Understanding the Basics of Ascites

Ascites, pronounced ah-sy-tees, is the medical term describing the abnormal accumulation of fluid in the abdomen. While ascites is most commonly caused by cirrhosis, cancer may also be a cause of ascites. Learn what ascites feels like, how it's diagnosed, and how doctors treat it.

Woman holding her stomach in pain
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Medical Causes

There are benign or non-cancerous conditions that can cause ascites with liver failure, or cirrhosis, being the most common one. Other examples of non-cancerous causes include heart failure, infection, and pancreatitis.

In about 10% of cases, ascites is caused by cancer. Types of cancer that cause ascites include ovarian, colon, pancreatic, and uterine cancer. Lymphoma, lung cancer, and breast cancer may also spread to the abdomen, causing ascites.

In order to differentiate between benign versus malignant or cancerous ascites, a doctor will perform a procedure called a paracentesis. In this procedure, a needle is inserted into the abdomen and a small fluid sample is removed. The fluid sample is then examined under a microscope. Certain characteristics of the fluid, like the presence of cancer cells, can help determine the cause of the ascites.

What Ascites Feels Like

While mild ascites may cause no symptoms, more advanced ascites can become uncomfortable, creating a bloated appearance to the abdomen. Common symptoms of more advanced ascites include:

  • Abdominal pain
  • Shortness of breath because the pressure of the fluid compresses the diaphragm
  • Nausea
  • Vomiting
  • Loss of appetite

Treatment

The treatment of ascites depends on the severity of the ascites and is geared towards alleviating a person's symptoms and making them more comfortable. Therapies include salt-restricted diets, diuretics, and a therapeutic paracentesis, in which a large volume of fluid is removed from the abdomen. It's not uncommon for a person with ascites to need regular paracentesis to remove the fluid. The good news is that the procedure is relatively low risk and effective.

That being said, if a person's ascites cannot be controlled well with these traditional therapies, a shunt may be placed surgically—although this procedure is higher risk and not commonly done.

In the case of malignant ascites, a person's doctor may consider cytoreductive surgery and chemotherapy that is administered directly into the abdomen—called direct intraperitoneal chemotherapy. This is only considered for certain patients and requires a careful discussion with a person's doctors to weigh the potential risks and benefits.

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Article Sources
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  2. Moore CM, Van Thiel DH. Cirrhotic ascites review: pathophysiology, diagnosis and managementWorld J Hepatol. 2013;5(5):251–263. doi:10.4254/wjh.v5.i5.251

  3. Pedersen JS, Bendtsen F, Møller S. Management of cirrhotic ascitesTher Adv Chronic Dis. 2015;6(3):124–137. doi:10.1177/2040622315580069

Additional Reading
  • Runyon BA. Care of patients with ascites. N Eng J Med. 1994 Feb 3;330(5):337-42.
  • Sangisetty SL & Miner TJ. Malignant ascites: A review of prognostic factors, pathophysiology and therapeutic measures. World J Gastrointes Surg. 2012 Apr 27;4(4):87-95.