Ascites

Overview

Ascites is a buildup of extra fluid in the space inside the belly (abdomen). It causes the belly to swell and feel tight.

Ascites is fairly common in people with advanced liver disease. It can also happen with certain cancers, heart failure, or kidney problems.

It most often affects adults with long-term liver conditions, such as cirrhosis from heavy alcohol use or hepatitis. It can also occur in people with heart failure or certain cancers (like ovarian or pancreatic cancer).

Symptoms

Common symptoms

• Swollen belly that grows larger over days or weeks
• Rapid weight gain (from fluid, not fat)
• Feeling of fullness or pressure in the belly
• Shortness of breath (because fluid pushes against the lungs)
• Nausea, vomiting, or loss of appetite

Symptoms in children

• Ascites in children is rare. When it happens, it shows as a swollen belly and rapid weight gain, often linked to liver, heart, or kidney problems.

Symptoms in older adults

• Older adults may notice the same symptoms but can also have trouble breathing more easily because their lungs are less stretchy.

Causes

Main causes

• Liver cirrhosis (scarring of the liver from alcohol, hepatitis, or fatty liver disease) – the most common cause
• Cancer that spreads to the belly (especially ovarian, liver, pancreatic, or stomach cancer)
• Heart failure (the heart doesn't pump well, leading to fluid buildup)
• Kidney failure
• Infection (like tuberculosis) or inflammation of the pancreas

Risk factors

• Heavy or long-term alcohol use
• Hepatitis B or C infection
• Obesity and fatty liver disease
• Family history of liver disease
• Congestive heart failure

When to see a doctor

See a doctor urgently if:

• If you have sudden severe belly pain, trouble breathing, fever, or confusion – call emergency services immediately.

Book a routine appointment if:

• If you notice gradual belly swelling or unexplained weight gain, make an appointment to see your doctor within a week.

Diagnosis

Your doctor will start with a physical exam – pressing on your belly to feel for fluid. They may also tap on it to check for dull sounds that mean fluid is present. Then they'll usually recommend imaging tests to confirm and measure the fluid.

Tests that may be done

• Abdominal ultrasound (uses sound waves to see the fluid and look at your liver and other organs)
• Blood tests to check liver and kidney function
• Paracentesis (a small sample of fluid taken from the belly with a thin needle to test for infection or cancer)
• CT scan (if more detail is needed)

What to expect at your appointment

The process is generally straightforward. The doctor will explain each test. A paracentesis takes only a few minutes and is usually done with local numbing medicine so you feel little discomfort. You can go home the same day.

Treatment

Treatment for ascites aims to reduce the fluid and treat the underlying condition. The approach depends on how much fluid there is and what's causing it.

Self-care at home

• Follow a low-salt (sodium) diet – less than 2,000 mg per day – to help your body hold less fluid.
• Limit or avoid alcohol entirely, as it worsens liver damage.
• Weigh yourself daily to track fluid changes – tell your doctor if you gain 2 pounds or more in a day.
• Get plenty of rest and avoid heavy lifting.

Medical treatments

Doctors may prescribe diuretics (medicines that help your kidneys remove extra salt and water) and recommend a procedure called paracentesis to drain fluid when it causes discomfort. For people with severe liver disease, a liver transplant might be considered. Treatment also focuses on the underlying cause, such as managing heart failure or treating cancer.

When is surgery considered?

Surgery is rarely the first treatment. In some cases, a procedure called TIPS (transjugular intrahepatic portosystemic shunt) can be done to relieve pressure in the liver and reduce fluid. Liver transplant is an option if the liver is severely damaged.

Living with this condition

Living with ascites means paying close attention to your body. Weigh yourself each morning and note any sudden changes. Watch for signs of infection like fever or belly pain. Work with your healthcare team to manage your diet and medications.

Lifestyle tips

• Avoid alcohol completely.
• Limit salt: don't add salt to food and eat fewer processed foods.
• Stay active within your energy limits – gentle walking is good.
• Keep all medical appointments for blood tests and check-ups.

Diet and exercise

Eat a low-sodium diet with fresh fruits, vegetables, lean proteins, and whole grains. Avoid canned soups, salty snacks, and fast food. Gentle exercise like walking or stretching can help maintain muscle and circulation. Ask your doctor what level of activity is safe for you.

Mental health and emotional wellbeing

Dealing with a chronic condition like ascites can be stressful and affect your mood. It's normal to feel anxious or sad. Talk to your doctor about these feelings – they can connect you with counselling or support groups. Remember that you are not alone.

Prevention

You can lower your risk of ascites by preventing the conditions that cause it. For liver disease, this means limiting alcohol, maintaining a healthy weight, and getting vaccinated against hepatitis B. If you already have liver or heart problems, careful management can reduce the chance of fluid buildup.

Vaccines

Hepatitis B vaccine is recommended for everyone. Also ask your doctor about the hepatitis A vaccine and annual flu shot to protect your liver.

Screening programmes

If you are at high risk for liver disease (for example, heavy alcohol use or family history), your doctor may recommend regular blood tests and ultrasound screening to catch problems early.

Complications

If left untreated

• Spontaneous bacterial peritonitis (a serious infection of the belly fluid) – symptoms: fever, belly pain, confusion
• Hepatic encephalopathy (toxic substances build up because the liver can't filter them) – symptoms: confusion, drowsiness, coma
• Kidney failure (hepatorenal syndrome) – the kidneys stop working well
• Breathing trouble from fluid pressing on the lungs
• Malnutrition and muscle wasting

Long-term outlook

With proper treatment, many people with ascites feel better and can avoid serious complications. The outlook depends on the underlying cause – for example, people with cirrhosis may need ongoing care, but ascites can often be controlled. If a liver transplant is an option, long-term outcomes are good. Your healthcare team will help you manage the condition and maintain the best possible quality of life.

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