What is ascites?

Ascites is a condition that occurs when fluid collects in spaces in your belly (abdomen). If severe, it may be painful. The problem may keep you from moving around comfortably. Ascites can set the stage for an infection in your abdomen. Fluid may also move into your chest and surround your lungs. This makes it hard to breathe.

What causes ascites?

The most common cause of ascites is cirrhosis of the liver. Drinking too much alcohol is one of the most common causes of cirrhosis of the liver.  

Different types of cancer can also cause this condition. Ascites caused by cancer most often occurs with advanced or recurrent cancer. Ascites may also be caused by other problems such as heart conditions, dialysis, low protein levels, and infection.

What are the symptoms of ascites?

Symptoms of ascites include:

• Belly swelling

• Weight gain

• Sense of fullness

• Bloating

• Sense of heaviness

• Nausea or indigestion

• Vomiting

• Swelling in the lower legs

• Shortness of breath

• Hemorrhoids

How is ascites diagnosed?

Your healthcare provider will do a physical exam and ask about your symptoms. You may also have tests, such as:

• Fluid sample.  A sample of fluid from your belly may be taken using a needle. This fluid will be checked for signs of disease, such as cancer or an infection. This test may help point to the cause of the ascites.

• Imaging.Your healthcare provider may request images of the inside of your abdomen using ultrasound, MRI, or a CT scan. An MRI creates images using magnetics and radio waves. A CT scan creates detailed computer images using X-rays.

How is ascites treated?

A number of steps may help ease your ascites. Your healthcare provider may tell you to:

• Limit your salt intake. Your healthcare provider or a dietitian can show you how to follow a low-sodium diet. Don't use salt substitutes that contain potassium. This is because some medicines used in treating ascites can cause your potassium levels to rise.

• Limit the amount of fluids you drink.

• Stop drinking alcohol.

• Take diuretic medicines to help reduce the fluid in your body.

• In certain cases, your provider may need to remove large amounts of fluid from your abdomen through a needle. This may be done if you have trouble breathing or the diuretic is not working.

• In very complex cases, you may need to have a procedure called TIPS. In this procedure, a connection is made inside the liver between the blood vessels. This eases the high pressure that causes ascites.

What are possible complications of ascites?

Ascites can make eating, drinking, and moving around difficult. It can also make it hard to breathe. Ascites can lead to abdominal infections, which may cause kidney failure. It can also cause umbilical or inguinal hernias. Don't take NSAID pain relievers such as ibuprofen or naproxen if you have liver disease with ascites. These medicines can cause problems, such as kidney failure.

Can ascites be prevented?

Certain steps to help you prevent cirrhosis of the liver and cancer can also prevent ascites. These include:

• Stop drinking alcohol.

• Stay at a healthy weight.

• Exercise regularly.

• Stop smoking.

• Limit salt intake.

• Practice safe sex to reduce your chance of getting hepatitis.

• Don't use recreational drugs to reduce your chance of getting hepatitis.

Living with ascites

Follow your healthcare provider's advice for lowering your salt intake. You'll need to do this even if you're taking diuretic medicines to reduce fluid in your body. Also, weigh yourself daily. Call your healthcare provider if you gain too much weight. Continue or begin a daily exercise program. Ask your healthcare provider if you need help to quit smoking, drinking alcohol, or using illegal drugs.

Ask your provider if you can take NSAIDs for pain. These include ibuprofen and naproxen. Also, ask if you can take acetaminophen.

Key points about ascites

• Ascites occurs when fluid collects in spaces in your belly (abdomen).

• As fluid collects in the belly, it can affect your lungs, kidneys, and other organs.

• Ascites causes belly pain, swelling, nausea, vomiting, and other problems.

• Certain things that help prevent cirrhosis of the liver and cancer can also prevent ascites. This includes not drinking alcohol, staying at a healthy weight, exercising, not smoking, and limiting salt intake.

• Ascites can’t be cured. But lifestyle changes and treatments may decrease complications.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also, write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed, and how it will help you. Also, know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your provider if you have questions.