Ascites usually occurs when the liver stops working properly, leading to a build up of fluid in the abdominal area.
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.
There are also other causes, such as:
- Heart failure accounts for around 3 percent.
- Tuberculosis accounts for 2 percent.
- Dialysis accounts for 1 percent.
- Pancreatic disease, such as chronic pancreatitis, accounts for 1 percent.
Around 2 percent of cases are due to other causes, such as:
- intravenous drug use
- high cholesterol levels
- type 2 diabetes
- kidney disease
- ovarian lesions
- severe malnutrition
- pancreatic, liver, or endometrial cancer
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 cirrhosis
The risk of developing cirrhosis is
- chronic hepatitis B
- chronic hepatitis C
- a history of high alcohol consumption
- nonalcholic fatty liver disease
Other, less common causes of cirrhosis include:
- autoimmune hepatitis
- primary biliary cholangitis, primary sclerosing cholangitis, or another disease that block the bile ducts
- inherited liver diseases, such as Wilson disease or hemochromatosis
- long-term use of certain drugs, such as anabolic steroids and methotrexate
- chronic heart failure with liver congestion
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:
- painless swelling in the abdomen that worsens rather than going away
- abdominal discomfort
- weight gain
- feeling full after eating a little
- shortness of breath as pressure increases in the abdomen, pushing up on the diaphragm and reducing the space for the lungs to expand
With bacterial peritonitis, you may have:
- a fever
- tenderness in the abdomen
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.
Diuretics 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.
In 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.
In 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.
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:
- eating a diet that is high in fresh fruits and vegetables and low in added fats and salt
- consuming whole foods rather than highly processed foods
- managing your body weight
- getting regular exercise
- following guidelines for preventing hepatitis, such as asking your doctor about the hepatitis B vaccine and using a condom during sex to reduce the risk of infection
- limiting alcohol use
If you have cirrhosis, the
- taking care to avoid raw or undercooked fish, shellfish, or meat to reduce the risk of infection
- limiting the amount of salt in your diet
- limiting your intake of fat and protein
- avoiding alcohol consumption
Your doctor can advise on measures appropriate to your situation.
Complications associated with ascites include:
- abdominal pain
- pleural effusion, or “water on the lung,” which can lead to difficulty breathing
- hernias, such as inguinal hernias
- bacterial infections, such as spontaneous bacterial peritonitis (SBP)
- hepatorenal syndrome, a rare type of progressive kidney failure
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:
- a distended, or swollen, abdomen
- sudden weight gain
- difficulty breathing when lying down
- diminished appetite
- abdominal pain
- nausea and vomiting
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.