Answers
What is ascites (fluid in the abdomen), and how is it treated?
Short answer
Ascites is a build-up of fluid inside the abdomen. The commonest cause is cirrhosis of the liver; tuberculosis, cancer, heart failure and kidney disease are other causes. It is treated by finding the cause, cutting down salt, tablets that remove extra water, and draining the fluid when needed.
Symptoms
- A belly that swells over weeks, with weight gain
- Tight clothes, a feeling of fullness and poor appetite
- Breathlessness when the fluid is large
- Swelling of the feet
Tests
An ultrasound confirms the fluid. A small sample is usually taken with a thin needle (diagnostic tap) to find the cause and check for infection. Blood tests, liver tests and sometimes an endoscopy for varices are done when cirrhosis is the cause.
Treatment
Drinking water is not usually restricted unless blood sodium is low. Avoid painkillers such as NSAIDs, which can harm the kidneys in people with ascites.
- Cut down salt: no added salt at the table, and avoid pickles, papad, namkeen, packaged and restaurant food. Most people are advised to take no more than 2 g of sodium a day, which is about one level teaspoon (5 g) of salt in total.
- Tablets that help the kidneys remove extra salt and water (diuretics), with regular blood tests
- Removing large amounts of fluid with a needle (therapeutic paracentesis), often with albumin given through a drip
- Treating the cause, and stopping alcohol completely
- In repeated or difficult cases, a TIPS procedure or assessment for liver transplant
Warning signs
Fever, belly pain or tenderness, confusion or passing very little urine can mean infection of the fluid or kidney problems. These need urgent care: go to the nearest emergency department or call 112.
Diet with ascites
Eat more
- Home-cooked food with salt added only while cooking
- Protein at every meal: dal, curd, paneer, eggs, fish or chicken
- Flavour with lemon, herbs, jeera, ginger and garlic instead of salt
Cut down
- Pickles, papad, namkeen, chutney powders and sauces
- Packaged, bakery and restaurant food, which hide a lot of salt
- Baking soda in batters and salted butter or cheese
Good to know
- Do not use 'low sodium' salt substitutes unless your doctor approves; many contain potassium, which can be dangerous with water tablets.
- Weigh yourself at the same time every day and note it for your doctor.
Common questions
Should I drink less water with ascites?
Usually not. Fluid is restricted only when blood sodium is low, and then your doctor will tell you how much. Cutting salt matters far more than cutting water.
Will the fluid come back after it is drained?
It often does if the cause is still active. Salt control, water tablets and treating the cause help keep it away. Repeated drainage is a sign to discuss other options, including liver transplant.
Is removing the fluid with a needle safe?
Yes. It is done under ultrasound with local anaesthetic, and albumin is often given through a drip when large amounts are removed.