Rarely does a week go by, that patients do not mention the symptom of bloating. If you are a woman of a certain age, you certainly know that bloating can be a symptom of ovarian cancer. Many of us know women who have been diagnosed with ovarian cancer, some with minimal symptoms. Of those symptoms, bloating is quite common, but bloating is also common in a number of other conditions, many involving the GI system.
Today, WebMD published a presentation on bloating. It was under their Digestive Diseases section. Let’s look at the various causes of bloating, and try to differentiate them from the symptoms of ovarian cancer.
Here are some highlights of the article:
Bloating is that sensation that your abdomen feels very full and may be protruding. Maybe you did eat too much, and maybe the foods you ate gave you some terrible gas. This can happen, but will usually resolve by the next day. GI conditions that can cause this are irritable bowel syndrome and gastric reflux. In IBS, the symptoms can be abdominal pain, gas, bloating, and diarrhea or constipation. In reflux, acid from the stomach enters the esophagus and causes pain. Sometimes, excessive salt and carbohydrates can lead to water retention and the sensation of bloating. The gas in soda, beer, champagne, and seltzer can also make you feel bloated. If you eat too fast, your stomach can fill with air, and make you will be distended. It takes about 20 minutes after eating for the signal to get to your brain that your stomach is full, so eating slowly makes sense, and helps to prevent overeating.
Then, there is constipation. Some people suffer from chronic constipation, and often feel very uncomfortable. Drinking more water, exercising, and a high fiber diet can help. Sometimes medications need to be prescribed. Some people develop lactose intolerance as they get older. If you develop lactose intolerance, taking dairy products such as milk and cheese can cause gas, abdominal pain, and bloating. Some dairy products are lactose-free.
It is not unusual to gain about five pounds with menopause. Many women know that the weight often goes to the abdominal area. Women who always had flat stomachs complain that their pants are too tight. No one is really certain why the weight seems to settle in the mid-section, but it is a very common complaint.
Fructose is a type of sugar that can be hard to digest, and fructose is found in corn syrup, dried fruits, honey, onions and garlic. Monitoring your reaction to these foods can help determine if they bother your GI tract. Excessive fat in the diet can make you feel bloated, because it takes longer to digest.
Hormones can play a role in feeling bloated. Many women notice bloating premenstrually, and will sometimes feel constipated. Soon after the period begins, these symptoms seem to abate. Many women who are in the peri-menopause will notice that they feel bloated for weeks at a time, and feel premenstrual, but the period is delayed. This is related to changes in hormones that occur during this time, and this is very difficult to treat.
Have you heard of anyone on a FODMAP diet? Doctors have found that foods that contain certain carbohydrates are difficult for some people to digest, so they are started on an elimination diet that includes restricting such foods onion, garlic, many vegetables and fruits, grains and dairy. The diet is very restrictive, but foods are added back until it is determined which are the most problematic. Many patients have found the FODMAP diet very helpful in eliminating their irritable bowel type symptoms. Many patients have found the FODMAP diet very helpful in eliminating their irritable bowel type symptoms.
If you have celiac disease, you GI tract has trouble digesting a protein in wheat, barley and rye. Celiac disease is autoimmune, and affects about 1% of the population. In celiac disease, the villi of the intestine that absorb nutrients are destroyed, this can lead to weight loss and osteoporosis. The symptoms of celiac disease can vary from none, to abdominal pain, diarrhea, gas, and loss of weight. Adhering to a gluten-free diet can correct some of the damage and eliminate symptoms. Tests can be done to diagnose celiac disease.
The symptoms of ovarian cancer can mimic some of these previously mentioned GI complaints. In early stage ovarian cancer symptoms are often absent. Many women notice mild symptoms of bloating, distention, feeling full more quickly when eating, or pressure on the bowel or bladder. Pain or discomfort is often mild. Moderate or severe pain is not typically present, but it can signal obstruction of the bowel. Sometimes the first symptom a women will notice is that her clothes feel tight or she cannot button her pants. Symptoms of ovarian cancer are often thought initially to be related to the stomach or bowels, and many women receive this diagnosis from a gastroenterologist who performs an evaluation for GI disease. An important distinction can be made when you look at the frequency of symptoms. GI problems often come and go, while symptoms of ovarian cancer will worsen over time.
My best advice would be this: if you develop a symptom such as bloating and it is persistent over several weeks, see your doctor. Taking a good history, performing an exam,and possibly ordering some tests can often determine the cause and rule out any serious disease.
Marilyn Jerome, M.D.
P.S. Additional information on ovarian cancer can be found under that title in Menopause 101