Abdominal Distension, Swelling

What Causes Swollen, Enlarged, Or Distended Abdomen?

Swollen, enlarged, or distended abdomen can have various causes, ranging in severity from 'minor' to 'generally fatal'.  Finding the true cause means ruling out or confirming each possibility – in other words, diagnosis.

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Diagnosis is usually a complex process due to the sheer number of possible causes and related symptoms.  In order to diagnose swollen, enlarged, or distended abdomen, we could:

  • Research the topic
  • Find a doctor with the time
  • Use a diagnostic computer system.
The process is the same, whichever method is used.

Step 1: List all Possible Causes

We begin by identifying the disease conditions which have "swollen, enlarged, or distended abdomen" as a symptom.  Here are eight of many possibilities (more below):
  • A Weight Problem
  • Ascites
  • Enlarged Spleen
  • Intestinal Obstruction
  • PMS
  • Drug Side-Effects
  • Bacterial Dysbiosis
  • Giardia

Step 2: Build a Symptom Checklist

We then identify all possible symptoms and risk factors of each possible cause, and check the ones that apply:
regular bizarre dreams
significant epigastric pain
elevated lymphocyte count
having excess body fat
long term history of obesity
meal-related bloating
slightly oily/sticky stools
occasionally feeling unusually cold
broad-spectrum antibiotic use
meals worsen left iliac pain
recent onset nausea
intolerance of sugars
... and more than 30 others

Step 3: Rule Out or Confirm each Possible Cause

A differential diagnosis of your symptoms and risk factors finds the likely cause of swollen, enlarged, or distended abdomen:
Cause Probability Status
PMS 98% Confirm
Enlarged Spleen 15% Unlikely
Giardia 14% Unlikely
Intestinal Obstruction 0% Ruled out
A Weight Problem 0% Ruled out
Drug Side-Effects 0% Ruled out
Ascites 0% Ruled out
Bacterial Dysbiosis 0% Ruled out
* This is a simple example to illustrate the process

Arriving at a Correct Diagnosis

The Analyst™ is our online diagnosis tool that learns all about you through a straightforward process of multi-level questioning, providing diagnosis at the end.

If you indicate abdominal discomfort, The Analyst™ will ask further questions including this one:
Do you experience any abdominal swelling / distension that does not appear to be meal-, gas- or weight-related? In other words, is your abdomen larger than it should be?
Possible responses:
→ No / probably meal/gas/weight-related / don't know
→ Slight, comes and goes with or without meals
→ Slight, always present with or without meals
→ Significant, comes and goes with or without meals
→ Significant, always present with or without meals
Based on your response to this question, which may indicate either slight abdominal distension or significant abdominal distension, The Analyst™ will consider possibilities such as:
(Prescription) Drug Side-Effects

Certain medications, including those containing lactulose or sorbitol, may cause bloating.

Abdominal Hernia

A strangulated hernia may cause abdominal distension.


A study of 51 women, 26 with endometriosis and 25 without, found that a significantly larger proportion of women with endometriosis than control subjects experienced abdominal bloating (96% vs. 64%) [J Obstet Gynaecol Can.  2009 Dec; 31(12): pp1159-71]

Enlarged Lymph Nodes

Enlarged Lymph Nodes also suggests the following possibilities:

Ovarian Cancer

Abdominal swelling/bloating/clothes being too tight is a possible early warning sign.  The symptoms of ovarian cancer are vague, which means that it is often diagnosed too late.  If bloating is continuous and you have other symptoms such as abdominal fullness and pain, it should be considered.

Problems Caused By Being Overweight

The classic 'beer belly' is usually caused by high levels of visceral fat.  This is not the same as subcutaneous fat, which lies immediately under the skin.  Visceral fat or "gut fat" surrounds the internal organs and causes central obesity.

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