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What is ascites?
What are the signs of ascites?
What causes ascites?
How does my doctor tell if I have ascites?
How is ascites treated?

What is ascites?

Ascites is excessive fluid in the abdomen. It is a serious condition and usually occurs when cirrhosis of the liver has developed.

What are the signs of ascites?

Small amounts of fluid usually do not cause symptoms, but as more fluid builds up, the abdomen begins to swell. This can cause:

  • Rapid weight gain
  • Loss of appetite
  • Shortness of breath
  • Pain in the abdomen
  • Heartburn
  • Development of hernias (groin, navel)

It is often accompanied by swelling in the legs and ankles (edema).

What causes ascites?

In almost 80% of cases, ascites is caused by liver disease that has led to cirrhosis. Ascites can also be caused by cancer, heart failure, kidney disease, or pancreatic disease.

How does my doctor tell if I have ascites?

Severe cases of ascites are easily noted during a physical exam. However, your doctor will want to perform one or more of the following tests to diagnose or confirm ascites:

  • An ultrasound, which uses sound waves to create images of the inside of your body.
  • A computerized axial tomography (CT) scan, which is an X-ray that provides images of the inside of your abdomen, showing your liver, spleen, fluid, etc.
  • Paracentesis, which is a procedure to collect a sample of the fluid in the abdomen for laboratory analysis. This is the most important test to also identify the cause of the problem.

How is ascites treated?

Treatment focuses on the underlying cause. For example, some patients may need cancer treatment, or treatment for heart failure.

If the ascites is due to chronic liver disease (cirrhosis) the following measures should help:

  • A low-sodium diet (typically a limit of about 2 grams of salt daily)
  • Diuretics ("fluid pills") to improve fluid loss by increasing urine production. These include:
    • Spironolactone (Aldactone)
    • Furosemide (Lasix)
  • Bed rest a few times daily for an hour at a time
  • Large-volume paracentesis, in which large amounts of fluid (5 to 10 liters or more) are drained from the patient's abdomen with a needle. In some cases, the fluid will need to be removed in several sessions.
  • Antibiotics may also be needed to prevent infection. These are usually taken one or two times a week.

In severe cases, other procedures may be required. These include using a shunt to improve blood flow in the liver (known as TIPS), or a liver transplant.

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