Ascites usually occurs when the liver stops working properly, leading to a build up of fluid in the abdominal area. A doctor may diagnose ascites when more than 25 milliliters (mL) of fluid builds up inside the abdomen. When the liver malfunctions, fluid fills the space between the abdominal lining and the organs. Ascites is the most common complication of cirrhosis (scarring of the liver), according to 2010 clinical guidelines published in the Journal of Hepatology. It affects around 60 percent of people with cirrhosis within 10 years of their diagnosis, and the 2-year survival rate is 50 percent. If you experience ascites symptoms like those below, talk with your doctor as soon as possible. Liver damage, or cirrhosis, accounts for around 80 percent of ascites cases, according to 2021 research. In fact, it is the single biggest risk factor for ascites. There are also other causes, such as: Around 2 percent of cases are due to other causes, such as: Some people have hemorrhagic ascites. This is when blood is present in the fluid. It can happen if you have liver cancer or blood in lymph fluid. Risk factors for cirrhosisThe risk of developing cirrhosis is higher if you have: Other, less common causes of cirrhosis include:
Ascites often results from liver scarring, also called cirrhosis. Cirrhotic ascites develops when blood pressure in the portal vein — the blood vessel that carries blood from the digestive organs to the liver – becomes too high. As the pressure rises, kidney function worsens and fluid builds up in the abdomen. As the liver struggles to manage this fluid, it is forced into the abdominal cavity, resulting in ascites. Some cancers can also lead to ascites. In peritoneal cancer, tumor cells in the peritoneum (the lining of your abdomen that covers your abdominal organs) produce a proteinous fluid, which can become ascites. If you have heart or kidney failure, the blood volume in your arteries may fall. This triggers changes in various body systems that cause constriction in the kidney’s blood vessels and sodium and water retention. These, too, can form ascites. People with ascites may have the following symptoms:
With bacterial peritonitis, you may have:
There are also other symptoms that are specific to cancer, heart failure, advanced cirrhosis, or other underlying conditions. Diagnosing ascites takes multiple steps. Your doctor will first check for swelling in your abdomen and carry out a thorough abdominal examination. They’ll probably use imaging or another testing method to look for fluid. Tests you may receive include:
Treatment for ascites will depend on what’s causing the condition. If you have a bacterial or viral infection, the doctor will treat the underlying cause and will prescribe other therapy to relieve symptoms. DiureticsDiuretics are commonly used to treat ascites and are effective for most people with the condition. These drugs increase the amount of salt and water leaving your body, which reduces pressure within the veins around the liver. While you’re on diuretics, your doctor may want to monitor your blood chemistry. You’ll probably need to reduce your alcohol use (if you drink alcohol) and your salt intake. Learn more about low-sodium diets. ParacentesisIn this procedure, a doctor uses a long, thin needle to remove the excess fluid from your abdomen. They insert the needle through the skin and into the abdominal cavity. You may need this if you have severe or recurrent ascites, or if symptoms don’t improve with diuretics. SurgeryIn some cases, a surgeon may plant a permanent tube, called a shunt, in the body. It reroutes blood flow around the liver and reduces the need for regular drainage. A shunt may be suitable if diuretics don’t help. Your doctor may recommend a liver transplant if ascites doesn’t respond to treatment and you have severe liver disease. If ascites results from heart failure, you may also need surgery. It is not always possible to prevent ascites or its causes. However, there are ways to reduce the risk of some causes, such as cirrhosis, heart disease, peritoneal infections, and nonalcoholic fatty liver disease. These methods include:
If you have cirrhosis, the National Institute for Diabetes and Digestive and Kidney Diseases recommends:
Your doctor can advise on measures appropriate to your situation. Symptoms of ascites can appear either slowly or suddenly, depending on the cause of the fluid buildup. They don’t always signal an emergency, but you should talk with your doctor if you experience the following symptoms:
Keep in mind that other conditions can cause ascites symptoms. If you need help finding a hepatologist, you can browse doctors in your area through the Healthline FindCare tool. Ascites is most likely to affect people with cirrhosis, but there are other causes, such as peritonitis, heart disease, and hepatitis. The main symptoms are swelling in the abdominal area that does not go away. The swelling may not be painful, but it can cause discomfort and may make it harder to breathe. It’s a good idea to see a doctor if you experience symptoms that could indicate ascites. They will carry out tests to find the underlying cause and treat it accordingly. If ascites is due to a short-term illness, such as acute hepatitis, successful treatment is usually possible. If the underlying cause is cirrhosis, you may need long-term medical help. Last medically reviewed on October 25, 2021 Medically Reviewed by Minesh Khatri, MD on August 11, 2022 Ascites is the buildup of fluid in your belly, often due to severe liver disease. The extra fluid makes your belly swell. Ascites is usually accompanied by a feeling of fullness, a ballooning belly, and weight gain. Other symptoms often include: If you have a combination of these symptoms, see your doctor. If you have ascites, it’s often a sign of liver failure. It occurs most often with cirrhosis. Ascites happens when pressure builds up in the veins of your liver and it doesn’t work as it should. These two problems usually are caused by another condition -- cirrhosis, heart or kidney failure, cancer, or an infection. The pressure blocks blood flow in the liver. Over time this keeps your kidneys from removing excess salt from your body. This, in turn, causes fluid to build up. Any disease that causes liver damage or scarring can make you more likely to get ascites. Common risk factors for ascites include:
The doctor will give you a physical exam and ask about your symptoms. They may perform a variety of tests, including blood work, an ultrasound, or a CT scan. If they think you have ascites, the doctor will use a needle to remove fluid from your belly for testing. This procedure is called a paracentesis. It’ll help the doctor find out what’s causing your condition so they can treat it properly. In most cases of ascites, the doctor will refer you to a liver specialist, who may discuss a liver transplant. The doctor may prescribe “water pills,” also called diuretics, to help flush the extra fluid from your body. Two of the most common diuretics are:
They both help your kidneys remove more sodium and water. If changes in your diet and prescription diuretics don’t help, or your symptoms are severe, your doctor may have to use paracentesis to remove large amounts of excess fluid through a needle inserted into your belly. When you have this done, you have to follow a low-salt, low-liquid diet, otherwise the fluid will come back. If these treatments don’t work, you may need a surgery to place a shunt in your liver or get a liver transplant. |