Ascites occurs when fluid in the abdomen builds up, most often from cirrhosis, or scarring in the liver. Symptoms include a hard, swollen stomach (“pregnancy belly”), sharp pains, weight gain, and a decreased appetite. Treatment is focused on keeping the liver healthy with lifestyle changes such as quitting alcohol, medication, and procedures to help manage the condition.
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What Is Ascites?
Ascites is a buildup of fluid in the abdominal cavity.
Your stomach is covered by a two-layered sheet of tissue called the peritoneum. Ascites occurs when fluid builds up between the layers and pools, making the abdomen look like a pregnant belly.
Most people who have this condition have already been diagnosed with cirrhosis or scarring of the liver. People with ascites often have painful swelling that can make movement uncomfortable and challenging. It can be a sign that your liver disease is getting worse.
How common is ascites?
While ascites isn’t a common condition on its own, it is very common in people who have cirrhosis.
What causes ascites?
Cirrhosis of the liver is the main cause of ascites. More than 50% of people with cirrhosis develop ascites within 10 years of their liver disease diagnosis.
Cirrhosis often causes portal hypertension, which reduces blood flow and can cause internal bleeding. Portal hypertension causes ascites. But sometimes people with congestive heart failure, hepatitis, or cancer get ascites.
Cirrhosis or other advanced liver disease causes scarring that makes it hard for the liver to filter the blood. Since blood can't easily flow on its normal path into the liver, pressure builds up in the blood vessels nearby. This causes high blood pressure, known as portal hypertension, around the liver.
The fluid that the liver would normally filter builds up and moves into other parts of the body. This fluid often collects in the abdominal cavity. There may be a small amount of fluid, or there may be enough to cause the belly to swell painfully.
Ascites risk factors
Liver damage is the biggest risk factor for ascites.
Problems that cause liver damage include:
- A history of alcohol use.
- Cirrhosis of the liver.
- Hepatitis B or C.
- Some other conditions that increase your risk for ascites are:
- Heart or kidney failure.
- Hypothyroidism.
- Ovarian, pancreatic, liver, or endometrial cancer.
- Pancreatitis.
- Tuberculosis.
Complications of ascites
Having ascites makes it likely you'll have other complications of liver disease, such as:
- Abdominal wall hernias.
- Edema (swelling of legs and ankles).
- Hepatic encephalopathy (liver fails to properly remove toxins from the body, leading to mental confusion).
- Hepatic hydrothorax (fluid that pushes into the lung cavity).
- Hepatorenal syndrome (kidney failure).
- Spontaneous bacterial peritonitis (unexplained and potentially life-threatening infection of the ascitic fluid).
How can I prevent ascites?
The only sure way to avoid ascites is to maintain a healthy liver.
If you have liver disease, you can prevent further damage by:
- Eating a healthy diet.
- Maintaining a healthy weight.
- Not drinking alcohol.
- Seeing your liver doctor on a routine basis.
What Are the Signs and Symptoms of Ascites?
The signs of ascites can form slowly or come on fast. If there's only a small amount of fluid in the belly, you may not have any symptoms.
As the build-up of fluid increases, you may have symptoms such as:
- A swollen, hard abdomen (“pregnancy belly”).
- Belly button pushed out.
- Bloating.
- Decreased appetite.
- Heartburn.
- Nausea and vomiting.
- Shortness of breath.
- Stomach pain.
- Sudden weight gain.
When should I see a doctor about my ascites symptoms?
If you are experiencing any of the above symptoms, talk with your primary care provider for a proper diagnosis and treatment options.
How Do You Diagnose Ascites?
Your doctor will conduct a physical exam and ask you about your health history, particularly about your liver disease.
They may order the following tests to confirm an ascites diagnosis:
- Abdominal ultrasound.
- Blood tests.
- CT scan of the stomach.
- Kidney function tests.
- Liver function tests.
- Paracentesis to check for signs of infection or cancer.
- Urine tests.
How Do You Treat Ascites?
Ascites is a serious complication of liver disease. Your doctor will want to treat it as early as possible with these methods.
Lifestyle changes to treat ascites
Reducing your sodium (salt) intake is the first step in treating ascites. Doctors recommend consuming no more than 2,000 milligrams of sodium a day.
Salt causes you to retain water, which can add to fluid buildup in the belly.
Medication to treat ascites
Your doctor may prescribe diuretics, also known as water pills.
Water pills can:
- Ease fluid buildup in the belly.
- Help lower portal hypertension.
- Rid your body of sodium and water.
Procedures to treat ascites
Sometimes reducing salt in your diet and taking water pills aren't enough. You may need surgery or another type of treatment.
Types of procedures to treat ascites include:
- Paracentesis — Removes fluid from the abdominal cavity. A radiologist will use an ultrasound to guide a needle into the stomach. They may need to repeat the procedure if fluid builds up again.
- Transjugular intrahepatic portosystemic shunt (TIPS) — Reduces portal hypertension. Doctors place a stent into a vein to bypass the liver. The increased blood flow may relieve the buildup of fluids in the abdominal cavity.
- Liver transplant — If other treatments don't work, you may need a liver transplant. Surgeons remove your diseased liver and replace it with a healthy one from an organ donor.
