Diagnosis
To diagnose ascites, your healthcare professional will ask about your symptoms and perform a physical exam. The exam may include pressing your abdomen to check for signs of fluid. Larger amounts of fluid are easier to detect during an exam.
Tests and procedures that help diagnose ascites include the following:
Imaging tests
Imaging tests are often used to confirm ascites. An abdominal ultrasound is usually the first test. It can detect even small amounts of fluid and show where fluid has collected. During this test, ascites appears as fluid collecting around the abdominal organs rather than inside them.
In some cases, a CT scan is used to get a closer look at the abdomen and nearby organs. Imaging reports may mention free fluid, which means fluid is present in the abdominal cavity.
On imaging tests, a small amount of fluid in the pelvis can sometimes be a regular finding in women. In men, visible fluid is not expected. A healthcare professional looks at how much fluid is present and whether symptoms are occurring.
Blood tests
Blood tests can help find possible causes of ascites. These tests may check kidney and liver function, look for signs of infection, and measure protein levels in the blood.
Diagnostic paracentesis
Most people with ascites also have a procedure called diagnostic paracentesis. In this procedure, a thin needle removes a small amount of fluid from the abdomen. The fluid is tested for protein content, infection, cancer and other conditions.
Healthcare professionals often use a combination of exam findings, imaging, blood tests and fluid tests to confirm ascites and find its cause. This helps them understand the cause and plan the best treatment for you.
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Treatment
How ascites is treated depends on why the fluid is building up and how much there is. The main goals are to ease symptoms, lower the amount of fluid and address the underlying cause.
Medicines
If ascites is related to liver disease, treatment usually begins with medicines and diet changes. Your healthcare professional may prescribe medicines called diuretics. These help your body remove extra salt and water through urine. In addition, eating less salt helps your body hold on to less fluid.
Managing the underlying liver disease also is an important part of treatment. Managing liver disease may help lower fluid buildup over time and reduce the chance that ascites will return.
Treatment for ascites caused by other conditions focuses on managing the underlying issue. For example, cancer-related ascites may be treated with cancer therapies and medicines. Heart-related ascites may improve when heart failure is treated.
Surgery or other procedures
If excess fluid is making you uncomfortable or making it hard to breathe, your care team may need to remove some of the fluid from your belly. This procedure is called therapeutic paracentesis. A thin needle is used to drain the extra fluid, which can help relieve symptoms. The procedure is done by a trained healthcare professional, often with ultrasound guidance to improve safety. After fluid is drained, ascites may return, especially if the underlying cause is still present.
In some cases, albumin may be given after paracentesis of large volumes of fluid to help prevent circulation problems, support fluid balance and protect kidney function.
For people with advanced liver disease, a transjugular intrahepatic portosystemic shunt (TIPS) may be considered. This procedure creates a new pathway for blood to flow through the liver, which can lower pressure and help reduce fluid buildup.
If you have serious liver disease, a liver transplant might be an option. Your care team will look at your overall health to decide if a transplant is an option for you.
Clinical trials
Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.
Lifestyle and home remedies
Making changes to your daily habits can support medical treatment for ascites.
- Limit salt. Eating too much salt makes your body hold on to extra fluid. Following a low-sodium diet can help lower fluid buildup. Many people with ascites are advised to limit sodium to less than about 2,000 milligrams a day.
- Check your weight regularly. If you take diuretics, your healthcare team may recommend weighing yourself daily while your dose is being adjusted. Let your healthcare team know if you gain weight quickly or notice more swelling.
- Avoid alcohol if you have liver disease. Alcohol can worsen liver damage and increase complications.
Coping and support
Living with ascites can be stressful, especially when symptoms change or make daily life harder. It's natural to feel worried or overwhelmed sometimes. Here are some strategies that may help:
- Learn about your condition. Understanding ascites and its management can help you feel more involved in your care. Ask your healthcare team questions and share concerns.
- Stay connected with your healthcare team. Regular follow-up visits help keep track of symptoms and adjust treatment when needed.
- Reach out for support when you need it. Family, friends or caregivers can help with daily chores, getting to appointments and offering emotional support.
- Consider counseling or support groups. Talking with others, including those who have chronic illnesses, can help you feel less alone.
If ascites is linked to a long-term condition, your healthcare team can help connect you with more resources as needed.
Preparing for your appointment
Often, your first step is to see your primary healthcare professional. You may then be referred to a specialist, such as a liver specialist called a hepatologist, depending on what is causing the ascites.
To help make the most of your appointment, you may want to:
- Write down your symptoms. Include when they began, how often they happen and if they are getting worse.
- Keep track of any changes in your weight or swelling. This helps your healthcare team understand changes in fluid buildup.
- Make a list of all medicines and supplements you take. This includes prescriptions, medicines you can buy without a prescription, vitamins and herbal products.
- Bring key medical information. Note any liver disease, heart disease, cancer or past infections, including hepatitis.
- Consider bringing a family member or friend. Another person can help remember information and offer support.
- Write down any questions you have. This helps make sure your concerns are discussed during your visit.
Your healthcare professional may ask questions such as:
- When did you first notice swelling in your belly or weight gain?
- Have your symptoms changed over time?
- Do you have a history of liver disease, heart disease or cancer?
- What medicines or supplements do you take?
- Do you drink alcohol, or have you in the past?
Getting ready ahead of time can help you feel more confident and make your appointment go more smoothly.