Ascites are an accumulation of too much fluid in the abdomen (belly). The fluid may move into the chest and surround the lungs. This, in turn, causes shortness of breath (dyspnea).

It may be painful. It may restrict your movement. Sometimes it is an indication of stomach infection. It often occurs in people who have liver cirrhosis (liver scarring). It can also occur when cancer spreads to the liver.

It is very important for you to learn how bad (severe) your symptoms are.

How bad are my ascites?

Mild: Swelling in the abdomen, weight gain, nausea and vomiting. In such cases, treatment is usually not required, and the underlying condition causing the ascites is managed. The patient may need to follow a low-sodium diet and take diuretics to reduce fluid buildup.

Moderate: Bloating, indigestion and sense of heaviness. It may require medical assistance. In moderate ascites, the fluid accumulation is significant, and the patient may experience discomfort or pain in the abdomen, difficulty breathing, and reduced appetite. The treatment for moderate ascites involves managing the underlying condition and using diuretics to reduce the fluid buildup. In some cases, a paracentesis procedure may be done to remove excess fluid from the abdomen.

Severe: Shortness of breath (Dyspnea), fever that does not go away and belly pain. You may also experience blood in stool or vomit or black, tarry stools, bruising and confusion. In severe ascites, the fluid accumulation is extensive. The treatment for severe ascites involves managing the underlying condition and performing a paracentesis procedure to remove a large volume of fluid from the abdomen. In some cases, a transjugular intrahepatic portosystemic shunt (TIPS) procedure may be done to reroute blood flow in the liver and reduce fluid buildup in the abdomen.

Warning signs/severe symptoms of ascites that need immediate medical attention

• Fever above 100.5°F (38.05°C), or a fever that does not go away
• Abdominal Pain
• Blood in your stool or black, tarry stools
• Blood in your vomit
• Bruising or bleeding that occurs easily
• Build-up of fluid in your belly
• Swollen legs or ankles
• Breathing problems
• Confusion or problems staying awake
• Yellow color in your skin and the whites of your eyes (Jaundice)

Keep track of ascites using Ankr (myAnkr web portal or the Ankr app). It will help you describe the severity to your doctor or nurse.

What tests are needed to diagnose ascites?

• Ultrasound: A non-invasive imaging test that uses sound waves to create pictures of the abdominal organs and the amount of fluid present.
• CT Scan or MRI: More detailed imaging tests that can help identify the underlying cause of ascites.
• Blood Tests: These tests can help identify liver and kidney function and check for infection and other underlying conditions.
• Paracentesis: A procedure in which a small amount of fluid is removed from the abdominal cavity with a needle and syringe for laboratory analysis.

Supportive care for ascites

• Weigh yourself daily. Call your healthcare provider if you gain more than 10 pounds, or more than two pounds per day for three consecutive days.
• Avoid alcoholic beverages.
• Nonsteroidal anti-inflammatory drugs, ibuprofen (Motrin® and Advil®) and aspirin, affect your kidneys. They can cause your body to retain excess water and salt.
• Stick to a low-sodium diet. Not more than 2,000 to 4,000 milligrams per day.
• Limit fluid intake.

What caused my ascites?

It can happen when cancer spreads to the liver. You are more likely to develop ascites if you have one of these cancers:

• Breast Cancer
• Colon cancer
• Gastrointestinal tract cancers (stomach and intestinal cancers)
• Ovarian Cancer or fallopian tube cancer
• Pancreatic Cancer
• Uterine Cancer