There's bloating and then there's, well, bloating. We're talking about when your stomach bloats outward — or distends — and becomes hard to press on. It can feel like you're carrying around a bowling ball in your belly.
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So what exactly is going on here? First, your stomach feeling hard when you press on it is what doctors call a non-specific finding, Shabnam Sarker, MD, assistant professor of medicine at Vanderbilt University Medical Center in Nashville, Tennessee, tells LIVESTRONG.com. This means that a hard stomach doesn't point to one condition, and there are generally quite a few possible causes.
"This could be from distension from air, such as bloating that happens when you swallow extra air or consume food products that create a lot of gas," she says. (While bloating is that feeling of fullness, distension is when your stomach noticeably pushes out.) Other times, it may be indicative of a more serious condition, such as a bowel blockage or inflammatory bowel disease (IBD).
For your day-to-day comfort and general health overall, a hard, bloated belly isn't something you should ignore. Here's what it could mean, and how to get the help you need:
1. You're Plain Bloated
"Bloating is a gaseous distension," Dr. Sarker says. You may notice that the level of bloating fluctuates during the day, or maybe it happens as the day goes on or based on what you're eating. (This is different from a hard mass, which remains regardless of the time of day or what you ate.)
Some things that can help bloating include eating more slowly, avoiding chewing gum and limiting your carbonated drinks — all of this will help decrease the amount of air you're swallowing.
2. You Have a Food Intolerance
The most common intolerance associated with bloating is lactose intolerance, Dr. Sarker says. But other food intolerances, as well as Celiac disease (an autoimmune disease where eating gluten leads to damage in the small intestine) or bacterial overgrowth, known as SIBO (small intestinal bacterial overgrowth), can cause both distension and other GI symptoms like diarrhea, she says.
If you suspect a food intolerance, Dr. Sarker suggests avoiding the foods most likely to produce uncomfortable gas, including beans, cabbage, Brussels sprouts, onion and wheat. Feel better? You can then slowly add in small amounts of each food to see what and how much you can tolerate. For example, maybe a quarter-cup of beans on a salad is just fine, but a big bowl of three-bean chili is not. Keeping a food journal during this time will help you play detective and notice trends in order to pinpoint the aggravating food.
If that doesn't do it, then you might consider a low-FODMAP diet. This diet is geared toward people with irritable bowel syndrome (IBS) and removes foods that contain certain sugars that are not completely digested and therefore are fermented by gut bacteria. These triggering foods can lead to gas, according to Monash University, which developed the diet and offers a handy app to identify these foods.
The start of the low-FODMAP diet is extremely restrictive in the beginning; you'll be eliminating a lot of healthy foods, some of which may be your favorites. The goal is to create a wash-out period and then slowly add in those foods again and watch for symptoms to crop back up.
Over time, you'll learn what your body can and can't handle. It's best to work with a registered dietitian, gastroenterologist or knowledgeable primary care provider (PCP). The low-FODMAP diet "is easy to do incorrectly and can cause nutritional deficiencies," Dr. Sarker says.
3. You Have IBD
Inflammatory bowel disease is a chronic inflammation of the GI tract, according to the Crohn's & Colitis Foundation. Both ulcerative colitis and Crohn's disease fall under the umbrella of IBD. While this type of intestinal inflammation can lead to distension, Dr. Sarker says, you'll also notice other symptoms, including crampy abdominal pain, change in bowel habits, diarrhea or constipation, BM urgency or blood in your stool.
If you suspect IBD, or notice some of the above symptoms, see your doctor for a proper evaluation and diagnosis. Blood in the stool can also be a sign of colorectal cancer, a cancer that in recent years has been on the rise in younger adults.
4. It's Something Else
Having a hard stomach might not have anything to do with what you're eating at all. It's possible that you may have a bowel blockage that affects how stool moves through your system. If that's the case, you'll usually also have other symptoms, including vomiting or inability to poop, Dr. Sarker says. Advanced liver disease, abdominal masses and cysts (like ovarian cysts) can also affect the way your stomach feels and looks, she says.
Finally, bloating, belly pain and feeling full quickly are symptoms of ovarian cancer. Persistent bloating and stomach swelling can be initial signs of this often silent cancer, according to Rush University Medical Center in Chicago, which is very treatable when detected early.
When to See a Doctor
Before you start feeling worried or distressed about what the bloating could be, make an appointment with your doctor. Be sure to keep track of all of the symptoms you're experiencing, especially if they are persistent or lingering, and if you notice blood in your stool. A professional will be best equipped to help you diagnose the issue and recommend specific treatment.
- Crohn’s & Colitis Foundation: “What is IBD?”
- Crohn’s & Colitis Foundation: “When to Take Stomach Pain and Other GI Issues Seriously”
- American Cancer Society: “Key Statistics for Colorectal Cancer”
- American Cancer Society: “Signs and Symptoms of Ovarian Cancer”
- American Cancer Society: “Can Ovarian Cancer Be Found Early?”