14792 Ascites

Overview

Ascites (say: ass-SY-teez) is an abnormal buildup of fluid in the space between the lining of the belly and the organs inside it. It makes the belly swell and feel heavy.

Ascites is fairly common in people with advanced liver disease. Around 1 in 2 people with cirrhosis (severe scarring of the liver) develop ascites at some point.

It mostly affects adults with long-term liver conditions, but it can also happen in children and older adults with certain heart, liver, or kidney problems.

Symptoms

Common symptoms

• Swelling of the belly that comes on gradually or quickly
• Rapid weight gain without a clear reason
• A feeling of fullness or early satiety when eating
• Shortness of breath or difficulty breathing
• Pressure, pain, or discomfort in the abdomen

Symptoms in children

• Abdominal swelling or a distended tummy
• Difficulty feeding or a feeling of fullness
• Unusual fatigue or tiredness
• Breathing faster than usual

Symptoms in older adults

• Abdominal swelling that may be mistaken for weight gain
• Loss of appetite
• Swelling in the legs or feet
• Increased confusion (sometimes due to liver or kidney problems)

Causes

Main causes

• Liver cirrhosis — scarring of the liver, often from alcohol-related liver disease, hepatitis B or C, or fatty liver disease
• Heart failure — when the heart cannot pump blood effectively and fluid backs up
• Kidney disease — when the kidneys cannot remove extra fluid
• Cancer in the abdomen, such as liver or ovarian cancer
• Infection or inflammation of the lining of the belly (peritonitis)

Risk factors

• Heavy alcohol use over many years
• Chronic hepatitis B or C
• Obesity and metabolic syndrome
• Previous liver damage or cirrhosis
• Heart failure or kidney failure

When to see a doctor

See a doctor urgently if:

• If you have symptoms of ascites and a known liver condition and feel any sudden worsening, seek care the same day.
• If you have new belly swelling that is painful or accompanied by fever, get medical attention quickly.

Book a routine appointment if:

• Make an appointment if you notice your belly is staying tight or growing.
• Talk to your GP if you have new swelling in your legs or feet.

Diagnosis

Your doctor will ask about your medical history, examine your abdomen, and usually arrange tests to find out if fluid is present and what is causing it.

Tests that may be done

• Ultrasound scan — uses sound waves to look inside the abdomen and detect fluid
• Blood tests — to check liver, kidney, and overall health
• Paracentesis — a small sample of fluid is taken with a thin needle and sent to a laboratory for analysis
• Urine tests — to check for protein or other clues to kidney problems

What to expect at your appointment

The doctor will gently press on your belly and may listen to it. You may be asked to lie on your side so fluid can be detected more easily. If a sample of fluid is needed, a local anaesthetic will numb the skin and a small needle is inserted; this usually takes only a few minutes.

Treatment

Treatment for ascites has two aims: to reduce the fluid build-up and to manage the underlying condition. The plan will depend on the cause, your overall health, and how much fluid is present.

Self-care at home

• Limit salt in your diet to help reduce fluid retention — your doctor or dietitian can tell you how much is appropriate
• Stop drinking alcohol completely if you have liver disease — support is available to help you cut down or quit
• Weigh yourself daily and report sudden increases to your healthcare team
• Rest with your legs raised if swelling in your legs is bothersome

Medical treatments

Medical treatment usually begins with diuretic medicines, which help the kidneys remove extra fluid. You will be monitored with blood tests to ensure the dose is safe. If a large amount of fluid needs to be removed quickly, a procedure called paracentesis can be done to drain fluid with a thin tube. In some people, a special tube called a transjugular intrahepatic portosystemic shunt (TIPSS) may be used to reduce pressure in the liver. These options are discussed in specialist liver clinics.

When is surgery considered?

If ascites is due to advanced liver disease and other treatments are not effective, a liver transplant may be considered. This is always a major decision that is carefully discussed with a specialist team.

Living with this condition

Living with ascites can be challenging, but many people manage it well by following their treatment plan and attending regular appointments. Daily weighing, a low-salt diet, and staying in touch with your care team are key.

Lifestyle tips

• Attend all scheduled check-ups and blood tests
• Take your medicines exactly as prescribed — do not stop without talking to your doctor
• Ask about vaccines for flu, pneumonia, and hepatitis to avoid infections
• If you smoke, talk to your GP about support to quit

Diet and exercise

Aim for a balanced diet with limited salt. A dietitian may recommend salty foods to avoid and can help you plan meals. Light activity, such as walking, can help you maintain strength and prevent muscle loss, but always check with your doctor before starting new exercise, especially if you have fluid on your lungs or feel breathless.

Mental health and emotional wellbeing

A chronic condition like ascites can cause stress, anxiety, or low mood. It is normal to feel overwhelmed at times. Speak to your doctor or nurse about your feelings, and remember that effective treatments are available for mental health.

Prevention

Not always, but you can reduce your risk of developing ascites by protecting your liver. This means limiting alcohol, maintaining a healthy weight, managing diabetes and high blood pressure, and seeking early treatment for any liver infection.

Vaccines

Vaccines against hepatitis A and hepatitis B can help protect your liver. Ask your GP or local health service about these vaccinations.

Screening programmes

There is no routine screening test for ascites. But if you have cirrhosis or another known liver condition, your healthcare team will monitor you closely so any fluid build-up is spotted early.

Complications

If left untreated

• Infection of the fluid (spontaneous bacterial peritonitis) — a serious medical emergency
• Kidney dysfunction or failure
• Breathing problems due to extra pressure on the chest
• Umbilical hernia from increased pressure in the belly
• Poor nutrition and muscle wasting

Long-term outlook

With prompt treatment, ascites can often be controlled. The outlook depends entirely on the underlying cause. For example, people with alcohol-related ascites who stop drinking may improve greatly. Even if the condition is serious, modern treatments can help you feel better and live longer. Your doctor will give you a realistic and hopeful picture based on your own situation.

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