What is ascites and how does it affect the body. What are the common causes of ascites and who is at risk. How is ascites diagnosed and what treatment options are available. What lifestyle changes can help prevent or manage ascites. How does ascites impact quality of life and what complications can arise.

What is Ascites and How Does it Affect the Body?

Ascites is a medical condition characterized by the accumulation of fluid in the abdominal cavity. This buildup of fluid can lead to a range of uncomfortable symptoms and potentially serious complications. But what exactly causes this condition, and how does it impact the body?

The fluid accumulation in ascites typically occurs in the peritoneal space, which is the area between the abdominal wall and the organs within the abdomen. As this space fills with fluid, it can cause:

• Abdominal swelling and distension
• Increased pressure on internal organs
• Difficulty breathing due to pressure on the diaphragm
• Discomfort and pain in the abdominal area

In severe cases, ascites can lead to complications such as:

• Bacterial infections in the abdominal cavity
• Hernias due to increased abdominal pressure
• Kidney dysfunction
• Pleural effusion (fluid around the lungs)

Common Causes of Ascites: From Liver Disease to Cancer

While there are several potential causes of ascites, some are more common than others. What are the primary culprits behind this condition?

Liver Cirrhosis: The Leading Cause

Cirrhosis of the liver is the most frequent cause of ascites, accounting for approximately 75% of cases. This chronic liver disease results in scarring of the liver tissue, which can lead to portal hypertension – increased pressure in the portal vein that carries blood from the digestive organs to the liver. This pressure causes fluid to leak into the abdominal cavity.

Other Common Causes

While cirrhosis is the primary cause, other conditions can also result in ascites:

• Cancer: Various types of cancer, particularly those affecting the abdominal organs, can cause ascites.
• Heart failure: When the heart cannot pump blood effectively, fluid can build up in the body, including the abdomen.
• Kidney disease: Certain kidney conditions can disrupt the body’s fluid balance, leading to ascites.
• Pancreatic disorders: Diseases of the pancreas can sometimes result in fluid accumulation in the abdomen.
• Tuberculosis: In rare cases, tuberculosis infection can cause ascites.

Recognizing the Symptoms: When to Suspect Ascites

Identifying ascites early can lead to more effective treatment and management. What signs and symptoms should you be aware of?

The most common symptoms of ascites include:

• Abdominal swelling or distension
• Weight gain, often rapid and unexplained
• Feeling of fullness or bloating
• Nausea or indigestion
• Shortness of breath, especially when lying down
• Swelling in the lower legs (edema)
• Decreased appetite
• Fatigue

It’s important to note that the severity of symptoms can vary greatly depending on the amount of fluid accumulation and the underlying cause. In some cases, mild ascites may not cause noticeable symptoms, while severe cases can lead to significant discomfort and complications.

Diagnosing Ascites: From Physical Exams to Advanced Imaging

Accurate diagnosis of ascites is crucial for determining the appropriate treatment plan. How do healthcare providers diagnose this condition?

Physical Examination

The initial step in diagnosing ascites often involves a thorough physical examination. During this exam, the healthcare provider may:

• Observe the abdomen for visible swelling or distension
• Perform percussion (tapping) of the abdomen to detect fluid
• Check for shifting dullness, a sign that indicates the presence of free fluid in the abdomen

Diagnostic Tests

To confirm the diagnosis and determine the underlying cause, several tests may be ordered:

1. Ultrasound: This non-invasive imaging technique can detect even small amounts of fluid in the abdomen.
2. CT scan or MRI: These advanced imaging methods provide detailed pictures of the abdominal organs and can help identify the cause of ascites.
3. Paracentesis: In this procedure, a small amount of fluid is removed from the abdomen using a needle. The fluid is then analyzed to determine its composition and check for signs of infection or cancer.
4. Blood tests: These can help assess liver and kidney function, as well as check for signs of infection or cancer.

Treatment Options for Ascites: Managing Symptoms and Addressing Underlying Causes

The treatment of ascites typically involves a multi-faceted approach aimed at reducing fluid buildup and addressing the underlying cause. What are the primary treatment strategies for managing ascites?

Dietary and Lifestyle Changes

Often, the first line of treatment involves modifications to diet and lifestyle:

• Sodium restriction: Limiting salt intake can help reduce fluid retention.
• Fluid restriction: In some cases, limiting fluid intake may be necessary.
• Alcohol cessation: For those with liver disease, stopping alcohol consumption is crucial.
• Weight management: Maintaining a healthy weight can help reduce pressure on the abdominal organs.

Medications

Several types of medications may be prescribed to manage ascites:

• Diuretics: These medications, often referred to as “water pills,” help the body eliminate excess fluid through increased urine production.
• Albumin: In some cases, intravenous albumin may be administered to help maintain fluid balance in the body.
• Antibiotics: If infection is present or suspected, antibiotics may be prescribed.

Procedures

In cases where dietary changes and medications are not sufficient, more invasive procedures may be necessary:

• Large volume paracentesis: This procedure involves removing large amounts of fluid from the abdomen using a needle.
• Transjugular intrahepatic portosystemic shunt (TIPS): This procedure creates a new route for blood to flow through the liver, reducing pressure in the portal vein.
• Liver transplantation: In severe cases of liver disease, a liver transplant may be the most effective long-term solution.

Preventing Ascites: Lifestyle Choices That Make a Difference

While not all cases of ascites can be prevented, certain lifestyle choices can significantly reduce the risk of developing conditions that lead to ascites. What steps can individuals take to lower their risk?

Liver Health

Since liver disease is the most common cause of ascites, maintaining liver health is crucial:

• Limit alcohol consumption: Excessive alcohol use is a leading cause of liver cirrhosis.
• Maintain a healthy weight: Obesity can lead to non-alcoholic fatty liver disease, which can progress to cirrhosis.
• Practice safe behaviors: Avoid sharing needles and practice safe sex to reduce the risk of hepatitis B and C, which can cause liver damage.

General Health Practices

Other lifestyle choices that can help prevent ascites include:

• Regular exercise: Physical activity helps maintain a healthy weight and promotes overall health.
• Balanced diet: A diet rich in fruits, vegetables, and whole grains supports liver health and overall well-being.
• Stress management: Chronic stress can negatively impact health, so finding effective ways to manage stress is important.
• Regular check-ups: Routine medical check-ups can help detect and address potential health issues early.

Living with Ascites: Management Strategies for Daily Life

For individuals diagnosed with ascites, managing the condition becomes an important part of daily life. What strategies can help improve quality of life while living with ascites?

Dietary Management

Careful attention to diet is crucial:

• Follow a low-sodium diet: Work with a dietitian to create a meal plan that limits sodium intake.
• Stay hydrated: While fluid restriction may be necessary in some cases, it’s important to maintain proper hydration under medical guidance.
• Eat small, frequent meals: This can help alleviate feelings of fullness and improve nutrient intake.

Monitoring and Self-Care

Regular monitoring and self-care practices are essential:

• Daily weight checks: Sudden weight gain can indicate fluid accumulation.
• Skin care: Keep the abdominal skin clean and dry to prevent infections.
• Activity modification: Gentle exercise, as approved by a healthcare provider, can help maintain muscle strength and overall health.
• Stress reduction: Practices such as meditation or yoga can help manage stress and improve overall well-being.

Medical Management

Staying engaged with medical care is crucial:

• Regular check-ups: Attend all scheduled appointments with healthcare providers.
• Medication adherence: Take all prescribed medications as directed.
• Symptom reporting: Promptly report any new or worsening symptoms to the healthcare team.

Complications of Ascites: Understanding the Risks

While ascites itself can be challenging to manage, it can also lead to several complications. What are the potential risks associated with ascites?

Spontaneous Bacterial Peritonitis (SBP)

One of the most serious complications of ascites is spontaneous bacterial peritonitis, an infection of the ascitic fluid. SBP can occur without an obvious source of infection and can be life-threatening if not promptly treated. Symptoms of SBP may include:

• Fever and chills
• Abdominal pain or tenderness
• Confusion or changes in mental status
• Nausea and vomiting

Hepatorenal Syndrome

Hepatorenal syndrome is a severe complication that can occur in patients with advanced liver disease and ascites. It involves progressive kidney failure and is associated with a poor prognosis if not addressed quickly.

Hepatic Hydrothorax

In some cases, the ascitic fluid can move into the chest cavity, causing a condition called hepatic hydrothorax. This can lead to breathing difficulties and may require additional treatment.

Malnutrition

The presence of ascites can lead to decreased appetite and difficulty eating, which may result in malnutrition. This can further complicate the management of the underlying condition and impact overall health.

Hernias

The increased abdominal pressure from ascites can lead to the development of hernias, particularly umbilical (belly button) or inguinal (groin) hernias.

Understanding these potential complications underscores the importance of proper management and regular medical follow-up for individuals with ascites. Early detection and treatment of complications can significantly improve outcomes and quality of 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.

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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

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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.