What is Ascites Fluid? - Causes, Symptoms and Treatment

Ascites is a medical disorder in which there is a fluid buildup in the abdomen. The abdominal regions are covered with a tissue called the peritoneum. Further, the peritoneum consists of two layers. During ascites, the fluid gets filled between the two layers of the peritoneum.

Not only does ascites disease cause hardness and swelling in the abdomen, but it also leads to severe pain. Higher than 25 ml of fluid in the peritoneal cavity is regarded as ascites. If not treated on time, it may threaten the patient’s life.

There are different types of ascites that can occur due to various underlying medical conditions. Here are some of the common types of ascites:

1. Cirrhotic ascites: This is the most common type of ascites, which occurs as a complication of liver cirrhosis. Liver cirrhosis leads to increased pressure in the blood vessels that supply the liver, causing fluid to leak into the abdominal cavity.
2. Cardiac ascites: This type of ascites is caused by heart failure, which leads to decreased cardiac output and increased pressure in the blood vessels. The increased pressure causes fluid to accumulate in the abdominal cavity.
3. Nephrotic ascites: This type of ascites occurs due to kidney disease, which leads to a decrease in protein levels in the blood. The decrease in protein levels causes fluid to leak into the abdominal cavity. 
4. Malignant ascites: This type of ascites occurs due to cancer, particularly cancers of the ovaries, pancreas, stomach, and colon.
5. Pancreatic ascites: This type of ascites is caused by leakage of pancreatic enzymes into the abdominal cavity due to inflammation or trauma. 

The severity of ascites can be graded based on the amount of fluid present, which can help guide treatment decisions and monitor disease progression. There are three grades of ascites:

1. Grade 1: Mild ascites, which is characterised by a small amount of fluid in the abdominal cavity. Patients with grade 1 ascites may not experience any symptoms and may not require treatment.
2. Grade 2: Moderate ascites, which is characterised by a larger amount of fluid in the abdominal cavity. Patients with grade 2 ascites may experience discomfort or abdominal distension and may require diuretic therapy to remove excess fluid.
3. Grade 3: Severe ascites, which is characterised by a large amount of fluid in the abdominal cavity. Patients with grade 3 ascites may experience significant abdominal distension, difficulty breathing, and other complications.

A few of the most common symptoms of ascites are sudden and excess weight gain and a big swollen belly. Apart from that, patients may also experience the following ascites symptoms and signs: 

1. Shortness of breath
2. Hardness around belly
3. Bloating
4. Loss of appetite
5. Indigestion
6. Fatigue
7. Back pain
8. Difficulty sitting for a long time
9. Enlarged belly
10. Swelling in ankles
11. Excessive weight gain

There are various causes and risk factors that can lead to the development of ascites. Here are some of the common causes and risk factors of ascites:

1. Liver cirrhosis: This is the most common cause of ascites, accounting for around 75% of all cases.
   Liver cirrhosis can occur due to various factors such as chronic alcohol consumption, viral hepatitis, and nonalcoholic fatty liver disease.
2. Heart failure: Heart failure can lead to fluid accumulation in the abdominal cavity due to increased pressure in the blood vessels.
3. Kidney disease: Kidney disease can lead to a decrease in protein levels in the blood, which can cause fluid to leak into the abdominal cavity.
4. Cancer: Certain types of cancer, such as ovarian, pancreatic, stomach, and colon cancers, can cause ascites.
5. Infection: Infections such as tuberculosis and peritonitis can lead to the accumulation of fluid in the abdominal cavity.
6. Pancreatitis: Inflammation of the pancreas can cause leakage of pancreatic enzymes into the abdominal cavity, leading to ascites.
7. Malnutrition: Severe malnutrition can lead to a decrease in protein levels in the blood, which can cause fluid to leak into the abdominal cavity.
8. Blood clots: Blood clots in the veins that supply the liver can lead to liver damage and ascites.

There are also certain risk factors that can increase the likelihood of developing ascites, including:

1. Chronic alcohol consumption
2. Chronic viral hepatitis
3. Nonalcoholic fatty liver disease
4. Obesity
5. Age over 50 years
6. Male gender
7. Smoking
8. Use of certain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids.

Ascites is a medical condition that is caused by a variety of underlying factors. Prevention of ascites depends on identifying and addressing the underlying cause of the condition. Here are some general measures that can be taken to prevent ascites:

1. Maintain a healthy diet: A healthy diet that is low in salt and high in fibre can help prevent the development of ascites. Avoiding alcohol and limiting the intake of processed foods, saturated fats, and sugars can also help.
2. Exercise regularly: Regular exercise can help prevent obesity and reduce the risk of developing liver disease, which can cause ascites.
3. Manage underlying medical conditions: Managing underlying medical conditions such as liver disease, heart failure, and kidney disease can help prevent the development of ascites.
4. Avoid risky behaviours: Avoiding risky behaviours such as intravenous drug use and unprotected sex can help prevent the development of infections that can cause ascites.
5. Take medications as prescribed: Taking medications as prescribed by the healthcare provider can help prevent the development of complications that can lead to ascites.
6. Monitor for symptoms: Monitoring for symptoms such as abdominal swelling, shortness of breath, and fatigue can help identify the development of ascites early on and allow for timely intervention.

There is no specific test to diagnose ascites. It usually depends on the signs and symptoms that the patient shows. As per evidence, ultrasound is considered the most accurate diagnostic test for ascites.

Nevertheless, ascites can be diagnosed through a physical examination, imaging tests, and laboratory tests. Here are some details about the diagnosis of ascites:

1. Patient’s medical history: The first step in diagnosing ascites is a physical examination. The healthcare provider will check ascites symptoms, such as increased belly size, swollen abdomen, and rapid weight gain.
   The healthcare provider will also ask the patient about their medical history. He may ask the patient about the following:
   1. Any past or ongoing case of liver cirrhosis or other liver-related diseases.
   2. Past or current medications, including ayurveda and homeopathy. 
2. Laboratory tests: Blood tests may be ordered to evaluate the function of the liver and kidneys, and to check for any infections that may be contributing to the development of ascites. These include: 
   1. Liver function test: They’re a group of blood tests that help detect the liver’s health status and disease (if any).
      These tests provide reports on the basis of protein, enzymes, and other substances present in the blood. 
   2. Complete Blood Count (CBC): CBC is a blood test through which a physician checks all the components of the blood including white blood cells, red blood cells, and platelets.
      CBC helps to assess the overall health of a person. In addition, it also helps rule out specific illnesses, such as liver disease. 
3. Paracentesis: It is a diagnostic procedure in which the healthcare provider takes out fluid from the patient’s body. This helps detect if there is ascites fluid. Generally, the doctor carries out the test by inserting a needle into the patient’s abdomen. 
4. Imaging Tests:
   1. Abdominal Ultrasound: It is an imaging test, which with the help of high-frequency sound waves, forms pictures (images) of the organs and rules out diseases. Ultrasound is among the preferred tests for ascites disease.
   2. CT Scan or MRI: Both these tests provide detailed images of internal organs. This, in turn, helps to diagnose ascites fluid. 
   3. Laparoscopy: It is a procedure in which the doctor makes a small incision in the patient’s body. After that, he inserts an instrument, called a laparoscope, into the body.
      As the laparoscope contains a tiny camera and is connected to a computer, the doctor easily sees the patient's internal organs in the computer screen. Hence, it aids in ruling out ascites fluid buildup.

How to Prepare for the Doctor's Consultation?

Here are some pieces of advice that patients must take into account when visiting the doctor's clinic for consultation on ascites disease: 

1. Make an early appointment to visit the clinic.
2. Carry previous medical reports and prescriptions of medications.
3. The doctor may ask questions about the treatment undergoing (in case of any disease like cirrhosis, hepatitis B and C). 
4. The doctor may also ask the patient if the patient or any family member has genetic disorders. 
5. The patient must wear comfortable clothes so that it becomes easy for the doctor to conduct physical or clinical examinations. 
6. Patients should also make a list of questions that he/she should ask the healthcare providers. Some of the questions could include:
   1. Can ascites be treated without surgery?
   2. Do I need to undergo a liver transplant?
   3. Do I have to undergo surgery?
   4. What is the optimal time of surgery in my case?
   5. Is the ascites life-threatening (in my case)?
   6. What is the recovery period after surgery?
   7. What foods should I eat and avoid?
   8. How can I relieve my pain?
   9. Why do I need to undergo surgery?
   10.  Is there any alternative to surgery?
   11. Why have I developed ascites?
   12. Do I have other diseases, too?
   13. Why has my belly area swollen so much?
   14. What’s the life expectancy after ascites?

The ascites treatment depends on the grade and severity of the ascites. Below are the most common ascites treatment: 

Treatment of Ascites without surgery

1. Diuretics: Also known as water pills, diuretics are drugs that help the kidneys remove excess salt and water from the body. Thus, in turn, they flush out ascites fluid. Since their availability, diuretics have remained the most preferred non-surgical method for ascites.
2. Antibiotics for infection: To prevent bacterial infection caused by ascites, patients might need antibiotics such as intravenous cefotaxime.
3. Ayurvedic Medications: Evidences show that ayurvedic medicines and Nitya Virechana provide relief in ascites fluid, and that too with zero side effects. Some of the ayurvedic medications and herbs for ascites are:

Treatment of Ascites with surgery 

If none of the non-surgical methods is beneficial for ascites, the patient might need surgery to help treat their condition. Below are the common surgical options for ascites:

1. Paracentesis: The healthcare provider uses a needle to remove excess fluid from the patient’s body. 
2. Transjugular Intrahepatic Portosystemic Shunt (TIPS): TIPS helps flush the excess abdominal fluid from the patient’s body. During TIPS, the healthcare provider puts a stent or mesh into the patient's portal vein.
   The treatment provides relief to around 80% of ascites patients. Further, many patients do not even require paracentesis after undergoing TIPS. 
3. Liver Transplant: If no ascites treatment works, a liver transplant becomes the last treatment option. It is a surgical procedure in which healthcare providers replace the damaged liver with a healthy one.

Table showing the estimated cost of ascites surgery

Note: The treatment approach and selection of procedures depend on the patient's health condition and your treating doctor's opinion.

If not treated on time, ascites can lead to permanent liver damage. Along with that, there are a variety of risks and complications of ascites, including:

1. Kidney failure
2. Abdominal pain
3. Shortness of breath
4. Infection in fluid
5. Ascites-related hernias 
6. Lungs filled by fluid 

When to Consult a Doctor?

Patients must visit a doctor if they feel:

1. Difficulty sitting
2. Shortness of breath
3. Severe back pain
4. Excess weight gain
5. Swollen belly

A healthy diet is an important part of the management of ascites. The goal of the diet is to reduce the buildup of fluid in the abdomen and to prevent complications associated with ascites. Here are some details about the diet of ascites:

1. Low-sodium diet: A low-sodium diet is recommended for people with ascites to help reduce fluid retention in the body. This involves limiting the intake of salt to less than 2,000 mg per day.
2. High-protein diet: A diet that is high in protein is recommended to help maintain muscle mass and prevent muscle wasting that can occur with ascites.
3. Small, frequent meals: Eating small, frequent meals throughout the day can help reduce the pressure on the abdomen and prevent bloating.
4. Avoiding alcohol: Alcohol consumption can worsen liver disease and increase the risk of developing ascites. Therefore, avoiding alcohol is recommended for people with ascites.
5. Limiting fluid intake: Limiting fluid intake may be recommended for people with severe ascites to prevent further fluid buildup in the abdomen.
6. Nutrient-rich foods: Eating nutrient-rich foods such as fruits, vegetables, whole grains, and lean proteins can help provide the body with essential vitamins and minerals.