What Is Ascites?
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Medically reviewed by Kashif J. Piracha, MD
Ascites is the buildup of fluid in the abdominal cavity, which often develops as a complication of liver disease. However, other conditions like pancreatic disease, malnutrition, certain cancers, heart failure, obesity, and substance use disorder can also cause symptoms.
The most common sign of ascites is abdominal swelling. Other symptoms include nausea, fever, swelling of the ankles, and shortness of breath. If you're experiencing symptoms, see your provider for a diagnosis and treatment. Treatment can be a little complex but focuses on reducing fluid retention and improving your overall quality of life.
Ascites Symptoms
The most common symptom of ascites is abnormal swelling of the abdomen due to excessive fluid build-up or retention. Other common symptoms include:
Abdominal pain and discomfort
Swelling in the ankles
Nausea
Limited ability to eat
Causes
Cirrhosis (liver scarring and damage) is the most common cause of ascites, accounting for about 80% of all cases. Other conditions can also lead to the development of ascites, including:
Obesity: Obesity is sharply rising globally and is closely associated with liver disease. Per a 2018 study, about 43% of people with obesity developed ascites as compared to 14% of people without obesity.
Type 2 diabetes: About 30% of people with cirrhosis also have a diagnosis of type 2 diabetes.
Severe malnutrition: Malnutrition often occurs alongside liver cirrhosis. Malnutrition accounts for about 5% to 10% of ascites cases.
Pancreatic disease: Although rare, pancreatic disease can lead to ascites due to leakage of pancreatic secretions into the peritoneum (the membrane that lines the abdominal cavity).
Tuberculosis: Peritoneal tuberculosis (a subtype of tuberculosis) can cause ascites to develop in about 2% of people with the condition.
Nephrotic syndrome: This condition is a group of symptoms that suggests your kidneys are not working properly. Your kidneys filter out excess fluid, waste, and toxins. If your kidneys don't function as they're supposed to, ascites can develop.
Alcohol use: Drinking excess alcohol or having substance use disorder can often lead to liver damage, which can increase your risk of ascites.
Heart failure: Heart failure can affect proper blood flow into the heart, which can increase volume and pressure in the veins. As a result, fluid can leak into the abdominal cavity and cause ascites.
Cancer: Liver, pancreatic, ovarian, and colon cancers can cause ascites if cancer cells spread to the abdominal lining or liver.
Diagnosis
If you're experiencing ascites or have a history of liver disease, your healthcare provider will want to test you to learn more about your symptoms. During your appointment, your provider will ask about your medical history and perform a physical exam. They'll likely also order other tests to confirm a diagnosis, which may include:
Blood test: Includes a complete blood cell count (CBC), liver function tests, and total protein tests to determine the signs of infection, liver functioning status, and indicators of any underlying conditions that may lead to ascites
Ultrasound: Uses high-energy ultrasound waves to create images of the insides of your abdomen, which can detect ascites by checking for fluid buildup in the abdominal cavity
Computed tomography (CT) scan: Utilizes X-rays and a computer to create images of the inside of your body to check for fluid buildup in the abdomen and the presence of any tumors
Paracentesis: Involves inserting a small needle through the abdominal wall to remove ascitic fluid to determine what's causing the fluid buildup
Ascites Treatment
Knowing the underlying cause of your condition can help your healthcare team understand what treatment options are best for you. The goal of treatment is to reduce fluid buildup. Some common treatments for ascites include:
Reducing sodium intake: Your healthcare provider may recommend restricting sodium intake to 2000 milligrams (mg) or less per day. This means having a diet with no added salt and avoiding pre-prepared meals.
Taking diuretics: Diuretics (also known as water pills) can help remove excess fluid from your body. Two common diuretics that can help with ascites are Lasix (furosemide) and Aldactone (spironolactone).
Undergoing therapeutic paracentesis: This procedure involves removing five liters or more of abdominal fluid. Healthcare providers recommend therapeutic paracentesis to people who do not respond to diuretics or sodium restriction alone.
Getting a transjugular intrahepatic portosystemic stent‐shunt (TIPS): In this procedure, a radiologist (a doctor who specializes in diagnosing and treating conditions using imaging technology) places a shunt in your abdomen to prevent fluid accumulation.
Prevention
Fortunately, you can use strategies to reduce your chances of developing ascites. Consider the following:
Eat a low-salt diet
Avoid or quit alcohol
Maintain a weight that's right for you
Get regular exercise or physical activity
Check with your healthcare provider periodically if you live with a condition that can increase your risk of developing ascites
Complications
Unfortunately, ascites can cause some complications—especially if you don't receive treatment. These complications include:
Spontaneous bacterial peritonitis: A bacterial infection of the ascitic fluid
Hepatorenal syndrome: Progressive kidney failure that occurs in people who have ascites due to liver disease
Pleural effusion: Buildup of fluid between the layers of tissue that line the lungs and chest cavity
Hernia: An outward bulge that occurs around the belly button
Living With Ascites
The outlook of ascites depends on the underlying medical condition causing your symptoms. If left untreated, ascites can lead to some life-threatening complications. That's why getting treatment to reduce abdominal swelling and fluid buildup is so important.
For most people, diuretics, paracentesis, or TIPS can improve the condition and overall quality of life. In very serious cases, you may need a liver transplant to improve your overall liver health and reduce symptoms.
Frequently Asked Questions
What is the life expectancy of a person with ascites?
The life expectancy of 50% of people who have cirrhosis and live with ascites is about two years.
Does ascites mean your liver is failing?
In most cases, ascites means that your liver is not functioning properly and if not treated promptly, the condition may cause liver failure. However, other underlying conditions like pancreatic disease and certain cancers can also cause ascites.
If you're experiencing symptoms, getting a diagnosis to understand the underlying cause is essential.
Does drinking water help ascites?
Research suggests that drinking water does not play a significant role in improving ascites. Instead, following a low-salt diet and avoiding alcohol can reduce symptoms.
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