Seriously Bloated: Warning Signs You Shouldn't Ignore

4. Pancreatic cancer tends to be very aggressive with low survival rates. The combination of bloating associated with jaundice (yellowing of the eyes and skin), weight loss, poor appetite, and upper abdominal pain that radiates to the back is a worrisome constellation of symptoms and may indicate pancreatic cancer. Newly onset diabetes, in association with bloating, weight loss, and abdominal pain, may also be a sign of pancreatic cancer.

What to do if you’re concerned about pancreatic cancer:

Fortunately, pancreatic cancer is not a common cause of bloating. But if you do have it, early diagnosis is the key to ensuring a good outcome. Seek immediate medical evaluation if you are experiencing the above constellation of symptoms.

5. Stomach cancer is usually asymptomatic early on, or causes vague symptoms like bloating, indigestion, and a feeling of fullness in the upper abdomen. Like pancreatic cancer, it may have already reached an advanced stage at diagnosis, in which case there will likely be additional symptoms of weight loss, nausea, and abdominal pain.

What to do if you’re concerned about stomach cancer:

Infection with the bacteria Helicobacter pylori is probably the most significant risk factor for developing stomach cancer, so it’s a good idea to be tested for H. pylori if you think you may be at risk. Nitrates and nitrites in smoked and processed meats are also risk factors for stomach cancer, and in a small number of patients, stomach cancer is genetic.

6. Liver disease is often benign. But cancer from distant organs can spread to the liver. When cancer cells get into the bloodstream, they eventually get filtered through the liver. Bloating that's accompanied by ascites and jaundice may be a sign of cancer that’s spread to the liver or of primary liver cancer, which can develop in people with a history of hepatitis or heavy alcohol use.

What to do if you’re concerned about liver disease:

If you think you may have liver disease, seek medical attention for a thorough physical exam, an ultrasound of the liver and abdomen, and a blood test that evaluates liver function to confirm the diagnosis. Some liver disease can be treated through dietary changes: more green leafy vegetables, legumes, and other plants, and less animal protein and starchy, sugary foods. Some cases require prescription medication.

7. Diverticulitis refers to infection or inflammation of small pothole-type lesions that can develop in the colon called diverticulae. Diverticulitis usually occurs in people over age 50, and is often accompanied by abdominal pain and tenderness, loss of appetite, fever, and constipation or diarrhea.

What to do if you’re concerned abut diverticulitis:

Bouts of diverticulitis can be treated in a number of ways: bowel rest (nothing to eat or drink), a liquid diet, antibiotics (if severe pain, fever, or an elevated white blood cell count are present), and analgesia (pain management). Severe tenderness may prompt a CAT scan to exclude an abscess. Worst-case scenario includes drainage of any abscesses, or surgery to remove a severely affected area. The longer your stool sits in the diverticular orifices, the greater the risk of developing diverticulitis — so constipation is definitely to be avoided. Once the acute episode of diverticulitis is over, a high-fiber diet can help keep you regular and avoid future complications.

8. Pelvic inflammatory disease (PID) occurs when the uterine lining, fallopian tubes, or ovaries become infected, usually from sexually transmitted diseases like chlamydia or gonorrhea.It can also occur during childbirth, abortion, or miscarriage, or with insertion of an intrauterine device. Bloating accompanied by fever, pain, and tenderness in the pelvic area, plus a vaginal discharge, is very suggestive of PID.

What to do if you’re concerned about PID:

A careful pelvic exam and treatment with antibiotics are essential for PID. Untreated, it can lead to infertility and ectopic pregnancies (a pregnancy that implants and grows in the fallopian tubes rather than in the uterus and can cause life-threatening tubal rupture). If you’re having bloating, vaginal bleeding or discharge, and lower back or pelvic pain and think you may be pregnant, you should seek immediate medical attention to exclude PID.

9. Crohn’s disease is an autoimmune disorder that affects the GI tract, usually in the small intestine or colon. The lag time between initial symptoms and diagnosis can be years, and bloating is one of the early symptoms. Crohn’s can cause narrowing of the intestines and ultimately lead to a bowel obstruction, resulting in severe bloating, weight loss, and nausea and vomiting after meals. Diarrhea with blood is typical when Crohn’s occurs in the colon. There may be other symptoms present outside of the GI tract, including mouth ulcers, joint pain, skin lesions, and inflammation in the eyes.

What to do if you’re concerned about Crohn’s disease:

Diagnosis is often the most challenging aspect of Crohn’s disease. X-rays and even colonoscopy may not show the inflammation, which usually occurs at the end of the small intestine (the ileum), an area not within easy reach of the endoscope. More sophisticated imaging techniques such as a CAT scan, MRI, or video capsule endoscopy (a tiny ingestible micro-camera in a pill) may be required. Like its sister disease ulcerative colitis, dietary changes, supplements, and more potent prescription drugs all play a role in getting the inflammation and bloating associated with Crohn’s under control.

The good news is that most people with bloating don’t have cancer, infection, or inflammation. If you’re not sure whether your bloating is serious, it’s always better to err on the side of seeking medical attention rather than ignoring it and hoping for the best.

Robynne Chutkan, MD, FASGE, is the author of The Bloat Cure: 101 Solutions for Real and Lasting Relief, The Microbiome Solution, and Gutbliss. Dr. Chutkan has been on faculty at Georgetown MedStar Hospital in Washington, DC, since 1997. In 2004, she founded the Digestive Center for Women, an integrative practice that incorporates nutritional optimization, exercise physiology, biofeedback, and stress reduction as part of the therapeutic approach to digestive disorders.