What is ascites?
Ascites is the abnormal build-up of fluid in the abdominal cavity. This condition results in uncomfortable abdominal swelling.

What causes ascites?
The most common cause of ascites is liver damage or scarring.  Liver damage or advanced liver disease increases the pressure inside the blood vessels of the liver. This is called portal hypertension, which causes ascites.

Ascites is also caused by diseases that can result in severe liver damage. These diseases include long-term hepatitis C or B infection, long-term alcohol abuse, non-alcoholic fatty liver disease.

Certain cancers in the abdomen may also lead to ascites. These include cancer of the appendix, colon, ovaries, uterus, pancreas, and liver.

The following conditions can also cause ascites:

• Thickening and scarring of the sac-like covering of the heart
• Congestive heart failure
• Pancreatitis
• Portal vein thrombosis (clots in the veins of the liver)

What are the symptoms of ascites?
Symptoms of ascites may develop slowly or suddenly depending on the cause of ascites. There may not be any symptoms if there is only a small amount of fluid in the belly.

As more fluid accumulates, you may have abdominal pain and bloating. Large amounts of fluid build-up can cause shortness of breath.

The following are the common symptoms of ascites:

• Heartburn
• Abdominal pain
• Abdominal distension (swelling)
• Bloating
• Nausea and vomiting
• Sudden weight gain
• Difficulty breathing when lying down.
• Decreased appetite.

How is ascites diagnosed?
Your doctor will do a physical exam and review your symptoms. The physical exam includes direct percussion over the abdomen in a supine position to determine the presence of the fluid.

Your doctor may also order the following tests to assess your liver and kidneys:

• Abdominal ultrasound
• Kidney function tests
• Liver function tests
• Tests to measure the risk of bleeding and protein levels in the blood
• Electrolyte levels
• 24-hour urine collection
• Urinalysis

Your doctor may also use a thin needle to withdraw ascites fluid from your stomach. The fluid is tested to check for the cause of ascites.

How is ascites treated?
Treatment of ascites depends on the underlying cause. The doctor will treat the condition that caused ascites if it is diagnosed. Treatment to manage ascites and alleviate symptoms includes lifestyle changes, diuretics, or draining the fluid.

The doctor may recommend the following lifestyle changes:

• Lowering salt in your diet (no more than 1,500 mg/day of sodium)
• Limiting fluid intake
• Avoiding alcohol

The doctor may prescribe the following medicines:

• Diuretics (water pills) to get rid of extra fluid
• Antibiotics for infections

The doctor may recommend the following procedures:

• Paracentesis. This procedure involves inserting a needle into the belly to remove large volumes of fluid.
• Transjugular Intrahepatic Portosystemic Shunt (TIPS). This procedure involves placing a special tube or shunt inside your liver to repair blood flow to the liver.

The doctor may recommend a liver transplant for people with the end-stage liver disease.

This feature is for informational purposes only and is not intended to substitute the expert guidance of a doctor. We advise seeing a doctor if you have any health concerns.