Abdominal bloating: an under-recognized endometriosis symptom

J Obstet Gynaecol Can. 2009 Dec;31(12):1159-71. doi: 10.1016/s1701-2163(16)34377-8.


Objective: To explore the association between the symptom of abdominal bloating and the diagnosis of endometriosis.

Methods: Twenty-six patients with endometriosis diagnosed by laparoscopy and 25 women without endometriosis were recruited to a case-control study. Subjects completed detailed questionnaires regarding perception of abdominal bloating, bloating-related symptoms, and effect on lifestyle. Abdominal girth was measured three times daily for one whole menstrual cycle, as were ratings of perceived abdominal bloating severity and discomfort. Experiences of abdominal and gastrointestinal symptoms were compared.

Results: A significantly larger proportion of women with endometriosis than control subjects experienced abdominal bloating (96% vs. 64%). In women with abdominal bloating, the following were more common in those who had endometriosis: associated severe discomfort (30% vs. 0%), wearing loose clothes during bloating (87% vs. 38%), and simultaneous hand swelling (30% vs. 6%). The experiences of cyclically related diarrhea and constipation were more frequent with endometriosis. While there were significant changes in bloating and discomfort ratings across the menstrual cycle, there was a trend towards a difference between the control subjects and unmedicated endometriosis groups only in how the pattern of bloating severity fluctuated across the cycle. Lower abdominal girth measurements changed significantly across menstrual cycle phases. Control and unmedicated endometriosis groups differed significantly in girth changes across the menstrual cycle, controls experiencing much less variation. Compared with the unmedicated endometriosis group, women receiving hormonal treatment had higher bloating severity ratings and discomfort scores, but there was no objective difference in abdominal girth.

Conclusion: Painful abdominal bloating appears to be common in women with endometriosis and causes considerable symptomatic distress.

MeSH terms

  • Abdomen / physiopathology*
  • Abdominal Pain / etiology*
  • Abdominal Pain / physiopathology
  • Adult
  • Analysis of Variance
  • Case-Control Studies
  • Endometriosis / complications*
  • Endometriosis / diagnosis
  • Female
  • Gastrointestinal Diseases / etiology*
  • Gastrointestinal Diseases / physiopathology
  • Humans
  • Laparoscopy
  • Menstrual Cycle
  • Middle Aged
  • Severity of Illness Index
  • Surveys and Questionnaires
  • Young Adult