What is ascites?

Ascites is a condition that happens when fluid collects in spaces in your belly (abdomen). If severe, it may be painful. The problem may keep you from moving around comfortably. It 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.

Some types of cancer, like ovarian or bladder cancer, can also cause it. Ascites caused by cancer most often occurs with advanced or recurrent cancer. It may also be caused by other problems like heart conditions, dialysis, low protein levels, and infection. Other causes of ascites are infections like tuberculosis, pancreatitis, certain kidney problems, and severe malnutrition.

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 ankles or lower legs.

• Shortness of breath.

• Hemorrhoids.

How is ascites diagnosed?

Your doctor 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.

• Lab tests. Blood and urine samples may be tested.

• Imaging. Your doctor may request images of the inside of your abdomen. An ultrasound is a simple imaging test that can be done to confirm ascites. An MRI or a CT scan may be ordered to find the cause of ascites. An MRI creates images using magnetics and radio waves. A CT scan creates detailed computer images using X-rays. They may also find any masses if they exist.

How is ascites treated?

The treatment of ascites depends on its cause.

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

• Limit your salt intake. Your doctor or a dietitian can show you how to follow a low-sodium diet.

• You may need to limit the amount of fluids you drink if your sodium levels are low.

• Stop drinking alcohol.

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

In certain cases, your doctor 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.

If there is an infection of ascitic fluid (spontaneous bacterial peritonitis), antibiotics will be needed. If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.

What are possible complications of ascites?

Ascites can make it hard to eat, drink, breathe, and move around. An infection of ascitic fluid can lead to an abdominal infection that can lead to 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. You can:

• 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.

• Avoid using recreational drugs to reduce your chance of getting hepatitis.

• Get vaccinated for diseases, such as influenza, hepatitis A and hepatitis B, and pneumococcal infection.

Living with ascites

Follow your doctor'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 doctor if you gain too much weight. Continue or begin a daily exercise program. Ask your doctor if you need help to quit smoking, drinking alcohol, or using illegal drugs.

Ask your doctor if you can take NSAIDs for pain. Also, ask if you can take acetaminophen. Discuss all the medicines you take, including over-the-counter medicines for allergies, colds, fever, and dietary and herbal supplements. They may interfere with your treatment, cause side effects, and damage your liver and kidneys.

Key points about ascites

• Ascites happens 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, 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 doctor:

• 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 doctor 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 doctor 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 doctor if you have questions, especially after office hours or on weekends.