What is ascites?
Ascites is swelling of your belly (abdomen) with fluid. It is a complication of decompensated cirrhosis.
It is a serious symptom of liver disease.
In most cases the ascites can be controlled with medicine. But sometimes you may need hospital treatment to drain the fluid. In most cases you will not need to stay in hospital overnight. The fluid can be drained as an outpatient. But it often comes back again. You may need to take medicines or make changes to your diet to help manage ascites.
What causes ascites?
Scarring and portal hypertension
If you have cirrhosis, your liver has permanent scars caused by damage over a long time. This can make it hard for blood to flow through the main vein in your liver. Which causes a build-up of pressure in the blood vessels in your liver.
This problem is called “portal hypertension”.
The pressure of portal hypertension forces fluid out of your blood vessels into your belly (abdomen).
If this pressure stays high, your liver will also start to change how it manages fluid and salt. This will mean your body does not get rid of as much fluid as it should. Instead the fluid builds up in your belly.
Reduced albumin
A healthy liver makes albumin. Albumin is a protein which helps stop fluid from leaking out of your blood vessels. Damaged livers tend to make less albumin. Which means blood vessels are more likely to leak. This can also contribute to ascites.
What are the symptoms of ascites?
The main sign of ascites is a swollen belly.
Early signs
It can be hard to notice changes in your belly at first. You might feel or see a new heavy, sagging weight around your middle. Or your belly might move in an unusual, wave-like motion when prodded or pushed.
Later signs
In the later stage of ascites your belly might be very obvious. It might feel hard or tight.
When to talk to your doctor
If you have a liver condition, contact your doctor as soon as possible if you get any of these symptoms:
- a swollen or extended belly (abdomen)
- swelling in your legs
- bruising easily
- changes to your belly button
- loss of appetite
- sudden weight gain
- difficulty breathing (especially when lying down)
- abdominal pain
- feeling or being sick (nausea or vomiting)
fever and pain in your belly (these could mean you have an infection)
How is ascites diagnosed?
Your doctor might suggest an ultrasound or CT scan to confirm that you have ascites.
If your ascites is more advanced, then you might not need scans. Your doctor will be able to diagnose ascites from your symptoms and medical history.
Treatment for ascites
Dietitians
If you have ascites you should talk to your medical team for personal advice. Ask them if you can be referred to a registered NHS dietitian.
Dietitians are the experts in diet for people with medical conditions. Some dietitians specialise in helping people with liver and other digestive problems. They will be able to help you cut down on salt while still getting all the other nutrients you need.
Diuretic medicines
Sometimes called water tablets
As well as reducing salt you might be given a medicine called a diuretic. The diuretic helps to remove salt and water from your body. This will cause your body to lose water by peeing more.
It is usually best to take your diuretic in the morning. So you do not have to make lots of trips to the toilet at night.
Antibiotic medicines
Sometimes you can get an infection in the fluid in your belly. If this happens, you will need antibiotics to treat the infection.
In some cases you might be offered antibiotics to prevent an infection. For example:
- If you are at high risk of an infection because of severe liver disease.
- If you have had an infection of your ascites before.
- If it is important that you do not get an infection because you are on the transplant list. Or you are waiting for a TIPS procedure.
Paracentesis (draining fluid)
If you have a lot of fluid in your belly it can be drained. This is called paracentesis. You might also hear it being called a drain.
You will be given a local anaesthetic to numb the skin. You will be awake and might feel some pushing or tugging but should not feel any pain.
A needle is put into your belly to draw out the liquid. Paracentesis can remove a lot of fluid from your body. It can also be repeated when necessary. But you will usually have to go to hospital to have it done.
Taking out too much liquid can affect your blood pressure. So your medical team will find a balance where they can safely take as much fluid as possible. The drain should not stay in place for more than 6 hours.
If ascites keeps coming back, you might have regular appointments at your hospital’s ascites clinic to get the fluid drained.
Albumin infusions
Albumin is an important protein in your blood, that is made by your liver. If you have cirrhosis your liver might not make enough albumin. This can be one of the causes of ascites. So you may be offered an albumin infusion to increase the amount of albumin in your blood.
The infusion will be a drip. This is usually given through a needle put into your arm. You might have an albumin infusion at the same time as paracentesis (a drain).
TIPS procedure
TIPS stands for transjugular intrahepatic portosystemic shunt or stent. It is a surgical procedure to reduce portal hypertension by inserting a small tube (called a shunt or stent) into the veins in the liver. This creates a new way for blood to get through your liver. It should reduce the pressure and stop you getting ascites.
Your doctor might consider a TIPS procedure if you have ascites that keeps coming back. This is called refractory ascites. Because it is a surgical procedure, not everyone can have it
Living with ascites
Ascites is a common problem for people with decompensated liver disease. It can be very difficult. But there are some things that you can do to help manage it:
- do not drink alcohol
- talk to a registered dietitian to get advice on what to eat
- reduce the salt in your diet
- follow the instructions on any medicines you are given and take them regularly
Getting support
Living with ascites can be challenging. It can help to talk to other people who have a similar experience. The British Liver Trust also offers a variety of support. Including support groups and an online forum.
We also have a nurse helpline.
Find out more about how we can support you here.
We also offer support to those closest to someone with a liver condition. You can find more information in our Family, friends, and carers section.
More information:
- Living with a liver condition
- Diet and cirrhosis
- Coping with eating difficulties
- Cirrhosis
- Complications of decompensated cirrhosis
Special thanks
We would like to thank all of the medical specialists, and people with personal experience of cirrhosis who helped us to plan, develop, and review this information.
Including members of our patient advisory group, Jennifer Voller, Michael Kennedy, Dr Victoria Kronsten, Senior Clinical Research Fellow in Hepatology, King’s College Hospital, Katharine Caddick, Consultant Nurse, North Bristol Trust, Maria-Emanuela Maxan, Senior Clinical Research Fellow in Hepatology, King’s College Hospital and Dr Vishal Patel, Consultant Hepatologist, Kings College hospital.
Published: March 2025
Support for you
Find out more
Living with a liver condition
Find out more
Information for families and carers
Find out more