What is Ascites?

Ascites occurs when fluid accumulates in the abdomen. This buildup occurs between two layers of membranes that together form the peritoneum, a smooth sac that contains the organs of the body. A small volume of fluid is normal in the peritoneum cavity.

Symptoms

Ascites is generally followed by a feeling of fullness, a ballooning belly and a rapid increase in weight. Other symptoms often include:

• Shortness of breath
• Nausea
• Swelling in legs and ankles
• Indigestion
• Vomiting
• Heartburn
• Loss of appetite
• Fever
• Hernia

If you have a combination of these symptoms, see your doctor. If you have ascites, this is also a symptom of liver failure, which happens with cirrhosis most frequently.

When to call your doctor

Symptoms of ascites may occur either gradually or abruptly, depending on the fluid buildup.

Symptoms do not necessarily signify an emergency but if you encounter the following, you should talk to your doctor:

• A distended, or swollen, abdomen
• Sudden weight gain
• Difficulty breathing when lying down
• Diminished appetite
• Abdominal pain
• Bloating
• Nausea and vomiting
• Heartburn

Bear in mind that other conditions may be causing ascites symptoms.

Causes

Many underlying diseases, including tuberculosis, kidney disease, pancreatitis and an underactive thyroid, can be responsible for causing ascites. However, ascites are primarily caused by heart failure, cirrhosis, and cancer.

Ascites may develop if cancer affects the:

• Peritoneum
• Liver
• Lymphatic System
• Ovaries
• Breast
• Bowel
• Stomach
• Pancreas
• Lung
• Womb

Risk factors

Common risk factors for ascites development are any diseases which can cause liver cirrhosis. These include hepatitis B, hepatitis C, and alcoholism/alcohol abuse. Other diseases that lead to fluid buildup are congestive heart failure and kidney failure. Cancers of organs in the abdomen also may lead to ascites.

Natural Ways to Manage Symptoms

1. Restrict Salt

Salt restriction is associated with a lower diuretic requirement, faster resolution of ascites and shorter hospitalization for those with cirrhotic ascites, according to a randomized study from 1986 published in Gut. Half of the participants were given a low sodium diet of 21 mmol per day and the other half was unrestricted on sodium intake. Both groups received diuretics. While this is an older study, the American College of Gastroenterology states: “The most important step to treat ascites is to strictly reduce salt intake,” placing salt restriction at the top of the list.

Following a high blood pressure diet that focuses on eating fresh vegetables and fruit, lean proteins and legumes, healthy fats, sprouted whole grains, and organic dairy products, along with limiting any excess salt in the diet may help relieve fluid retention.

2. Eat More, Smaller Meals

If appetite is low, which is common for those with ascites, try eating small meals four to seven times a day as recommended by the U.S. Department of Veterans Affairs. Try a recipe for a high protein smoothie and dive into a nutrient-dense high-protein Buddha bowl for dinner. Some individuals may benefit by obtaining protein from plant sources including nutritional yeast, ancient grains, vegetables, legumes and dairy products instead of meat.

3. Avoid Toxins and Chemicals

Eat organic whenever possible as when the liver is damaged and not functioning optimally, it cannot properly detoxify and clear toxins from the blood. As it builds up, the toxins can move to the brain causing a condition called hepatic encephalopathy.

Complications

Complications associated with ascites include:

• Abdominal pain
• Pleural effusion, or “water on the lung”; this can lead to difficulty breathing
• Hernias, such as inguinal hernias
• Bacterial infections, such as spontaneous bacterial peritonitis (sbp)
• Hepatorenal syndrome, a rare type of progressive kidney failure

Treatments

Your doctor may prescribe “water pills,” also called diuretics, to help flush the extra fluid from your body.

Two of the most common diuretics are:

•    Furosemide (Lasix)

•    Spironolactone (Aldactone)

They both help your kidneys remove more sodium and water.

If the change in diet and prescription diuretics isn’t effective or your symptoms are severe, your doctor may have to use paracentesis to remove large amounts of excess fluid through a needle inserted into your abdomen. This procedure must be combined with a low-salt, low-liquid diet; otherwise, the fluid will simply come back.

If these treatments don’t work, you may need surgery to place a shunt in your liver or replace it altogether.

Prevention

Weigh yourself daily Call your doctor if you gain more than 10 lbs (or more than 2 lbs per day on 3 consecutive days).

Limit the amount of alcohol you drink: Better yet, do not drink any alcoholic beverages at all. Reducing the amount of alcohol you drink reduces the risk of developing ascites.

Limit the use of nonsteroidal anti-inflammatory drugs (NSAIDs): Ibuprofen, aspirin, indomethacin, sulindac are examples of NSAIDs. These drugs affect the kidneys, causing water and salt to be retained by the body.

Follow guidelines for a low-salt diet: Recommended limits are 2,000 mg or less a day.