Understanding the Basics of Ascites

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Ascites is the abnormal or extra accumulation of peritoneal fluid in the abdomen (belly). While ascites is most commonly caused by cirrhosis, it can also be caused by heart failure, pancreatitis, infection, cancer, and more.

Healthcare providers use a variety of blood tests, imaging procedures, and paracentesis to diagnose ascites. Treatment focuses on treating the underlying cause, if possible, and relieving symptoms.

This article reviews the symptoms, causes, diagnosis, and treatment of ascites.

Woman holding her stomach in pain
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Benign (noncancerous) conditions can cause ascites. Liver failure or cirrhosis are the most common causes. Cirrhosis is scarring of the liver that occurs when a disease attacks and damages the liver.

While this is not an exhaustive list, diseases that can cause liver damage and lead to cirrhosis include:

  • Liver disease
  • Chronic hepatitis B or C
  • Alcoholism or heavy alcohol use
  • Kidney failure
  • Portal hypertension
  • Heart failure
  • Infection
  • Pancreatitis (inflammation of the pancreas)

Most cirrhosis is caused by heavy alcohol consumption or chronic hepatitis C.

How Common Is Ascites With Cirrhosis

About 60% of patients with cirrhosis get ascites within 10 years of their diagnosis.

In about 10% of cases, ascites is caused by cancer. Types of cancer that cause ascites include:

Cancers that may spread to the abdomen (belly) and cause ascites include:


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

  • Nausea
  • Vomiting
  • Loss of appetite
  • Feeling full when eating
  • Ankle swelling
  • Shortness of breath because the pressure of the fluid compresses the diaphragm
  • Fever or abdominal pain (may indicate the fluid is infected)


To diagnose ascites, your healthcare provider may perform the following tests:

  • Blood tests
  • Ultrasound (usually the first imaging test)
  • Computed tomography (CT)
  • Magnetic resonance imaging (MRI)
  • Paracentesis


A paracentesis is a procedure in which your healthcare provider uses a small needle to get a fluid sample from your abdomen.

The fluid sample is then examined under a microscope. Specific characteristics of the fluid, like the presence of white blood cells, bacteria, or cancer cells, can help determine the cause of the ascites. This helps differentiate benign vs. malignant (cancerous) ascites.


The treatment of ascites depends on the cause. It also depends on the severity and is geared towards alleviating a person's symptoms and making them more comfortable. Therapies include:

  • Salt-restricted diets
  • Diuretics (water pill)
  • Therapeutic paracentesis
  • Chemotherapy (for some types of cancer, if ascites is caused by cancer)
  • Peritoneovenous shunt (rare)
  • Liver transplant (rare)

Therapeutic Paracentesis

Therapeutic paracentesis is a relatively low-risk and effective procedure in which a large volume of fluid is removed from the abdomen. It's not uncommon for someone with ascites to need regular paracentesis to remove the fluid.

If someone is experiencing refractory ascites, meaning it cannot be controlled well with traditional therapies, a peritoneovenous shunt may be placed surgically to drain fluid out of the abdomen.

This procedure comes with a higher risk and is not commonly performed. However, it can drastically improve the quality of life for those waiting for a liver transplant.

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


Ascites is the accumulation of fluid in the abdomen. The most common cause is liver damage or cirrhosis, but it can also be caused by heart failure, pancreatitis, infection, cancer, and more.

Symptoms include nausea, vomiting, feeling full when eating, loss of appetite, and shortness of breath. You could also experience fever or abdominal pain if an infection occurs in the fluid. 

Various imaging procedures and possibly a paracentesis (draining fluid with a small needle) are used to diagnose ascites. 

Treatment depends on the cause and may include restricting salt in your diet, diuretics (water pills), and therapeutic paracentesis. Cancer treatment such as chemotherapy or surgery may be needed if the underlying cause is malignant (cancerous). A peritoneovenous shunt and a liver transplant are other treatment possibilities. However, they are rare and only used when other treatments have stopped working.

A Word From Verywell

The symptoms from ascites can be distressing and uncomfortable. They can interfere with work, school, relationships, exercise, and other activities of daily living. Ascites can be caused by some serious conditions, so it's best to talk with your healthcare provider if you are experiencing symptoms.

Frequently Asked Questions

  • Is ascites life threatening?

    Ascites is a symptom of an underlying health concern and requires medical attention. Left untreated, it can be fatal or life-threatening. It can cause infection, shortness of breath, pain, and swelling, leading to serious outcomes.

  • What stage of liver disease is ascites?

    Ascites is a common complication of end-stage liver disease.

  • Can ascites be reversed?

    Ascites can be temporarily reversed with treatment. Permanent reversal depends on the underlying cause. If liver failure or cirrhosis is the cause, there is no cure, and managing ascites will require continual treatment. In rare cases, you may need a liver transplant.

  • How long can you live once ascites starts?

    Research shows that 50% of those with ascites as a complication of end-stage renal disease (ESLD) will die within two to three years. When the ascites is refractory, meaning it is unmanageable and stops responding to treatment, six months is the average survival time. However, these are just averages and depend on many factors.

10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Pedersen J, Bendtsen F, Møller S. Management of cirrhotic ascitesTher Adv Chronic Dis. 2015;6(3):124–137. doi:10.1177/2040622315580069

  2. Biggins SW, Angeli P, Garcia‐Tsao G, et al. Diagnosis, evaluation, and management of ascites, spontaneous bacterial peritonitis and hepatorenal syndrome: 2021 practice guidance by the American Association for the Study of Liver DiseasesHepatology. 2021;74(2):1014-1048. doi:10.1002/hep.31884

  3. Smith A, Baumgartner K, Bositis C. Cirrhosis: Diagnosis and Management. Am Fam Physician. 2019;100(12):759-770. PMID: 31845776.

  4. Sangisetty SL, Miner TJ. Malignant ascites: A review of prognostic factors, pathophysiology and therapeutic measuresWorld J Gastrointest Surg. 2012;4(4):87–95. doi:10.4240/wjgs.v4.i4.87

  5. Gupta A, Sedhom R, Beg MS. Ascites, or fluid in the belly, in patients with cancer. JAMA Oncol. 2020;6(2):308. doi:10.1001/jamaoncol.2019.5409

  6. Li X, Zhu D, Li N, Yang H, Zhao Z, Li M. Characterization of ascites-derived tumor cells from an endometrial cancer patient. Cancer Sci. 2017;108(12):2352-2357. doi:10.1111/cas.13407

  7. 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

  8. Ayllón MD, Ciria R, Gómez-Luque I, et al. Use of peritoneovenous shunt for the management of refractory ascites. Transplant Proc. 2019;51(1):41-43. doi: 10.1016/j.transproceed.2018.04.089

  9. Macken L, Hashim A, Mason L, Verma S. Permanent indwelling peritoneal catheters for palliation of refractory ascites in end-stage liver disease: A systematic review. Liver Int. 2019;39(9):1594-1607. doi: 10.1111/liv.14162

  10. Potosek J, Curry M, Buss M, Chittenden E. Integration of palliative care in end-stage liver disease and liver transplantation. J Palliat Med. 2014;17(11):1271-1277. doi:10.1089/jpm.2013.0167

Additional Reading
  • Gupta A, Sedhom R, Beg MS. Ascites, or fluid in the belly, in patients with cancerJAMA Oncol. 2020;6(2):308. doi:10.1001/jamaoncol.2019.5409

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

  • 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.

By Brandi Jones, MSN-ED RN-BC
Brandi is a nurse and the owner of Brandi Jones LLC. She specializes in health and wellness writing including blogs, articles, and education.

Originally written by Lisa Fayed