Ascites (swollen belly)

People with liver disease often notice their belly is swollen. This can mean they have a condition called ascites. This means a build-up of fluid in the belly. It is a sign of cirrhosis.

At first, you might notice your waist expands and you gain weight. You might develop a pot-belly. In the end, it can look almost as if you are pregnant. It can be very uncomfortable. You might find it difficult to breathe.

Sometimes the fluid also leaks into your legs and ankles, making them swollen too.

Why you get ascites

When blood can’t flow into the liver properly, pressure builds up in one of the veins called the portal vein. Fluid starts to leak out of the liver, and this causes the ascites.

When to see your doctor

If you notice swelling in your belly, see your doctor. They can give you medicines and put you on a low-salt diet. Your doctor will probably send you for blood tests and a scan of the abdomen to see why you have suddenly developed swelling.

People with ascites can develop serious complications. The most common is that the fluid gets infected. This can be life threatening. If you know you have ascites, get medical help straightaway if:

• You have a fever, nausea or vomiting or pain in the belly
• Your belly suddenly gets more swollen
• You gain or lose weight rapidly (i.e. more than 1kg a day for 3 days in a row. Your doctor will tell you when to call them)
• You get new or worse leg swelling
• You get breathing problems, or your breathing problems get worse

Treatment for ascites

First of all, your doctor might recommend a low-salt diet. They might give you water tablets (diuretics) to reduce the fluid in your body.

If the ascites is severe, a drain can be put into the belly to drain out some of the fluid. This might be done every few weeks. It will involve going to hospital.

Another treatment is called a TIPS procedure. This is when a little metal tube (a ‘shunt’) is put into the liver to redirect the blood flow. This reduces pressure and stops fluid from building up.

Sometimes someone with ascites will be given regular infusions of albumin. This can reduce the need for surgery and can make you feel much more comfortable.

Tips for managing ascites

Ascites is treated with medicine (called diuretics) and a low-salt diet. Some people may need to have a procedure to remove the fluid, and this can be repeated as needed. Other people might be recommended for a procedure to reduce the pressure within the liver (called a TIPS procedure). Sometimes they might need referral to a liver transplant centre for assessment.

If you have ascites, it’s important to keep an eye on your condition as serious complications can happen (see below).

• Keep track of your weight every day.
• Make sure you follow a ‘reduced salt diet’ or a ‘no-added salt diet’
• Avoid all alcohol, as it can make the swelling worse
• Avoid nonsteroidal anti-inflammatory drugs, such as ibuprofen and aspirin. These affect your kidneys and can make our body hold onto water and salt
• Take your medicines as your doctor tells you, every day
• Have regular blood tests to check your kidney function, particularly if taking diuretic tablets

Reviewed September 2024