Understanding the Basics of Ascites

Ascites is the abnormal or extra accumulation of peritoneal fluid in the abdomen (belly). While ascites is most commonly caused by cirrhosis, it can also be caused by heart failure, pancreatitis, infection, cancer, and more.

Healthcare providers use a variety of blood tests, imaging procedures, and paracentesis to diagnose ascites. Treatment focuses on treating the underlying cause, if possible, and relieving symptoms.

This article reviews the symptoms, causes, diagnosis, and treatment of ascites.

Causes

Benign (noncancerous) conditions can cause ascites. Liver failure or cirrhosis are the most common causes. Cirrhosis is scarring of the liver that occurs when a disease attacks and damages the liver.

While this is not an exhaustive list, diseases that can cause liver damage and lead to cirrhosis include:

• Liver disease
• Chronic hepatitis B or C
• Alcoholism or heavy alcohol use
• Kidney failure
• Portal hypertension
  
• Heart failure
• Infection
• Pancreatitis (inflammation of the pancreas)

Most cirrhosis is caused by heavy alcohol consumption or chronic hepatitis C.

In about 10% of cases, ascites is caused by cancer. Types of cancer that cause ascites include:

• Ovarian
• Colon
• Pancreatic
• Uterine
• Liver

Cancers that may spread to the abdomen (belly) and cause ascites include:

• Lymphoma
• Lung
• Breast cancer
  

Symptoms

While mild ascites may cause no symptoms, more advanced ascites can become uncomfortable, creating a bloated or swollen appearance to the abdomen. Common symptoms of more advanced ascites include:

• Nausea
• Vomiting
• Loss of appetite
• Feeling full when eating
• Ankle swelling
• Shortness of breath because the pressure of the fluid compresses the diaphragm
• Fever or abdominal pain (may indicate the fluid is infected)

Diagnosis

To diagnose ascites, your healthcare provider may perform the following tests:

• Blood tests
• Ultrasound (usually the first imaging test)
• Computed tomography (CT)
• Magnetic resonance imaging (MRI)
• Paracentesis

Treatment

The treatment of ascites depends on the cause. It also depends on the severity and is geared towards alleviating a person's symptoms and making them more comfortable. Therapies include:

• Salt-restricted diets
• Diuretics (water pill)
• Therapeutic paracentesis
• Chemotherapy (for some types of cancer, if ascites is caused by cancer)
• Peritoneovenous shunt (rare)
• Liver transplant (rare)

If someone is experiencing refractory ascites, meaning it cannot be controlled well with traditional therapies, a peritoneovenous shunt may be placed surgically to drain fluid out of the abdomen.

This procedure comes with a higher risk and is not commonly performed. However, it can drastically improve the quality of life for those waiting for a liver transplant.

In the case of malignant ascites, a healthcare provider may consider cytoreductive surgery and chemotherapy administered directly into the abdomen called direct intraperitoneal chemotherapy. This is only considered for certain patients and requires a careful discussion with a healthcare provider to weigh the potential risks and benefits.

Summary

Ascites is the accumulation of fluid in the abdomen. The most common cause is liver damage or cirrhosis, but it can also be caused by heart failure, pancreatitis, infection, cancer, and more.

Symptoms include nausea, vomiting, feeling full when eating, loss of appetite, and shortness of breath. You could also experience fever or abdominal pain if an infection occurs in the fluid. 

Various imaging procedures and possibly a paracentesis (draining fluid with a small needle) are used to diagnose ascites. 

Treatment depends on the cause and may include restricting salt in your diet, diuretics (water pills), and therapeutic paracentesis. Cancer treatment such as chemotherapy or surgery may be needed if the underlying cause is malignant (cancerous). A peritoneovenous shunt and a liver transplant are other treatment possibilities. However, they are rare and only used when other treatments have stopped working.

A Word From Verywell

The symptoms from ascites can be distressing and uncomfortable. They can interfere with work, school, relationships, exercise, and other activities of daily living. Ascites can be caused by some serious conditions, so it's best to talk with your healthcare provider if you are experiencing symptoms.