Your client may have uterine fibroids that can become very large and push against the abdominal wall. This is very common among women, especially women with darker skin and those living at higher latitudes. I live in Wisconsin and had this problem. I was prescribed a high dosage of vitamin D (& iron) following a blood test that found my levels of vitamin D and iron were very low. It was amazing how quickly my abdominal distention was relieved. Heavy bleeding during my periods was also greatly diminished. I continue to take Vitamin D and try to get 10-20 minutes of sunshine when I can. For more info on Vitamin D, please do an internet search of Dr. Michael Holick’s reports or videos on the subject.