N E W Y O R K -- There's nothing like bloating to make you feel sluggish and uncomfortable. Who feels like working or going out when you're convinced you're lugging around extra water or gas?
Although many women have had days where the skirt they wore yesterday can't be zipped today, the precise cause of this feeling of fullness and tightness is sometimes unclear. That's because both gynecological and gastrointestinal troubles can lead to bloating, and sometimes it's due to a combination of these problems.
If bloating in a premenopausal woman follows a pattern, it's likely to be related to the menstrual cycle. During the last two weeks of the menstrual cycle, known as the luteal phase, women can retain water, which causes swelling in not only the abdomen but sometimes in the hands, feet and breasts.
The rising levels of hormones also have a direct effect on the gastointenstinal tract. "This hormonal effect causes the GI tract not to empty as quickly and to produce gas," explains Dr. Grace Janik, director of reproductive endocrinology at St. Mary's Hospital in Milwaukee.
Because stool and gas are moving more slowly through the intestines, women often have constipation and bloating in the two weeks before their periods. When women get their periods, their hormone levels drop and they sometimes get diarrhea.
Although it's less common, women can also have hormone-related bloating from changing or going on or off birth control pills or from the contraceptive Depo-Provera. Bloating due to these contraceptives, however, usually subsides after about three months.
Abdominal distension may be a sign of early pregnancy, particularly in women who aren't using birth control. And older women who are taking hormone therapy for menopausal symptoms such as hot flashes may also have discomfort from abdominal bloating.
Gynecologist Dr. Linda Bradley, director of hysteroscopic services at the Cleveland Clinic Foundation, says after she takes a medical history, she often suggests that younger women keep a diary of their symptoms to determine if the bloating is cyclical. If it appears to be related to the menstrual cycle, she may prescribe a mild diuretic or birth control pills.
Exercising, avoiding gas-producing foods and adding bulk fiber to the diet may also ease premenstrual bloating.
Sometimes, Bradley says, women are not necessarily seeking treatment. "You wouldn't believe how many women just want to know that it's nothing bad," she says.
If abdominal bloating is persistent rather then cyclical, it might be due to a mass such as an ovarian cyst or uterine fibroid, or, especially in women over 50, an ovarian cancer tumor. "Age makes a difference," Janik says. "An increase in abdominal size is much more concerning in women in the postmenopausal range."
To determine if a mass is present, gynecologists will usually perform a transvaginal ultrasound so that they can see if there is a mass on the ovaries that is putting pressure on the bladder or bowel and causing abdominal distension.
Women with ovarian cancer may also have ascites, which is excess fluid around the abdomen that can cause bloating.
Bloating that is not hormonal in nature is often due to gastrointestinal problem. Dr. Lin Chang, an associate professor of medicine in the division of digestive diseases at University of California, Los Angeles, says that the first step in figuring out the cause of abdominal bloating is taking a detailed history to determine, among other things, if it's associated with eating or drinking and or with other symptoms.
Bloating can be caused by diet, particularly if someone who has a high salt intake or eats a lot of gas-producing foods such as cruciferous or leafy vegetables or beans. Calcium supplements can also cause gas in some people. Doctors may recommend that people avoid these foods to see if they're the culprit.
But the most common gastrointestinal cause of abdominal bloating, Chang says, is irritable bowel syndrome. IBS is a common condition characterized by abdominal discomfort and diarrhea and/or constipation and abdominal bloating.
Women with IBS do not have more gas and bloating than other people, but instead have a hypersensitivity to gas. While IBS is difficult to treat, it may be helped by medications that ease constipation, tricyclic antidepressants or even psychotherapy.
Other women may have only abdominal bloating, Chang says. This may be the result of a partial or complete intestinal blockage. There are many possible causes of these blockages, including scar tissue from prior surgeries, certain medications, abdominal infections and hernias.
Those who have bloating, along with discomfort in the upper gut, may have a food intolerance such as an intolerance to lactose, the sugar in milk, or fructose, the sugar in fruit. Such intolerances can be handled by simply avoiding lactose or fructose. Women with lactose intolerance may also choose to treat milk products with the enzyme lactase.
In rare cases, women may have parasitic infection or an inflammatory bowel disease, or IBD, such as Crohn's disease or ulcerative colitis. Chang notes that bloating is not the prominent symptom of IBD; these diseases are usually distinguished by red-flag symptoms such as blood in the stool or a family history of IBD.
Bloating is very common in women, but if you have bloating that's making you uncomfortable, especially if it's persistent, experts say that getting it checked out is worthwhile.