FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

[NOTHING IS TOO EMBARRASSING TO TELL YOUR DOCTOR]

Question: I have a problem with my stomach swelling. It swells so big that people say I'm pot bellied even though I'm very skinny. I'm not pregnant, and I've noticed the swelling is a bit worse before I urinate and somewhat better afterwards. What could be causing this swelling? I'm so embarrassed by it that I don't know what to tell my doctor.

Answer: You've actually asked two separate and distinct questions:

- What is causing your stomach to be distended?

- What sort of things can you tell your doctor?

The second one is easy to answer. Tell your doctor anything that concerns you! It may seem embarrassing to you, but believe me, you don't have a problem that your physician hasn't already heard a similar story about before. Of course it is difficult for you, because it is the first time you have talked about the emotionally sensitive subject. It is also difficult to know what specific information about your problem you need to share with your doctor. Don't be worried about this. You just present your concern to your doctor. He or she will then ask specific questions to find the information he or she needs to help you.

Your first question is bit harder, because being pot bellied can have many causes. One of the most common is simply being overweight. Of course, everyone who is overweight doesn't have the rounded and distended shape of the abdomen that you call being pot bellied. Some individuals have a genetic tendency to store extra fat in the abdomen, thereby causing the pot belly. This often occurs before extra roundness is developed in the face, arms, rump, or legs. Perhaps you are one of these individuals.

Anything that takes up space within the abdomen can cause a pot belly to develop. This could be a normal physiological change such as pregnancy or an abnormal one like ovarian cancer. Distention of the urinary bladder can do this too, but the swelling it causes is only in the lower part of the abdomen. I suspect that urinary distention is responsible for making your problem more apparent rather than actually causing it.

If your pot belly is accompanied by diarrhea, constipation, belching and intestinal gas, it would make me suspicious of a colon abnormality such as irritable bowel syndrome or lactose intolerance. In addition, a poorly functioning gall bladder can cause abdominal distention.

I think you have figured out that I can't identify the specific cause for your pot belly without more information. You should go to your family doctor and explain your concerns. Don't be embarrassed. If your doctor won't take the time to listen to your complaints fire him or her. Get a new doctor.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.