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May 13-19 is Women’s Health Week. Instead of trying to tackle a whole host of all-over-the-place issues, we thought we would focus on something we always we have questions about — the area down there. That includes the vagina and its parts, the uterus, and a few issues pertaining to our private parts that it never hurts to know more about. To educate ourselves, we sought out the insight of Dr. Wendy Goodall McDonald. She is a board-certified OB-GYN based in Chicago and author of the super informative and funny book,  It Smells Just Like Popcorn: The Modern Woman’s A-V Guide to Her Vagina and Beyond. This women’s health expert gave us the rundown on what we should know about our sexual and reproductive anatomy, the right way to take care of it, and what it’s all capable of. 

Is it our diet or something else?

While many of us deal with a bit more meat on our midsection than we would like, some women deal with abdominal distention that is just hard to understand. No matter how healthy they eat or how many crunches they do, there is always a pudge. Abdominal bloating with distention is common in cases of irritable bowel syndrome and constipation, but it can also be a sign of fibroids. Uterine fibroids are the most commonly cited reason for an enlarged uterus, which would, in turn, cause stomach bulge. Nearly one-third of women in the U.S. between ages 25 and 44 claim to have symptoms of fibroids, and Black women often have multiple. Therefore, if your stomach is bulging out, then that could be the answer. But the truth is, having fibroids doesn’t mean that is always a symptom you will encounter. So is it fibroids or is just belly fat?

“It can go both ways,” says Dr. Wendy. “I’ve done exams on women where I can feel their fibroids that are up to their belly button. I can feel a big mass in their abdomen. But then I’ve had other women who felt like their bellies were poking out, and we get an ultrasound because they have a history of fibroids, and the uterus is so small.”

So when it’s not fibroids, Dr. Wendy says it could have something to do with your abdominal wall in general, or your bowels.

“Some of it has to do with the abdominal wall itself and how thick it is. Sometimes it has to do with your bowels,” she says. “You’d be surprised when a person doesn’t move their bowels regularly or finds themselves being bloated in that space, how that can affect the size of a person’s abdomen.”

Still, Dr. Wendy has seen plenty of women whose fibroids caused an enlarged uterus, and in turn, distention. “I have taken out women’s uteri or fibroids specifically that made them look five months pregnant, four months pregnant and it was their uterus,” she said. “You could feel it. You could press on it and say, ‘That’s your uterus. You’re a small person. You’re not like overweight or anything like that. This is all uterus.’ But a couple of years ago, I did a hysterectomy on a woman who was bleeding heavily. She had a pretty big uterus. Her uterus was probably the size of a four-month pregnancy, but she was also a little overweight. So we did a hysterectomy and she was happy with the blood loss being over, but not as happy that her abdomen didn’t really change. She had a pretty good-sized uterus. So in theory, if she were a little smaller, it probably would’ve made a difference. But what she was seeing still was her abdominal wall. It had a little bit more extra extra tissue there.”

And while your uterus size due to fibroids may not be the sole reason for your distention, it could definitely be playing a part.

“I don’t tell people that their fibroids can not make them look bigger because the other thing that you have to keep in mind too, is everything is space-occupying,” says Dr. Wendy. “So the uterus should be the size of like a pear, but if it’s the size of a grapefruit, even in total or the size of something that’s a little bit bigger, that’s pushing up from your pelvis, along with your bowels and other structures that would have normally rested down in there. So even though the uterus itself isn’t what you feel pushing out, maybe it’s displacing other abdominal contents that have nowhere else to go but push out. So maybe it is a factor because it’s taking up space that normally other structures can be in and now they can’t be in there because it’s being pushed out of the way. But to what degree does that actually change how your abs or how your belly looks? That really is hard to call, especially depending on the person’s muscle tone and their abdominal wall thickness.”

If you have questions about why you might be dealing with a stomach bulge, your best bet is to speak with your doctor. Because even if it isn’t fibroids, constipation or irritable bowel syndrome, it’s certainly a nuisance that you could obtain some insight on dealing with.

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