What is ascites and how does it affect the body. What are the main causes of ascites and who is at risk. How is ascites diagnosed and what treatment options are available. Can ascites be prevented through lifestyle changes. What are the potential complications of untreated ascites.

Understanding Ascites: Fluid Accumulation in the Abdomen

Ascites is a medical condition characterized by the abnormal accumulation of fluid in the peritoneal cavity, the space between the organs in the abdomen. This fluid buildup can cause significant discomfort and potentially lead to serious health complications if left untreated.

The severity of ascites can vary, with some individuals experiencing mild symptoms while others may face more severe manifestations. In advanced cases, ascites can cause considerable abdominal distension, making it difficult for patients to move comfortably or perform daily activities.

How does ascites develop?

Ascites typically develops as a result of underlying health conditions that affect the balance of fluid within the body. The most common causes include:

• Liver cirrhosis
• Advanced cancer
• Heart failure
• Kidney disease
• Pancreatitis

In many cases, ascites is a sign of advanced liver disease, particularly cirrhosis. The damaged liver cannot process fluids effectively, leading to fluid retention and accumulation in the abdominal cavity.

Recognizing the Signs and Symptoms of Ascites

Identifying ascites early can help in managing the condition more effectively. The symptoms of ascites can develop gradually or appear suddenly, depending on the underlying cause and the rate of fluid accumulation.

What are the common symptoms of ascites?

Patients with ascites may experience a range of symptoms, including:

• Abdominal swelling and distension
• Unexplained weight gain
• Feeling of fullness or bloating
• Nausea and loss of appetite
• Shortness of breath, especially when lying down
• Swelling in the legs and ankles
• Abdominal pain or discomfort

As the condition progresses, patients may also notice changes in their abdominal appearance, with the skin becoming tight and shiny. In some cases, the navel may protrude due to the increased pressure within the abdomen.

Diagnosing Ascites: Medical Evaluation and Tests

Proper diagnosis of ascites is crucial for determining the underlying cause and developing an appropriate treatment plan. Healthcare providers typically employ a combination of physical examination, medical history review, and diagnostic tests to confirm the presence of ascites and identify its origin.

What diagnostic methods are used to confirm ascites?

The following diagnostic approaches are commonly used to evaluate patients with suspected ascites:

1. Physical examination: A healthcare provider may perform an abdominal exam to check for signs of fluid accumulation, such as a distended abdomen or shifting dullness.
2. Imaging studies: Ultrasound, CT scans, or MRI may be used to visualize fluid in the abdominal cavity and assess the condition of internal organs.
3. Paracentesis: This procedure involves removing a small sample of abdominal fluid for analysis, which can help determine the cause of ascites and rule out infections.
4. Blood tests: Liver function tests, kidney function tests, and other blood work can provide valuable information about the underlying cause of ascites.

In some cases, additional tests may be necessary to evaluate specific organ function or to investigate potential malignancies contributing to ascites development.

Treatment Approaches for Managing Ascites

The management of ascites typically involves a multifaceted approach aimed at addressing the underlying cause, reducing fluid accumulation, and preventing complications. Treatment strategies may vary depending on the severity of ascites and the patient’s overall health status.

What are the primary treatment options for ascites?

Healthcare providers may recommend one or more of the following treatments for ascites:

• Dietary modifications: Reducing sodium intake is often a crucial first step in managing ascites, as salt promotes fluid retention.
• Diuretic medications: These drugs help increase urine output, promoting fluid elimination from the body.
• Paracentesis: Large-volume paracentesis may be performed to remove excess fluid from the abdominal cavity, providing immediate relief from symptoms.
• Transjugular intrahepatic portosystemic shunt (TIPS): This procedure may be considered for patients with refractory ascites, creating a new route for blood flow in the liver to reduce portal hypertension.
• Treatment of underlying conditions: Addressing the root cause of ascites, such as managing liver disease or treating cancer, is essential for long-term management.

In severe cases or when conservative treatments fail, liver transplantation may be considered as a definitive treatment for ascites caused by end-stage liver disease.

Lifestyle Modifications and Self-Care Strategies for Ascites Management

While medical treatments play a crucial role in managing ascites, patients can also take proactive steps to improve their condition and overall well-being. Implementing certain lifestyle changes and self-care practices can complement medical interventions and help prevent complications.

How can patients with ascites improve their quality of life?

Consider the following lifestyle modifications and self-care strategies:

• Adhere to a low-sodium diet: Limit salt intake to less than 2,000 mg per day, as recommended by healthcare providers.
• Monitor fluid intake: Follow guidelines provided by your healthcare team regarding daily fluid consumption.
• Maintain a healthy weight: Obesity can exacerbate ascites, so achieving and maintaining a healthy weight is important.
• Exercise regularly: Gentle physical activity, as approved by your healthcare provider, can help improve overall health and reduce fluid retention.
• Avoid alcohol: Abstaining from alcohol is crucial, especially for patients with liver-related ascites.
• Track your weight: Daily weight monitoring can help detect early signs of fluid accumulation.
• Manage underlying conditions: Follow treatment plans for any coexisting health issues that may contribute to ascites.

By incorporating these strategies into their daily routine, patients with ascites can potentially improve their symptoms and overall quality of life.

Potential Complications of Untreated Ascites

When left untreated or poorly managed, ascites can lead to various complications that may significantly impact a patient’s health and well-being. Understanding these potential risks emphasizes the importance of proper ascites management and regular medical follow-up.

What complications can arise from untreated ascites?

Patients with uncontrolled ascites may face the following complications:

• Spontaneous bacterial peritonitis (SBP): This is a serious infection of the ascitic fluid that can lead to sepsis and organ failure if not promptly treated.
• Hepatorenal syndrome: A severe form of kidney failure that can occur in patients with advanced liver disease and ascites.
• Hepatic hydrothorax: Accumulation of ascitic fluid in the chest cavity, causing breathing difficulties.
• Umbilical or inguinal hernias: Increased abdominal pressure can lead to the development of hernias.
• Malnutrition: Ascites can impair nutrient absorption and reduce appetite, leading to nutritional deficiencies.
• Decreased quality of life: Persistent ascites can significantly impact a patient’s mobility, comfort, and overall well-being.

Regular medical monitoring and adherence to treatment plans are essential for preventing or minimizing these potential complications.

Preventing Ascites: Risk Reduction and Healthy Lifestyle Choices

While not all cases of ascites can be prevented, adopting certain lifestyle habits and making informed health choices can significantly reduce the risk of developing conditions that lead to ascites. Prevention strategies primarily focus on maintaining liver health and avoiding known risk factors for liver disease.

How can individuals reduce their risk of developing ascites?

Consider implementing the following preventive measures:

• Limit alcohol consumption: Excessive alcohol intake is a leading cause of liver cirrhosis, which often leads to ascites.
• Maintain a healthy weight: Obesity increases the risk of non-alcoholic fatty liver disease, a potential precursor to cirrhosis.
• Practice safe behaviors: Avoid sharing needles and practice safe sex to reduce the risk of hepatitis B and C infections.
• Manage chronic conditions: Properly control conditions like diabetes and high blood pressure, which can impact liver health.
• Avoid toxins: Limit exposure to environmental toxins and follow safety guidelines when working with potentially harmful substances.
• Eat a balanced diet: Consume a diet rich in fruits, vegetables, whole grains, and lean proteins to support overall health and liver function.
• Stay hydrated: Drink adequate water to support proper bodily functions and help flush toxins from the system.

By incorporating these preventive strategies into their lifestyle, individuals can take proactive steps towards maintaining liver health and reducing their risk of developing ascites.

Living with Ascites: Coping Strategies and Support Resources

Dealing with ascites can be challenging, both physically and emotionally. Patients often face significant lifestyle adjustments and may experience anxiety or depression related to their condition. Developing effective coping strategies and seeking appropriate support can greatly improve the quality of life for individuals living with ascites.

What resources are available for patients coping with ascites?

Patients and their caregivers can benefit from the following support resources and coping strategies:

• Support groups: Joining support groups for individuals with liver disease or ascites can provide emotional support and practical advice.
• Patient education programs: Many hospitals and healthcare organizations offer educational programs to help patients better understand and manage their condition.
• Psychological counseling: Professional mental health support can help patients cope with the emotional challenges of living with a chronic condition.
• Nutritional counseling: Working with a registered dietitian can help patients develop appropriate meal plans and navigate dietary restrictions.
• Occupational therapy: Occupational therapists can provide strategies for managing daily activities and maintaining independence.
• Pain management services: For patients experiencing discomfort, pain management specialists can offer various treatment options.
• Online resources: Reputable websites and forums can provide valuable information and connect patients with others sharing similar experiences.

By utilizing these resources and developing a strong support network, patients with ascites can better navigate the challenges of their condition and maintain a positive outlook on life.

Ascites | Johns Hopkins Medicine

Ascites | Johns Hopkins Medicine

What is ascites?

Ascites is a condition in which fluid collects in spaces within your abdomen. If severe, ascites 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 occur 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?

These are symptoms of ascites:

• Swelling in the abdomen
• 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 abdomen 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 a magnetic field and radiofrequency energy. A CT scan creates computerized images using X-rays.

How is ascites treated?

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

• Cut back on your salt intake. Your healthcare provider or a dietitian can show you how to follow a low-sodium diet. Avoid salt substitutes that contain potassium. This is because some medicines used in treating ascites can cause your potassium levels to rise.
• Cut back on the amount of fluids you drink.
• 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 complicated situations, you may need to have a special procedure in radiology called TIPS. In this procedure, a connection is made inside the liver between the blood vessels to ease the high pressure causing ascites.

What are the 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.

Can ascites be prevented?

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

• Stop drinking alcohol.
• Maintain a healthy weight.
• Exercise regularly.
• Stop smoking.
• Limit salt in your diet.
• Practice safe sex to decrease your chance of getting hepatitis.
• Do not use recreational drugs to decrease your chance of getting hepatitis.

Living with ascites

Be sure to follow your healthcare provider’s advice for lowering your salt intake. You’ll need to do this even if you’re taking diuretic drugs to reduce fluid in your body. Also, weigh yourself daily and call your healthcare provider if you gain too much weight.

Key points

• Ascites is a condition in which fluid collects in spaces within your abdomen.
• As fluid collects in the abdomen, it can affect your lungs, kidneys, and other organs.
• Ascites causes abdominal pain, swelling, nausea, vomiting, and other difficulties.
• Stopping all alcohol intake, maintaining a healthy weight, exercising, not smoking, and limiting salt intake can help prevent cirrhosis or cancer that may lead to ascites.
• 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:

• 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 names of new medicines, treatments, or tests, and any new instructions your provider gives you.
• 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.

Related

• 
  
  Liver, Gallbladder and Pancreas

  Liver Health: Infographic

  
  

• 
  
  Chronic Liver Disease

  5 Reasons You May Be at Risk for Liver Disease

  
  

• 
  
  Non-alcoholic Fatty Liver Disease

  Detoxing Your Liver: Fact Versus Fiction

  
  

Related Topics

What is ascites (fluid in the abdomen)? | Coping physically

The medical name for a build up of fluid in the abdomen is ascites (pronounced ay-site-eez). It can also be called malignant ascites.

The tummy (abdomen) contains many organs, including the stomach, bowels, pancreas, liver, spleen and kidneys. There is a sheet of tissue (peritoneum) around these organs. It is made up of 2 layers. One layer lines the wall of the abdomen. The other covers the organs.

The layers produce a small amount of fluid so that the organs in the abdomen can move smoothly. Sometimes fluid builds up between the 2 layers, which makes the abdomen swell. This can be very uncomfortable.

This fluid build up is called ascites.

The causes of ascites

Cancers that can cause ascites include:

• ovarian cancer
• breast cancer
• bowel cancer
• stomach cancer
• pancreatic cancer
• mesothelioma in the peritoneum
• lung cancer
• liver cancer
• womb cancer

Fluid can build up when:

• cancer cells irritate the lining of the abdomen and make it produce too much fluid
• lymph glands in the abdomen get blocked and can’t drain fluid properly
• cancer has spread to the liver and raises the pressure in nearby blood vessels, which forces fluid out
• the liver can’t make enough blood proteins so fluid leaks out of veins into the abdominal cavity

Other conditions that can cause fluid in the abdomen include:

• liver disease
• heart disease

What are the symptoms of ascites?

The fluid causes swelling that can make the tummy feel tight and very uncomfortable. It often develops over a few weeks but might happen over a few days.

The fluid causes pressure on other organs in the abdominal area and may lead to:

• clothes feeling tighter or needing a bigger belt size
• bloating
• abdominal pain
• back pain
• difficulty sitting comfortably and moving around
• loss of appetite
• indigestion
• constipation
• needing to pass urine often
• breathlessness
• tiredness and weakness (fatigue)
• feeling or being sick

Tests

You might have tests to find the cause of the swelling.

Your doctor examines you and asks about your symptoms. They may also ask you to have:

• an ultrasound scan
• blood tests to check your general health and how well your liver and kidneys are working
• a CT scan
• a sample of the fluid taken from your abdomen to check for cancer cells or infection

Your doctor puts local anaesthetic on the skin to numb the area. Then they put a needle into your abdomen to take a sample of fluid. They use an ultrasound scan to guide them. This can be uncomfortable but isn’t usually painful.

They use a syringe to draw out some fluid to send to the laboratory. In the lab, they examine it under a microscope to look for cancer cells.

• Cancer Priniciples & Practice of Oncology (11th edition)
  VT DeVita and others
  Lippincott, Williams and Wilkins 2018

• Cancer and its Management (7th edition)
  J Tobias and D Hochhauser 
  Wiley-Blackwell 2014

• Diagnosis and treatment of ascites
  EA Tsochatzis and AL Gerbes
  Journal of Hepatology, 2017, Volume 67, Issue 1, Pages 184–185

Last reviewed: 

26 Apr 2021

Next review due: 

26 Apr 2024

Print page

Ascites: diagnosis and treatment

Ascites is an abnormal accumulation of fluid in the abdominal cavity. Among patients with ascites, the majority suffer from cirrhosis and portal hypertension. Ascites associated with malignant neoplasms is much less common: in about 7% of patients. Some patients have two causes of ascites at once – for example, cirrhosis and peritoneal carcinomatosis (multiple metastases in the peritoneum).

Why does ascites develop?

Ascites associated with malignancy can be seen in many tumors, including malignancies of the ovary, breast, colon, lung, pancreas, and liver. Lymphoma can also be complicated by ascites.

Ascites usually develops in the setting of recurrent or advanced cancer. Before ascites develops, patients may have peritoneal or hepatic metastases, enlarged intra-abdominal lymph nodes, or large tumor volume

The origin of the primary tumor influences the development of ascites.

• Malignant tumors of the ovary and bladder, as well as peritoneal mesothelioma, usually cause peritoneal carcinomatosis. In such cases, fluid accumulation is the result of blockage of draining lymphatic channels and increased vascular permeability.

• Cancer of the colon, stomach, breast, pancreas, and lung can cause peritoneal carcinomatosis and/or massive liver metastases, resulting in ascites, either due to fluid-producing tumor cells in the abdomen due to obstruction/compression of the portal veins leading to portal hypertension, or liver failure.

• Lymphomas may cause lymph node obstruction with accumulation of ascites, or symptomatic serous effusions.

Ascites in liver tumors

Ascites in patients with liver disease is usually due to hepatocellular carcinoma rather than liver metastases. The development of ascites may be the first sign of primary hepatocellular carcinoma of the liver.

The four most common ascites associated with hepatocellular carcinoma of the liver:

• in patients with chronic hepatitis B acquired in infancy or childhood,

• in patients with non-alcoholic fatty liver disease,

• in patients with chronic hepatitis C,

• in patients with alcoholic cirrhosis.

Under these conditions, ascites often develops when the volume of the tumor increases to such an extent that it replaces a critical part of the functional mass of the liver or leads to thrombosis of the portal vein.

Symptoms of ascites

Patients often seek medical attention because of abdominal pain, shortness of breath or early satiety, often swelling of the legs develops. Abdominal pain can be caused by a combination of factors, including nerve invasion by the tumor, distension of the liver capsule, or, in patients with large ascites, distension of the abdominal wall. Since ascites usually develops in the setting of a large tumor mass, patients usually lose weight before ascites develops (despite the added weight from the ascitic fluid itself).

Diagnosis of ascites

Diagnosis of ascites associated with malignancy is based on clinical presentation, imaging, puncture, and analysis of ascitic fluid.

Established cancer patients who develop ascites often do not require extensive evaluation. Since the development of ascites associated with malignancy is a poor prognostic sign, the diagnostic approach should focus on the rapid assessment and evacuation of ascites, with treatment aimed at improving the patient’s quality of life. On the other hand, the presence of ascites in a woman with epithelial ovarian cancer is not necessarily associated with a very poor prognosis.

Physical examination provides a rough estimate of the level of ascites accumulation. Patients with suspected malignant ascites should be examined to confirm the presence of ascites. The examination begins with an ultrasound of the abdominal organs, if necessary, a CT or MRI examination of the abdominal organs is connected.

Laparocentesis (puncture of the peritoneal wall) with the appropriate analysis of ascitic fluid is the most effective way to confirm the presence of ascites, diagnose its cause and determine if the fluid is infected and contains malignant cells.

Treatment of ascites

The main treatment for peritoneal carcinomatosis is therapeutic laparocentesis (evacuation of fluid from the abdominal cavity). The exception is ascites in ovarian cancer. For patients who cannot tolerate repetitive laparocentesis, peritoneal ports and catheters may be recommended. Patients with portal hypertension (those with massive liver metastases, cirrhosis with hepatocellular carcinoma, or malignant Budd-Chiari syndrome) may be given diuretics (drugs that increase urine output).

In patients with ascites from ovarian cancer, treatment options include cytoreductive surgery (removal of as much of the tumor and metastases as possible) and chemotherapy.

EMC Institute of Oncology, Moscow, st. Shchepkin, provides comprehensive care to patients with ascites according to modern international standards. Ascites can be evacuated both in a hospital and on an outpatient basis. Sometimes, in difficult cases, with poor tolerance of manipulation or at will, the patient can be hospitalized.

Hospitalization in EMC can be emergency – 24 hours a day, surgeons on duty are ready to assist in the evacuation of ascites.

causes and diagnosis, pelvic ultrasound

Sometimes, after an ultrasound examination, the doctor makes a note that the patient has fluid in the pelvis. In some cases, the presence of free fluid does not indicate any disease. This may indicate that the woman has ended ovulation, and after a while there will be no more fluid.

Unfortunately, more often the fluid in the pelvis indicates the development of pathology in the female genital organs. You can determine the disease after the procedure of ultrasound examination. The patient may feel some symptoms indicating the onset of the development of the disease. This is an increased body temperature, pulling or sharp pains in the lower abdomen, menstrual cycle failure.

Causes of fluid in the pelvis

Fluid accumulates in the pelvic region from the organ in which the pathology develops and the inflammatory process begins. Also, fluid may appear after an abortion. To find the cause of the disease, it is necessary to undergo an ultrasound of the pelvis. What diseases can be indicated by the presence of fluid in the pelvis.

• Endometriosis.

• Infectious disease leading to inflammation of the ovaries or uterus.

• Ascites. This is the accumulation of fluid caused by a malignant tumor.

• Ectopic pregnancy.

• Internal bleeding in the abdomen.

• Benign formation on the internal genital organs.

Before starting treatment, it is necessary to identify the affected organ and the cause of the inflammatory process. Only after an accurate diagnosis is made can treatment begin.

Treatment

After diagnosing fluid in the pelvis and identifying the affected organ, it is necessary to prescribe an effective treatment. It will be individual for each patient. As a rule, they begin with drug therapy. Most often prescribed:

• Antibiotics. They are used when there is an infection in the body. Thanks to them, the inflammatory process passes, which often causes the appearance of fluid in the pelvic area.

• Painkillers and anti-inflammatory drugs. Relieve inflammation and pain.

• Hormonal preparations. They are prescribed for violation of the menstrual cycle, as well as for diseases of the ovaries.

• Enzymes. Help fight inflammation.

• Vitamin complexes. Strengthen the immune system and the overall resistance of the body to infections.

All drugs should be taken strictly according to the doctor’s prescription, based on the diagnosis and taking into account contraindications, individual intolerance.

Prevention of fluid accumulation in the pelvis

Fluid in the small pelvis accumulates due to a disease of the internal organs of the small pelvis. Therefore, in order to avoid problems with the health of female internal genital organs, it is necessary to take preventive measures.

The main thing that women need to do is to lead a healthy lifestyle. Do not drink alcohol and do not smoke, these addictions adversely affect women’s health.