When more than 25 milliliters (mL) of fluid builds up inside the abdomen, it’s known as ascites. Ascites usually occurs when the liver stops working properly. When the liver malfunctions, fluid fills the space between the abdominal lining and the organs.
According to 2010 clinical guidelines published in the Journal of Hepatology, the two-year survival rate is 50 percent. If you experience ascites symptoms, talk to your doctor as soon as possible.
Ascites is most often caused by liver scarring, otherwise known as cirrhosis. Scarring increases pressure inside the liver’s blood vessels. The increased pressure can force fluid into the abdominal cavity, resulting in ascites.
Liver damage is the single biggest risk factor for ascites. Some causes of liver damage include:
- cirrhosis
- hepatitis B or C
- a history of alcohol use
Other conditions that may increase your risk for ascites include:
- ovarian, pancreatic, liver, or endometrial cancer
- heart or kidney failure
- pancreatitis
- tuberculosis
- hypothyroidism
Symptoms of ascites can appear either slowly or suddenly, depending on the cause of the fluid buildup.
Symptoms don’t always signal an emergency, but you should talk to your doctor if you experience the following:
- a distended, or swollen, abdomen
- sudden weight gain
- difficulty breathing when lying down
- diminished appetite
- abdominal pain
- bloating
- nausea and vomiting
- heartburn
Keep in mind that ascites symptoms may be caused by other conditions.
Diagnosing ascites takes multiple steps. Your doctor will first check for swelling in your abdomen.
Then they’ll probably use imaging or another testing method to look for fluid. Tests you may receive include:
- ultrasound
- CT scan
- MRI
- blood tests
- laparoscopy
- angiography
Treatment for ascites will depend on what’s causing the condition.
Diuretics
Diuretics are commonly used to treat ascites and are effective for most people with the condition. These drugs increase the amount of salt and water leaving your body, which reduces pressure within the veins around the liver.
While you’re on diuretics, your doctor may want to monitor your blood chemistry. You’ll probably need to reduce your alcohol use and salt intake. Learn more about low-sodium diets.
Paracentesis
In this procedure, a thin, long needle is used to remove the excess fluid. It’s inserted through the skin and into the abdominal cavity. There’s a risk of infection, so people who undergo paracentesis may be prescribed antibiotics.
This treatment is most commonly used when the ascites is severe or recurrent. Diuretics don’t work as well in such late-stage cases.
Surgery
In extreme cases, a permanent tube called a shunt is implanted in the body. It reroutes blood flow around the liver.
Your doctor may recommend a liver transplant if ascites doesn’t respond to treatment. This is generally used for end-stage liver disease.
Complications associated with ascites include:
- abdominal pain
- pleural effusion, or “water on the lung”; this can lead to difficulty breathing
- hernias, such as inguinal hernias
- bacterial infections, such as spontaneous bacterial peritonitis (SBP)
- hepatorenal syndrome, a rare type of progressive kidney failure
Ascites can’t be prevented. However, you can lower your risk of ascites by protecting your liver. Try adopting these healthy habits:
- Drink alcohol in moderation.This can help prevent cirrhosis.
- Get vaccinated for hepatitis B.
- Practice having sex with a condom. Hepatitis can be sexually transmitted.
- Avoid sharing needles. Hepatitis can be transmitted through shared needles.
- Know the potential side effects of your medications. If liver damage is a risk, talk to your doctor about whether your liver function should be tested.