating and severe stool issues.
FODMAP, fat, drinking, smoking: All those things are simply hard to digest. Anyone with diarrhea will benefit from quitting them, regardless of the diarrhea cause. Partial improvement indicates that they are not the leading cause. There is a possibility that certain groups might indicate a specific stage failure, however, most foods require all stages to be functional, to be digested.
Drugs and anxiety: Drugs and anxiety are actually more relevant, because of their known effects on muscles. Constipation due to opioids, might simply mean that opioids increase AMP. Interestingly, anxiety triggers a fight or flight response. And this automatically creates a slight AMP increment, because you should not “lose your stool” while fighting. Unfortunately, I thought this to be another HS habit, and inverted it. This is why, and how, my anxiety did have a negative effect. Considering that my main cause for anxiety the past years had been my IBS, this is another self-amplified loop, similar to my second AMP reduction (year 3-4).
V. DIAGNOSIS AND TREATMENT
Besides the fact that the easiness of the treatment allows it to be used as a diagnosis tool (suck your belly and see if it works), I run a quick test on ten healthy friends. I asked them to define where they breathe from (chest or belly), and to define where their belly rests with respect to its most contracted and expanded positions. They were almost equally split into two groups. People with belly resting closer to contracted position, breathing from the belly, and people with their belly resting closer to the expanded position, breathing from their chest. I was resting further than the most expanded measurements, and breathed with the belly, which I identify as diarrhea cause. Subjects who SMB and breath with their chest should be the most constipated, and that is what I do now. An actual intestinal pressure measurement can be obtained using a pressure capsule pill. Take a camera pill and replace the camera.
VI. CONCLUSIONS
My understanding is that only abdominal muscles can adapt to the necessary elasticity, required by random meal portions, which can happen in the wild. Intestinal wall should be capable to expand as needed, because today you ate an entire pig (that is also why we have no belly bones). It cannot be fully elastic and at the same time strong enough to maintain the required pressure. The later task is carried by the much stronger abdominal muscles. However, I am not a doctor. I am just a patient, and Roy Bott is an alias name. My PhD is in engineering. I write in IEEE format. I hope you enjoyed my speculation, and that you are happy that it worked for me. Proceed with caution, consult your doctor, and I wish you the best.
REFERENCES
[1] Canavan, C., West, J., & Card, T. (2014). The epidemiology of irritable bowel syndrome. Clinical Epidemiology, 6, 71–80. doi.org/10.2147/CLEP.S40245
[2] Holtmann, Gerald J et al. (2016). Pathophysiology of irritable bowel syndrome, The Lancet Gastroenterology & Hepatology, Volume 1, Issue 2, 133 - 146
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