Ascites

Ascites is when too much fluid builds up in your abdomen (belly). 

This condition often happens in people who have cirrhosis (scarring) of the liver.

A sheet of tissue called the peritoneum covers the abdominal organs, including the stomach, bowels, liver and kidneys. The peritoneum has two layers. Ascites happens when fluid builds up between the two layers.

What are risk factors for ascites?

Having a condition that causes cirrhosis puts you at greater risk for developing ascites. These conditions include:

Non-alcohol associated fatty liver disease.

Hepatitis B.

Hepatitis C.

Alcohol use disorder.

Autoimmune hepatitis.

Genetic liver diseases like hemochromatosis, Wilson disease and alpha-1-antitrypsin deficiency.

Other conditions that can lead to ascites include:

Congestive heart failure.

Kidney failure.

Cancers of the organs in the abdomen and pelvis.

Infections.

How common are ascites?

Fluid buildup rarely occurs in otherwise healthy people. It develops as a result of other diseases, most often cirrhosis. Ascites is the most common complication of cirrhosis. About half of people with decompensated cirrhosis will develop ascites. Cirrhosis accounts for about 80% of the cases of ascites.

What causes ascites?

Cirrhosis is the most common cause of ascites. Other conditions that can cause it include heart failure, kidney failure, infection or cancer.

How does cirrhosis cause ascites?

When you have cirrhosis, your liver doesn’t function as it should. The decrease in liver function combines with portal hypertension to cause ascites symptoms. Portal hypertension is high pressure in the portal vein that delivers blood to your liver. The high pressure causes fluid to leak out of your veins into your belly and collect there.

Symptoms Include:

The main symptoms of ascites are a large belly and rapid weight gain.

Other symptoms include:

Swelling in your ankles.

Shortness of breath.

Digestive issues, such as bloating, abdominal pain, loss of appetite, indigestion and constipation.

Back pain.

Difficulty sitting.

Fatigue.

How is ascites diagnosed?

Your healthcare provider performs a physical examination and asks you about your symptoms and medical history. You may need blood tests or imaging tests as well.

What tests might I need?

After the initial exam, your provider will recommend other tests to confirm a diagnosis:

Ultrasound or CT scan: These imaging scans show your abdominal area in more detail.

Paracentesis: You’ll get a local anesthetic before this procedure. Your provider inserts a needle into your abdomen to remove fluid. The fluid is analyzed for signs of cancer, infection, portal hypertension and other conditions.

How is ascites treated?

Limiting sodium in your diet is crucial for treating ascites. For people with ascites, recommended sodium intake is less than 2,000 to 4,000 milligrams a day.

A dietitian can help create a healthy eating plan for you. You may also need to take diuretics (water pills). These water pills help fluid and sodium leave your body.

Will I need surgery for ascites?

Sometimes, diuretics and a low-sodium diet aren’t enough to improve the ascites. You may need other treatments, including:

Paracentesis: Your provider inserts a needle into your abdomen to remove the fluid. This procedure can remove a large amount of excess fluid.

Transjugular intrahepatic portosystemic shunt (TIPS): This procedure is performed to treat fluid build-up in the abdomen. A wire mesh (stent) is inserted into a vein in your liver. When inflated, the stent forms a channel (shunt) to bypass the liver. TIPS may be appropriate if your ascites aren't responding to other therapies, if you need several paracentesis per month and you're not a candidate for a liver transplant.

Liver transplant: In cases of severe cirrhosis, when the liver is failing, a liver transplant may be necessary.

What other treatments are available?

If you have cancer, chemotherapy or hormone therapy can help shrink the tumor. The treatments can stop the fluid buildup.

Can ascites be cured?

Treatments for ascites can help improve symptoms and reduce complications. In some patients, ascites may resolve with diuretic therapy or with TIPS or liver transplant. In the case of alcohol-associated hepatitis, ascites may resolve with improvements in liver function. Follow your healthcare provider’s recommendations to stay as healthy as possible.