Episode 6: Why Bloating Isn’t Always a Gut Problem – Pelvic Venous Congestion in Women
Team Gut Girls Hosts – Dr. Christina Carew, ND, Dr. Dominque Vanier, ND and Dr. Whitney Baxter, ND discuss how chronic bloating, heaviness, pressure, constipation, and pelvic pain may be caused by pelvic venous disorders (pelvic venous congestion/insufficiency) rather than the gut, and note it is under-diagnosed, often mislabeled as IBS, and is the second leading cause of pelvic pain lasting over six months after endometriosis, with frequent comorbidity.
They explain how pelvic congestion creates blood pooling and pressure (“traffic jam”) that can worsen with standing/sitting, end of day, menstruation, ovulation, pregnancy, and sex, and may include urinary urgency without infection, painful bladder fullness, hemorrhoids, visible pelvic/leg veins, swelling (often left-sided), fatigue, and relief when lying down or with compression.
Risk factors mentioned include pregnancy, ages 25–40, hypermobility, POTS/orthostatic intolerance, and possible increases post-COVID/vaccination. Diagnosis may involve ultrasound, pelvic MRI, venography, and referral to interventional radiology; treatment can include stenting or trial injections.
00:00 Welcome
01:01 What Are Pelvic Venous Disorders?
07:18 Signs & Symptoms
19:44 Risk Factors
23:22 Diagnosis & Investigation
30:20 What You Can Do
Team Gut Girls Transcript Episode 6: Why Bloating Isn’t Always Gut Problem: Pelvic Venous Congestion in Women
What Are Pelvic Venous Disorders?
Dr. Christina Carew, ND: So today I wanted to talk about what if bloating doesn’t actually come from your gut. Because I have patients that come in and they talk about having this, heavy, swollen feeling, and they feel like they have pressure, and sometimes they have constipation, and they say nothing is working, and we’ve tried everything.
But it actually could be a circulation issue. And so today I wanted to talk about something that is massively under-diagnosed in women, and I would say even I’ve missed it, , many times. Pelvic venous congestion. And ironically, I had a patient that came in, last week that I hadn’t seen for seven years.
And she told me that, everything that I’ve been doing was really good for seven years, and then she got really constipated, and she said, “I had this massive hemorrhoid, and then I started taking Venexxia,” that,, hemorrhoid supplement that’s made from flavonoids. And she’s like, “It started [00:02:00] to improve things, and that got better.”
And I was like, “Wait a second.” . And I started asking her a bunch of questions, which we’ll kind of talk about today. , And I actually think that she actually has a pelvic venous disorder, which is one of the reasons why she was getting this chronic constipation on top of all the other things that she has going on.
And so I thought that this was a really valuable topic, especially ’cause I think it’s reasonably new that we’re starting to get more information about it. And, and even in the location where I am, , there is really, there’s, one person that we can refer to that knows what we’re talking about.
And , so I think that’s pretty helpful. Maybe we’ll start with, what are pelvic venous disorders, and, and then a little bit of, what you might see in your own life, or if you’re a practitioner listening, what you might see in your patient’s life, and then we can have some discussion around that.
They’re the second leading cause of pelvic pain- pain that exists for longer than six months other than endometriosis. And I would say very commonly, people with [00:03:00] endometriosis also have pelvic venous disorder, so don’t think of it as an either/or, think of it as an and. It often happens in pregnant women or women 25 to 40.
It’s not the only time, and sometimes they’ve had it for much longer and it just hasn’t been spotted. And certainly, people without pregnancy can also have this, and it’s actually also in males. So I have a male patient that was having all this… he had, irritation in his penis, and it was, like, always red, and he was always having, like, all this redness, and, , it was an infection, and we kept trying all these other things.
And then, one day he was talking about how he had, varicocele in, in one of his testicles at one point, and we were like, “Wait a second. Maybe this is it.” So we’ve actually sent him to get checked. So, looks a little bit different in males, but today we’ll primarily talk about females. It’s the, primarily the person who most likely has it.
And, often these patients are told that they have IBS, , and something just doesn’t add up. So they’ve done all the [00:04:00] gut stuff, they’ve done all the things, and it isn’t really helping, and so it’s, , it’s some- not really a gut problem at all. Okay. So what is pelvic venous congestion? So it’s a broad category, and it talks basically about varicose veins that are in the pelvis.
Instead of the blood moving back up to the heart and creating this sort of circulatory system, it pools and creates pressure in the abdominal region and stretches the veins. So when we think about things, , that are similar, when people with endometriosis, so they have, , lots of leg pain or lots of leg swelling, we think about endometriosis, we think about thyroid problems.
This is, should be on your DDX list or your consideration list. And so it’s basically like a traffic jam in the pelvis. So all the blood goes in, but, , doesn’t come back out, and so people start feeling heavy or swollen or pressurized, which can feel like bloating, right? It’s the most common thing that we’re gonna say, “I feel like I’m bloated all the time.”
And this wouldn’t really have much to do [00:05:00] with any kind of eating or foods in particular. Just be like, “Oh, it just doesn’t feel good.” , And so it’s actually, , a pressure buildup that sort of mimics gut symptoms ’cause it’s literally in the same place. And so I- I’ll give you an example. I have a patient that has, , Crohn’s disease, history of Crohn’s disease for, 20 years.
She has long COVID, and the doctor that I co-treat her with was like, “Oh, there’s all these studies on leaky gut and long COVID. It’s definitely what this woman has.” And so we did , a stool microbiome test, and it was amazing. It was like the best one I’ve ever seen. And I was like, I… , “it doesn’t look like you have Crohn’s even on this stool microbiome test.”
And at the same time, we sent her, for, some imaging around the pelvis. And sure enough, she had w- seemed like on the examination like collapsed veins. So basically like everything is building up in pressure. And so the interventional radiologist, who’s the person that typically cer- starts the process in this, opened [00:06:00] up,, one set of the, one set of the veins for , and arteries for blood flow, and suddenly the bloating changed completely.
And so it was really interesting ’cause it was like we assumed ’cause she had Crohn’s and she had long COVID that it was like this one category, and it was completely different. So, , even practitioners that are aware of it can still make symptom some questions. So what kinds of things do you guys wanna know?
Dr. Dominique Vanier, ND: Let’s see. I, I think this is a really important topic because it is not on the radar of a lot of practitioners, right? When patients come to you with all of these nonspecific, we’ll call them gut symptoms, but it’s actually an extra, an extraintestinal driver here. The treatment plans are often, trying to treat the gut when, like you said, it, that’s just not it.
This is… That’s like secondary to something else going on or at least presents in that region, but that’s not it. So I guess one of my questions is, like,
Christina, I think you’ve seen these cases a lot, , possibly more than, you know, we have, given like your clinic setup, et [00:07:00] cetera. , If somebody has like done a lot of their own digestive homework, like cut out certain foods, you know, tried supplements, are they coming to you saying, , “I didn’t respond to any of it”?
Dr. Christina Carew, ND: Yeah, I would say mostly people come in and they say, “I have bloating,” or, “I have pain,” , “I have pelvic pain.” And so,,
Signs & Symptoms
Dr. Christina Carew, ND: what I started doing was starting, like, questioning sort of around pelvic pain, is it all the time? Does it spread to your low back, to your hips, to your groin, like your thighs?
Is it, low body pain, right? Sort of like starting the endometriosis screen. Is it worse end of day? So we see that in some of the conditions we’ve already talked about. Is it worse with sitting or standing? So anything where things are, like, accumulating, right, not moving. Certainly, menstruation, ovulation, pregnancy, and sex all affect it because it’s, a lot of activity in that same pelvic region.
So that can be, like, a one where people say, “Oh, I have a lot of painful sex.” , Again, we’re still,, we still automatically start thinking about things like endo, but, , [00:08:00] this is also still, similar and can also be comorbid. Generally people will say, “I feel better when lying down.” So we, I see this a lot, we see it a lot in our POTS patients, so our, um- Mm-hmm
patients who have orthostatic intolerance, so their bodies are, like, having dysregulation of their blood pressure. Some of it actually could be as a cause of this, and some of it may actually be alleviated by treating the POTS, so it becomes this, chicken egg place. Um- Mm-hmm … sometimes other things people will say is, , “It feels like I have urinary urgency without infection,” right?
It’s all that pooling and pressure in the area. , Or, “I have pain when my, bladder is full,” “I have to go to the bathroom often at night. It feels tight or swollen or pressurized in the abdomen.” , I’ve… what they perceive as, like, bloating. Constipation actually, can result from this ’cause more pressure in the system, right?
No different than symptoms we would see with women who are [00:09:00] pregnant, so more pressure in the bowels, more varicose veins, things like that. Same kind of idea, it’s just carrying water instead of child. Lots of pelvic discomfort with bowel movement. So you can see there’s, like, a lot of interlinks between other things that we would start putting on our consideration list.
I would say not everyone, but some of them will say, “I have, , veins showing in my butt. I have hemorrhoids. I have inner thigh things. I have swelling in my legs. I feel better with compression.” And a big one is also, fatigue because they’re always in pain. They’re always discomfort, so they’re, they often will even come in with fatigue, and then it sort of starts this, you know, starting to go through this, this system.
And so there’s a lot of- Oh yeah, go ahead. Go ahead
Dr. Whitney Baxter, ND: I have a question. Is it because sometimes in pregnancy women will have, more varicose veins, and some will even need surgery, so are those… Are you seeing that connection too?
Dr. Christina Carew, ND: Yeah. So it’s like that vein stretching, the change in hormones, they seem to [00:10:00] maybe be part of what’s contributing to this,, either, hyperflexibility of the, of the veins, , collagen issues.
It can be just, flow issues. It can be, changes due to, , all kinds of different reasons. And so I don’t think it’s,, like, oh, because this happened, this happens. Mm-hmm. , But I would say that pregnancy definitely can make it worse, for sure. Mm-hmm. Or, or maybe also recognized, right?
Because now it’s like a very clear reason, that there is both maybe more pelvic pressure and also,, more baby on board pressure.
Dr. Dominique Vanier, ND: Mm-hmm.
Dr. Christina Carew, ND: Yeah, I would say there’s, , lots of kinda, like- comorbid things. So, you know, beyond pelvic pain, think about patients or people that have migraines, brain fog, mood changes, muscle pain, fatigue, , certainly GI issues.
And then we also think about it in patients that have, , [00:11:00] fibromyalgia or MECFS, any kind of fatigue issues, that POTS kind of patient, the hypermobile patient. So there’s, the endo patient. I have a patient that has endo and has, pelvic venous congestion, and, part of the problem is, , the treatment for this is actually creating more space, so, actually doing stents.
And so they’re worried that the reason that the collapse of, the structure is because of the endo. It’s like the endo’s actually creating col- Mm So then they’re like, “Oh, well, we need to get that endo treated first to make sure that- Right … like, the treatment will help.” But the endo kind of treatment…
So this treatment, because there aren’t a lot of people diagnosed, at least in our area, , seem to be pr- pretty quick. People are getting in within weeks, not- Wow … months or years, which is amazing, until people start knowing more about it, and then we’ll, like, extend., But the endo treatments are, like, years and years, right?
And so people- Yeah … have this, one piece of the [00:12:00] condition, which is, very much solvable, but they can’t get the other piece solved to… It’s like A, A has to happen before B.
Dr. Dominique Vanier, ND: Yeah. Yeah. And just a reminder, like, endometriosis, you can have endometriosis tissue grow far from the uterus. There’s cases where it’s found, like, in the lung region.
And so even though endometriosis is thought to be, like, a female pelvic region condition, it’s not actually. It’s kind of like a system-wide issue.
Dr. Christina Carew, ND: Yeah. It’s a structural issue, right? Yep. ‘Cause blood has gone through the fallopian tubes and, expanded into the body cavity, and then it adheres.
Dr. Dominique Vanier, ND: Yep. Yep.
Dr. Christina Carew, ND: And so I do have a patient that has it in their lungs, and it’s super hard to get even- Mm-hmm … someone to investigate it. So then people aren’t… You’re not crazy. Some of these things exist, but they’re super rare, and so they’re not always- Mm-hmm … on the radar.
Dr. Dominique Vanier, ND: Mm-hmm. Mm.
Dr. Christina Carew, ND: So there’s sort of like, there’s this [00:13:00] general area called, pelvic congestion syndrome or pelvic venous insufficiency or pelvic vein disorder.
And so it’s like the veins are compromised, leading to blood pooling. So people feel worse with intercourse, worse on standing, worse with menstruation, heaviness. Varicose veins in the vulva or in the legs, painful sex, fatigue, and some bowel urinary issues. That’s sort of general. Once someone is investigated, they actually can find, it’s often left-sided, so left renal vein compression or left iliac vein compression.
Often people will say, “I have more swelling on my left side.” That actually can be a, a hint. It’s not always the left side, but it can be. Blood in the urine. I actually had, a patient, I was thinking about this when I was, preparing this, podcast, was like, oh, I have this patient who has, blood in her urine, un- unknown why it is.
We sent her to a kidney specialist. We sent her for a cystoscopy, and I was like, “Oh, maybe it’s this actually.” Wrote myself a [00:14:00] note to call her and be like, “Hey, do you have any of these other things?” Orthostatic intolerance can be part of that. So one is called Nutcracker syndrome and one is called May-Thurner syndrome.
So it’s like which side is compressed. And in May-Thurner, it’s like the left ili- internal iliac vein is compressed, but then it overlays the right common iliac artery. So you have left-sided sort of interaction. Sometimes people will say they can tell by, feeling people’s abdomens and feeling, fluid or feeling things around the ovaries.
I don’t think it’s like… It’s not super clear. It’s not one of those things where you’re just like, “Oh, this is, one of the diagnoses where you’re like, ‘Okay, you have all of these things. Let’s make sure that it isn’t a part of what’s going on.'”
Dr. Whitney Baxter, ND: I have a question about, like, the lower leg swelling or if you do see some of this congestion.
Is it, like… ‘Cause, like, when there’s swelling, we’re looking to see, like [00:15:00] for listeners, if there’s pitting or if it’s just generalized or when it’s happening. So we’re trying to assess what the swelling, the characteristics around the swelling to help us figure out what could be causing it. So what would this look like?
Dr. Christina Carew, ND: It, honestly depends on the person and how much compression they get. , So some people, will start the day and, have to change their pants by the end of the day because there’s that much swelling. It also depends on, the amount of fluid that you have. You know, are you near your menstrual cycle?
So, , there are things that definitely can worsen it. And so it depends. Lots of people, when you… they’ll send pictures, and I don’t know if, if you guys get this, but I was pictured that people that send pictures of their abdomen, , to show me the bloating.
Dr. Dominique Vanier, ND: Yeah. Yeah. And
Dr. Christina Carew, ND: so sometimes they’ll be like, “Oh, it’s, so full there, and it goes down my legs, and I feel-” Yeah.
And so even asking- Yeah … like, do you get, , those little lines on your legs [00:16:00] when you wear socks? Mm-hmm. That can tell us, it may be really extreme for some people, and it might just be, like, what someone assumes is a normal amount of, fluid movement in the day.
Dr. Dominique Vanier, ND: I would expect it to, like, ebb and flow too, right?
Mm-hmm. . So, you know, there may be patterns, or there may not be. , But so far it seems like there’s some sort of,, peripheral fluid accumulation, fluid overload-type picture, plus digestive symptoms, possibly distension, too. Are you… You’re seeing bloating, but are we actually seeing an increase in girth- Mm-hmm
in the abdomen? Okay.
Dr. Christina Carew, ND: Yeah. Yeah, ’cause it’s, it’s fluid. It’s fluid. Right? And so-
Dr. Dominique Vanier, ND: Fluid, yeah.
Dr. Christina Carew, ND: And then also if people wear compression, so some of these patients also have diagnoses like, orthostatic tachycardia. And so in that, one of the treatments is wearing more compression, trying to keep the fluid up, but then it creates more pelvic congestion, so more bloating because it’s not going all the way back up to the heart.
It’s just going up from wherever the [00:17:00] stocking, socks, pants are. Yeah. Interesting. Mm-hmm. It’s crazy. So I would say one of the things that often happens is, like, motility gets slower, and the… ‘Cause remember, this is, a blood flow issue, right? And so when we’re thinking about blood flow and motility and nervous system and our, breathing patterns, so all of our diaphragm, which is something we’ll talk about in another episode, all those things become other side effects.
And so it- it’s easy to get distracted away from it ’cause you’re like, “Oh, I know what that is. I know what nervous system is. I know what motility is.” But I think we just don’t think enough. I actually was like, every time I think about it or I talk to someone, I’m like, oh, there was this person, and I know that this is probably the thing.
Like- Mm … the more you think about it, and once you see it a few times, you’re like, “Oh, there’s so many other patients that maybe this is part of what was going on.” [00:18:00] Especially, \, especially if you’ve treated everything to do with your gut and you’ve tried all these different things- And it hasn’t really resolved anything, I would say it’s certainly high on the list of things to be like, oh, is this actually a piece?
And especially if you’re getting, some of those urinary urgency, painful sex, hemorrhoids, any kind of varicose veins, low back pain. It might be … Or you’ve chased down endometriosis and been told, you don’t have lesions or you don’t have lesions that are detected, this might be another place to
Dr. Whitney Baxter, ND: look.
Mm-hmm. Or even for those, going through perimenopause, menopause, if it’s not, .. ’cause there’s the- Yeah … there’s the urinary and,, changes that can occur with, like, painful sex or, irritation, more UTIs. So if you’re having … , if you’ve tried some vaginal estrogen and I guess that wouldn’t really solve or wouldn’t-
Dr. Christina Carew, ND: Yeah
Dr. Whitney Baxter, ND: fully answer it, and your urinary analyses are all normal- Mm-hmm … this is something else to consider, too.
Dr. Christina Carew, ND: Or, or people that feel [00:19:00] pressure but not, like, gas. Like, not gas or- Yeah … burping. , Or anything where they’re getting, what’s a heaviness. I would say, , for me, I always … It’s like this place between, constipation and not constipation, right?
, Is the constipation the thing that’s causing the pelvic pressure, or is the pelvic pressure causing the constipation? And so I think it’s, , that, this sort of back-and-forth piece when we think about people that are not passing things in a way that feels like their body is able to do it very easily.
Dr. Dominique Vanier, ND: So if you think about the pelvic congestion issue leading to digestive issues, if we back up before , the whole pelvic issue started, what-
Risk Factors
Dr. Dominique Vanier, ND: If we’re thinking about some of the risk factors, pregnancy is definitely a big one that we’ve gone over. Yeah. I would assume like age is also one.
We’re more likely to have this as we age. People
Dr. Christina Carew, ND: that are hypermobile. Yeah. So hypermobile, one end of the spectrum is Ehlers-Danlos, but [00:20:00] you know, people can have more flexibility and not have Ehlers-Danlos or be somewhere on this like spectrum. So think about like swimmers, gymnasts, figure skaters, anyone that
yoga teachers, anyone that has more flexibility because that also means that the structure of their body is more, uh, bendy. And so in bending we see that. We think that part of this, that the vein system has really been impacted by COVID and COVID vaccinations, um, partially because the ACE inhibitors are in all of these structures, and so I think that’s a reason why we’re seeing more of it now, is just like w- a lot of people that maybe were on the edge are, like it’s now more common.
Certainly people with blood pressure dysregulation issues. Mm. Anyone that’s had like a long-standing illness, so whether that’s, you know, Lyme disease or, , mold toxicity, anything which like kinda stalled the mitochondria, stalled the [00:21:00] system. I think it’s like it’s more common than we would think, and I think some people are probably born with this.
Like I think- Right … we probably all know people even that we went to high school with who would be, you know, at home the days that they had their period because they would be in so much pain or agony. You know, how much of that was maybe undiagnosed endometriosis, and how much of that is maybe sort of like some blood flow issues that are also contributing to that pain?
Dr. Whitney Baxter, ND: Mm-hmm. So is that like an ischemic pain then? Like it’s just … Or I guess just like pressure, not ischemia, but just like-
Dr. Christina Carew, ND: Well, so some of my patients will say they like double over in pain lying on the floor of their bathroom. Like- Yeah … that sort of really intense pain. Some people will say it’s like a dull ache that they can kinda ignore.
And so it depends on like, I think the thinner- Right … the patient is, the more pain that they [00:22:00] have because it’s like more pressure and more pooling.
Dr. Whitney Baxter, ND: Mm-hmm.
Dr. Christina Carew, ND: But it also depends if like they also have another hormonal condition that overlies that.
Dr. Whitney Baxter, ND: Mm-hmm.
Dr. Christina Carew, ND: And so-
Dr. Whitney Baxter, ND: Right …
Dr. Christina Carew, ND: they have pain from endometriosis, and they have pain from having more pelvic pressure.
It’s not an either/or situation. It can be a both.
Dr. Whitney Baxter, ND: So would like an an- like would Advil help this pain, do you think? Or no? I was about to say, do you want people to take Advil and
Dr. Dominique Vanier, ND: just see? There’s some really-
Dr. Christina Carew, ND: The patience …
Dr. Whitney Baxter, ND: I’ve tried all
Dr. Christina Carew, ND: the
Dr. Whitney Baxter, ND: things- Yeah … and nothing works.
Dr. Christina Carew, ND: I would say people come in and they’ll be like, “I was given gabapentin for my pain.”
Like- Right. Yeah. Yeah … , or, “I was given these really strong medications,” or, “I was given like strong migraine medication, but it’s not working.”
Dr. Whitney Baxter, ND: Mm-hmm.
Dr. Christina Carew, ND: Start thinking about it in like the people where it’s not, things aren’t working.
Dr. Whitney Baxter, ND: Yeah.
Dr. Christina Carew, ND: Like, I don’t necessarily [00:23:00] think that we’re going to catch it as a primary diagnosis just ’cause there are al- so many like checkboxes.
Mm-hmm. But when people aren’t getting better or, you know, the things that you’re doing that should be helping aren’t getting better, um, then we can start looking at it and being like, “Oh, wait a second,” like, “Is this a piece that maybe is getting, getting missed?”
Dr. Dominique Vanier, ND: So
Diagnosis & Investigation
Dr. Dominique Vanier, ND: when you’re investigating this- Mm-hmm
’cause certainly like it’s , not in our scope to do some of these diagnostic tests- Mm-hmm … in Ontario or in BC, where Whitney’s located.
Dr. Christina Carew, ND: Yeah.
Dr. Dominique Vanier, ND: You’re referring to… Are you… Oh, so you’re co-managing. Yeah. So the medical doctor’s referring to which specialist, and what tests are you using-
Dr. Christina Carew, ND: Yeah …
Dr. Dominique Vanier, ND: to diagnose?
Dr. Christina Carew, ND: So, what we have been doing, so we, if we suspect, , we are referring to interventional radiology. And so patients can ask their practitioners, even their medical doctors, they can go in with a list of symptoms and say, “Hey, here’s kind of what’s go- [00:24:00] happening.” , I would say most of the traditional medical system has no idea.
It’s just not on their radar yet. And something, there are actually in the Toronto area, there’s a number of studies going on with, , a few doctors from a few different hospitals working together. So they are trying to actually like contract all these patients together to get a better understanding of like how it presents, how they’re addressing it, um, which is great.
So generally what happens is, patients may have like a pelvic ultrasound. The ultrasound doesn’t necessarily give like a ton of information they’ll generally go for like a pelvic MRI, and to be the next, , step, and usually that’s referred to by the radiologist, or if they’ve already had a pelvic MRI, they can look at it and say, “Okay, you need some more information.”
And so then it’s usually a venography, so it’s like actually patterning of the veins to see like where there’s [00:25:00] compression. And then if they are a straightforward case, then stenting often becomes an option for them, in my, , my patient has endo. They actually did, an injection to try to create, a mimic of a stent to see, , what kind of,, symptoms would it alleviate for her if they were able to open up the passageway.
And so that, in her, it only lasted like two or three days, so it wasn’t super long before it became compressed again. But she said, some people last, two weeks. , And so they were trying to see, if there is something like endo that’s, compressing everything. You know, does … Is this actually help with some of her pain, or is, is it, are they following down the wrong rabbit hole?
Is this something that’s also happening but maybe not the contributor to the pain that she’s having? And so that’s sort of where is. So from a, from like a naturopathic doctor standpoint, our role really is, helping people to even consider it on their radar, helping people [00:26:00] to present information to their, medical doctor or a nurse practitioner, someone who can refer them into the system, trying to figure out if there are interventional radiologists in the area who have more of a interest in this.
Even in, even in the US, there’s,, not a ton of people. There’s a couple of clinics who are really, really good at it and have a lot of, , patients that they treat. But I think this is a new area that is probably been around for a long time, but maybe more newly, newly kind of recognized. And so I think we will see more of this information coming a lot faster, especially with the internet.
, But I think it’s just not on the radar right now.
Dr. Dominique Vanier, ND: Mm-hmm. Mm-hmm. Definitely not. Yeah. Yeah. And certainly, what makes it tricky is it, there are s- there are so many systems in the body where we can have symptoms overlapping, like endometriosis, we’ve talked about, POTS, [00:27:00] digestive issues- Yeah
possibly circulatory issues, but that doesn’t seem like that’s the, the conversation that first starts with a patient. They’re coming to us for different reasons. Yeah.
Dr. Christina Carew, ND: Yeah. Right. And I would say- Mm-hmm … often the patient will come in because of constipation.
Dr. Dominique Vanier, ND: Yeah.
Dr. Christina Carew, ND: Yeah. They’ll come in because of constipation or, like, bloating.
Yeah. And then it’s only as you ask more questions and do it. And so I, I started in my practice kind of just being like, “Okay, it could be this or this, or it could be one of these three things. Let’s kind of investigate as much as we can simultaneously so that we can see, we can make sure we get an answer to you as quickly as possible.”
Dr. Dominique Vanier, ND: Mm-hmm.
Dr. Christina Carew, ND: Yeah. So certainly, I mean, we’re learning more every day. But I think- From a bloating perspective, maybe not a common reason why people think that they have bloating, but [00:28:00] gosh, I had four in the last week in my clinic that I was like, “Oh, no, I think this is actually it.”
Dr. Whitney Baxter, ND: Wow. Yeah, I’m already… I’m sure you are too, Dawn, thinking of like a few- Yeah
of the people.
Dr. Dominique Vanier, ND: There’s a few people. There’s definitely a few people, and it- Yeah … may have been that I missed it or, you know, one of them is like, “I’ve got constipation, digestive issues, and my legs and my arms also feel- Yeah … puffy.” There’s a fluid aspect, we talked about, a peripheral fluid aspect to this.
Yeah. And again, , it may be related, it may not be, but there definitely needs to be some level of investigation that happens there. And as naturopathic doctors,, one of the main benefits that we can bring to the table is, , our investigative hat because we have so much time with people. We’re asking about different systems, not just like- Mm-hmm
a five-minute appointment and “Oh, you’re constipated? Let’s try, let’s try this laxative, and then come back in a few months,” right?
Dr. Whitney Baxter, ND: Yeah. Yeah, exactly. Yeah, pulling it all together.
Dr. Dominique Vanier, ND: Yeah.
Dr. Whitney Baxter, ND: And then it’s peace of mind too to say to somebody, “Hey, all the things, like you’re not failing your treatments.
You’re not this [00:29:00] mystery. , There’s a possible explanation for all of these, what feels like random symptoms.” That when you know something is off in your body, like, people say that, right? Like, no one’s-
Dr. Dominique Vanier, ND: They know …
Dr. Whitney Baxter, ND: thought about this or, “I don’t think it’s IBS, but that’s what people keep telling me.
There’s something else going on.” It’s nice to have this conversation with people.
Dr. Dominique Vanier, ND: Well, and things can manifest as IBS, right? Like, IBS can be- Right … primary, but it can also be secondary, and that’s really important for people to know ’cause IBS, yes, is a true condition. It is not a catch-all condition where oh, we don’t know what’s going on, so you have IBS.
There are people that are definitely diagnosed with IBS, but IBS also… Some people I have had where, they’ve actually had celiac disease, and they’ve been told that they have IBS for years, right? And so when we talk about- Yes … root cause medicine where we’re able to actually find the root cause, that’s really important that we do end up doing that.
Dr. Christina Carew, ND: And really, it’s like a few additional questions, like thinking of just about that pooling, that gravitational piece, any kind of, veins, hemorrhoids. Some of the [00:30:00] questions that we ask but maybe don’t give as much weight to. And also, just looking at your patients, right? Like- Yes … they probably have come in, unless they’re the first person of the day, they’ve been sitting or standing.
Some of that is possible. You can even just be like, “Oh, do you have- Yeah … do you have any of this?” Yeah. So
What You Can Do
Dr. Christina Carew, ND: as , a patient, if this, if this is starting to resonate with you where you’re, you also are wanting to learn more, I would say certainly asking your nurse practitioner or medical doctor, you know- I’ve been having this pressure and bloating.
It doesn’t seem to be related to my food. It gets worse around my cycle. It might be not gut related anymore. I’ve heard about pelvic venous congestion and how it can mimic gut symptoms. Is this something we can consider or rule out? Can you help me to investigate this, or can you send me to a specialist that can help me look into this further?
So not to be completely surprised if your [00:31:00] practitioner’s never heard about it before. It’s not commonly on the radar. It used to be pretty rare. It’s now maybe not as rare, or maybe it was never rare. We just didn’t notice it. But certainly can be a thing to ask about. And if people don’t know, send them to our podcast and then tell them to reach out.
We will, we’ll give them some more information or resources. And, and we’ll link some… There’s a couple of good, , other podcasts that I listen to, on this topic, and we’ll link them in the show notes just so that you can get- hear some other voices talking about it as well. So key mindset shift, which is what Whitney said, you’re not failing treatment.
You’ve maybe just been given the wrong framework, the wrong diagnosis. You know, it’s not just IBS. Sometimes it’s maybe something else in the pelvic region that we need to consider. And certainly we have some upcoming episodes about other ar- other things in the pelvic region, hormonal conditions and, red flag [00:32:00] concerns that we have that we also can see as having more, external pelvic symptoms that aren’t gut related.
But certainly having any kind of congestion in the pelvic region can also mean that we get more gut symptoms because we’re just putting more pressure and, more signaling issues in one area. And so I would say certainly a lot of these conditions overlap. And fortunately, there’s just not one problem if someone has a problem generally, unless they’ve come to you very early on in their concerns.
And so, as gut health practitioners, it- it’s part of, you know, our responsibility is to, to look at all parts of the being and not just the gut. But certainly, , the gut is definitely affected.
So everyone, buckle up. We still have more episodes left on reasons for bloating. As much as everyone can- can’t imagine, I think we have more than 20 ideas of why you might be having chronic bloating. And so if we haven’t hit it yet, it’s [00:33:00] coming up.
Dr. Whitney Baxter, ND: Stay tuned.
Dr. Christina Carew, ND: Stay tuned because better gut health changes everything.
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