What Is Ascites?
Ascites is a buildup of fluid in the belly, often due to severe liver disease. The extra fluid collects in the space between the peritoneum—the layer of tissue that surrounds your belly—and the organs in your abdomen.
Not everyone with fluid in their belly has ascites. Doctors only diagnose you with ascites when you have at least 25 milliliters (0.8 ounces) of fluid built up.
How common is it?
It's rare to get ascites if you're healthy. About 80% of people with this condition have cirrhosis of the liver.
Other causes of ascites include:
- Heart failure
- Dialysis, a treatment of kidney failure
- Disease of the pancreas
You may not notice symptoms of mild ascites because there isn't much fluid in your belly. As the amount of fluid raises, your belly will grow and feel full and swollen. Your pants might be tighter from weight gain.
Other symptoms often include:
If you have any of these symptoms, see your doctor. Ascites is often a sign of liver failure that happens from the liver disease or cirrhosis. Yellow eyes and skin (jaundice) is another symptom of liver damage.
You may have other symptoms if another health condition is causing your ascites. Weight loss, for instance, can be a symptom of some cancers, and heart failure can cause shortness of breath and swelling in the legs.
Cirrhosis is the most common reason you get ascites, but other things like cancer and heart failure can cause it as well.
How does cirrhosis cause ascites?
When your liver doesn't work like it should, pressure builds up in the portal vein, the main vein that supplies blood to your liver. The extra pressure blocks blood flow in the liver.
Over time, the raised pressure affects your kidneys, too. When these organs can't remove excess salt from your blood, fluid builds up in your body. The extra fluid leaks out of your veins and collects in your belly.
Cancer in the belly can also cause ascites. The cancer cells release fluid into the abdomen.
In some types of heart failure, the heart is too weak to pump enough blood to the body. A drop in blood volume triggers the release of hormones that make your body hold onto more fluid, which collects in your belly.
Ascites Risk Factors
Any health issue that causes liver damage or scarring can make you more likely to get ascites. The most common risk factor is liver cirrhosis due to:
- Viral infections like hepatitis B or C
- Alcohol use disorder
Other risks include:
- Cancer in the belly area
- Kidney failure
- Heart failure
- Disease of the pancreas
- IV drug use
- High cholesterol
- Type 2 diabetes
- Ovarian lesions
- Severe malnutrition
Your doctor will give you a physical exam and ask about your symptoms. They may perform various tests, including:
Paracentesis: The doctor uses a needle to remove fluid from your belly. A lab tests the fluid for infection, cancer, and other conditions that cause ascites.
Blood tests: These tests can show whether you have high blood sugar from diabetes or an infection in your belly.
Imaging tests: An X-ray, ultrasound, or CT scan shows the inside of your belly in more detail to help your doctor find the cause of ascites.
Serum ascites albumin gradient (SAAG) test: This test compares the level of albumin, a protein your liver makes, in your blood and in your ascites fluid. A high SAAG level is a sign of raised pressure in your portal vein.
Your doctor may also refer you to a liver specialist for other tests or treatment.
Treatment is based on what caused your ascites. In general, the goal is to reduce the amount of fluid in your belly. Your doctor may do that in a few different ways.
Salt makes your body hold onto extra fluid. Your doctor or dietitian can show you ways to cut down on the sodium in your diet. For example, you might:
- Eat more fresh foods and less packaged ones
- Buy low-sodium or sodium-free foods
- Season your food with herbs and spices instead of salt
- Use less salad dressing, soy sauce, and other condiments that have salt
Your doctor might prescribe you "water pills," also called diuretics, to help flush the extra fluid and salt from your body.
Two of the most common diuretics used to treat ascites are:
This procedure lets the doctor bring down the swelling in your belly by removing fluid through a tube placed in your abdomen. You may need paracentesis if diet and diuretics haven't helped.
Paracentesis improves ascites in 90 percent of people, but the fluid can come back. You may need to take medicine or have a drain in your body long-term to prevent ascites again.
A shunt is a small tube your doctor places in your belly to drain the ascites. The extra fluid drains into a vein in your neck and goes back into your bloodstream.
If those treatments don't work, you may need one of these procedures on your liver:
- Transjugular intrahepatic portosystemic shunt (TIPS). The doctor places a wire mesh tube called a stent into a vein in your liver. A balloon inflates inside the stent to open it up. The stent allows your blood to flow more easily through your liver and other organs in your belly.
- Liver transplant. You may need a transplant if you have liver failure from cirrhosis. A transplant removes your damaged liver and replaces it with a healthy one from a donor.
Prevention and Control
There are many things you can do to prevent ascites or keep it from getting worse if you do have it:
Don't drink alcohol. It damages your liver and raises your risk of cirrhosis.
Limit salt. Extra sodium makes your body hold onto more fluid. Try to eat no more than 2,000-4,000 milligrams of salt a day.
Keep your weight at a healthy number. Obesity is a risk factor for ascites. If you have ascites, it's important to weigh yourself every day. Tell your doctor if you gain more than 10 pounds or more than 2 pounds a day for 3 days in a row.
Follow a healthy lifestyle. Eat a well-balanced diet, exercise often, and don't use tobacco products.
Practice safe sex. You can get hepatitis through unprotected sex. Hepatitis damages the liver and can lead to cirrhosis.
Treating ascites can help prevent more severe health issues like these:
Infections. Germs can grow inside the fluid and cause an infection called spontaneous bacterial peritonitis. Call your doctor for symptoms like fever and belly pain. These are signs of infection. You'll get antibiotics to treat the infection and prevent it from coming back.
Hernia. Ascites can make organs inside your belly bulge out through your belly button or lower abdomen.
Trouble eating. Belly pain and fullness could make it harder for you to eat or drink. You might become malnourished or dehydrated as a result.
Fluid in the lungs. Some of the fluid from your belly could get into your lungs. Fluid in the lungs causes symptoms like coughing, chest pain, and trouble catching your breath.
Kidney failure. High blood pressure in your liver can also damage blood vessels in your kidneys. Over time, your kidneys could stop working.
Is Ascites Life Threatening?
The most common cause of ascites is liver damage. If you don't treat it, it can cause serious complications that are often life-threatening.
Living With Ascites
Ascites is a serious condition. It's a sign that your liver isn't working well. You need this important organ to remove waste from your blood. Ascites can be life-threatening if you don't treat it and your liver fails. Then, you'll need a liver transplant to replace your damaged organ.
There's no cure for ascites, but treatments and diet changes can relieve symptoms, prevent complications, and help you feel better.
Even after you treat ascites it can come back. If the fluid builds up quickly, you'll need diuretics, TIPS, or a liver transplant. Follow your doctor's advice to protect your liver and stay healthy.
When Should I Consult My Doctor?
Call your doctor if:
- You gain weight
- Your belly gets bigger
- You have new or worse belly pain
- You have a fever
Go to an emergency room or call 911 if you have trouble breathing or you vomit blood or something that looks like coffee grounds.