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Q: lower abdominal swelling ( Answered 4 out of 5 stars,   1 Comment )
Subject: lower abdominal swelling
Category: Health > Women's Health
Asked by: dani2000-ga
List Price: $50.00
Posted: 09 Jan 2004 15:34 PST
Expires: 08 Feb 2004 15:34 PST
Question ID: 294894

I am a 43 year old woman with the following main complaint:
swollen/distended lower abdomen. Usually it gets worse after a
stressful day and/or after lack of sleep, before and during my period
and after a meal, particularly starch-rich food, fruit, beans etc...

what tests have been performed so far:

pelvic examination by a gynaecologist in May 2003

pelvic ultrasound

with endometrial biopsy (awaiting results)

(PAP test normal)

the following have been detected:

small intramural fibroids

fluid-rich ovarian cyst(s)

My question:

can both the above cause lower abdominal swelling?

I am TERRIFIED of ovarian cancer (abdominal bloating/swelling etc):
can it be totally excluded via the tests above?

Thank you

Subject: Re: lower abdominal swelling
Answered By: pinkfreud-ga on 09 Jan 2004 18:04 PST
Rated:4 out of 5 stars
Hello, Dani.

I can certainly understand your concern. When I was your age I, too,
experienced abdominal distention whose cause was initially unknown.
Every case is unique, and of course it is not possible to diagnose the
cause or causes of your abdominal swelling here. I've gathered some
information related to the two questions that you've asked. It is my
hope that this will provide insight into the information that you've
received from your physicians, and will help to put your mind at ease.

    can both the above [small intramural fibroids / fluid-rich ovarian
    cysts] cause lower abdominal swelling?

Yes, both intramural fibroids and ovarian cysts can cause lower
abdominal swelling. Intramural fibroids, which grow in the uterine
wall, are the most common type of fibroid growth. Fibroids (also
called myomas, fibromyomas, or leiomyomas) are benign (non-cancerous)
tumors that occur primarily in women of childbearing age. It is
estimated that from one-quarter to half of all women over the age of
40 have fibroids. Although hormones play a role in the development of
fibroids, the exact cause is not known. Some fibroids cause no
problems whatsoever; others can result in pain or a variety of
menstrual, gastrointestinal, and urinary symptoms; still others may
cause bloating and abdominal distention. In my own case (when I was in
my early forties), intramural fibroids caused my lower belly to swell
up so dramatically that I looked pregnant.

"Intramural Fibroids: These fibroids develop within the wall of the
uterus. As they grow, they increase the size of the uterus. This can
result in abdominal swelling and compression on the urinary bladder,
which is located next to the uterus; bladder compression can result in
frequent urination. Heavy menstrual bleeding can also result from an
intramural fibroid."

The Institute for Vascular Health and Disease: What are uterine fibroids?

"Most women do experience some abdominal swelling, although it may be
minor. In other women, the lower abdomen can look as though you are in
the early stages of pregnancy."

The Natural Health Website for Women: Fibroids

"Uterine fibroids generally occur in women between the ages of
thirty-five and fifty, and are estimated to affect one in four women
sometime during the course of their reproductive years. It is likely
that an even larger proportion of women have undetected fibroids.
Though rarely dangerous, large or multiple uterine fibroids can cause
symptoms and complications serious enough to demand treatment.
Problems and symptoms associated with uterine fibroids can include
menorrhagia (unusually heavy periods), dysmenorrhea (painful periods),
dyspareunia (pain during sexual intercourse), reproductive
complications including miscarriage, digestive problems or urinary
problems, abdominal pain, bloating or swelling, and back pain.

There are three types of uterine fibroids. Intramural fibroids are
fibroids that grow on or in the uterine wall. Subserosal fibroids grow
outside of the uterine cavity, and submucosal fibroids grow inside the
uterus. Especially large fibroids may fit into more than one category.
The location of fibroids is an important factor in diagnosis and
treatment, since types of complications and symptoms caused by
fibroids are frequently a result of their location."

Fibroids1: Research Center

"Most fibroids don't cause symptoms - only 10 percent to 20 percent of
women who have fibroids ever require treatment. Depending on location,
size and number of fibroids, a woman might experience the following:

Heavy, prolonged menstrual periods and unusual monthly bleeding,
sometimes clots. This often leads to anemia
Pelvic pain 
Pelvic pressure or heaviness caused by the bulk or weight of the
fibroids pressing on nearby structures
Pain in the back or legs as the fibroids press on nerves that supply
the pelvis and legs
Pain during sexual intercourse 
Bladder pressure leading to a constant urge to urinate 
Pressure on the bowel, leading to constipation and bloating 
Abnormally enlarged abdomen" 

Society of Interventional Radiology: Uterine Fibroid Symptoms and Diagnosis

"It is estimated that about a quarter of all women suffer from uterine
fibroids, noncancerous tumors that develop in the muscle layer of the
uterus. The swelling associated with fibroids often causes a woman's
uterus to expand to a size equivalent to a four- or five- month

Harvard University Gazette: Noninvasive uterine fibroids treatment shows promise

"What is an Ovarian cyst?
A cyst is an abnormal sac within the body containing fluid or
semisolid matter. Diagnosis is made between benign and malignant.

What are the symptoms?
The symptoms depend on the size of the cyst and whether or not it
secretes hormones. Cysts producing oestrogens may become evident
through abnormal uterine bleeding in the form of irregular bleeding or

Abdominal swelling is the first thing to be noticed with an enlarged
cyst. Frequency or retention of urine may also develop."

Internet Health Library: Ovarian Cyst

"An ovarian cyst is an abnormal swelling in the ovary. It can either
be fluid-filled or a solid benign (non dangerous) tumor. Cysts are
quite common, and about 95 percent of them are benign. Most disappear
with no treatment at all. Many women develop cysts at specific times
in their menstrual cycle, that come and go each month.

Symptoms of cysts may include irregular menstrual cycles, abdominal
swelling, or pain during intercourse. Small, unobtrusive cysts may
cause no symptoms at all, and may only be located during routine
pelvic exams. If a cyst does not disappear within two menstrual cycles
and your provider is concerned, s/he might use ultrasound scanning, or
laparoscopy (method of examination using an endoscope or type of
viewing tube) to look at the cyst more closely, determine its size and
position, and a correct diagnosis. Benign cysts can sometimes be
treated with alternative therapies, such as hormone therapy, stress
reduction techniques, acupuncture, dietary modifications and/or herbal
remedies. Other cysts may have to be removed surgically if they are
causing you undue discomfort or if they are interfering with normal
ovarian and reproductive functioning."

Go Ask Alice: Ovarian Cysts

  I am TERRIFIED of ovarian cancer (abdominal bloating/swelling etc): 
  can it be totally excluded via the tests above?

The tests that you mention (pelvic examination, pelvic ultrasound,
hysteroscopy with endometrial biopsy, and Pap smear) are useful tools.
However, they cannot totally rule out ovarian cancer. The only way to
do that is for a biopsy to be performed on ovarian tissue (this is not
the same as an endometrial biopsy). Since an ovarian biopsy is a
surgical procedure, most physicians are unlikely to leap to this
option unless preliminary tests show suspicious results.

Although a type of abdominal swelling called "ascites" (caused by the
buildup of fluid in the abdomen) can be a symptom of ovarian cancer,
it is not likely that this is the cause of your problem. If your
swelling were due to ascites, the CT scan would have revealed this.
Physicians like to rule out the simple things first. There's an old
saying, "When you hear hoofbeats, think horses, not zebras." All women
are frightened by the thought of ovarian cancer, but we can't let fear
rule us.

"There are several diagnostic tests that can be used to detect ovarian
cancer. The three most common tools are:
Vaginal-rectal pelvic exam
Transvaginal ultrasound 
CA-125 blood test 

Because of the margin of error associated with each of the tests, they
are most effective when used in combination with each other.

Other diagnostic tools include: 
Transvaginal color flow doppler 
CT (or CAT) Scan 
Lower GI series or barium enema (occasionally) 

Surgical Biopsy:
The only way to confirm a diagnosis of ovarian cancer suggested by the
above tests is through examining a sample of the tumor tissue under a

"Ovarian cancer is hard to find early. Often there are no symptoms in
the early stages and in many cases the cancer has spread by the time
it is found. Symptoms may include a swollen or bloated feeling or
general discomfort in the lower abdomen. These symptoms may be vague
and may be caused by other conditions.

Ovarian cancer can be diagnosed with ultrasonography, CT or CAT scans,
a lower GI series or barium enema, an intravenous pyelogram (IVP) (an
x-ray of the kidneys and ureters taken after the injection of a dye,
or through a biopsy.

A biopsy is the only sure way to know if cancer is present."

Cancer Survivors: Ovarian Cancer 

"Imaging Studies: These tests can show whether there is a mass in the
pelvis, but they cannot tell if it is cancer.

Ultrasound uses sound waves to create an image on a video screen.
Because tumors and normal tissue reflect sound waves differently, this
test may be useful in finding tumors and in telling whether a mass is
solid or a fluid-filled cyst.

CT scans (computed tomography), use an x-ray beam to take a series of
pictures of the body from many angles. A computer combines the
pictures to form a detailed image. CT scans are useful in showing how
large the tumor is, whether lymph nodes are enlarged, and whether the
tumor has spread to other organs. CT scans can also be used to guide a
biopsy needle into a tumor in order to remove a sample of tissue."

American Cancer Society: How Is Ovarian Cancer Found?


Google search strategy:

Google Web Search: "intramural fibroids" + "abdominal swelling OR distention"

Google Web Search: "intramural fibroids" + "symptoms"

Google Web Search: "ovarian cyst" + "abdominal swelling OR distention"

Google Web Search: "ovarian cancer" + "diagnosis"


Please keep in mind that Google Answers is not a source of
authoritative medical advice; the material I've presented above is for
informational purposes, and should not be viewed as a diagnosis, nor
as a substitute for the services of a qualified medical professional.

If anything is unclear, or if a link does not function, please request
clarification; I'll be glad to offer further assistance before you
rate my answer.

Best wishes,
dani2000-ga rated this answer:4 out of 5 stars
prompt, clear, comprehensive and to the point.

Subject: Re: lower abdominal swelling
From: surgeon-ga on 12 Jan 2004 11:58 PST
"small" fibroids, as you describe, would not cause abdominal
swellilng. Nor would ovarian cysts unless huge. I'd suggest
considering other causes as well, such as colon distention. In
addition to the "zebras -- horses" thing, we also say, "look at the
doughnut, and not the hole." It's a mistake to focus on only one
possible cause of a set of symptoms.

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