Ascites: A simple guide to causes, symptoms, and treatment

Have you ever had a swollen belly, clothes getting tight, and feeling like you're full of water? Sometimes this is normal, but sometimes it can be a sign of a serious health problem. Today we're going to talk about one such condition, "Ascites." This is when fluid, or simply water, accumulates in the empty space around the organs in our abdomen.

What exactly is ascites?

Simply put, ascites is an abnormal accumulation of fluid in the space between the abdominal cavity (peritoneum) and the abdominal organs. This does not normally occur in a healthy person. Just because there is a little water in the abdomen does not mean it is ascites. Doctors define this condition as ascites when there is at least 25 milliliters (0.8 ounces) of fluid.

This condition is most common in people with severe liver disease. About 80% of people with ascites have cirrhosis of the liver. In addition, ascites can also be caused by other conditions, such as cancer, heart disease, tuberculosis, and kidney disease.

What are the symptoms of this condition?

Ascites may not show any major symptoms at first. Because the amount of water that accumulates in the abdomen is small, you may not notice it. But as the amount of water that accumulates gradually increases, you will notice that your abdomen is getting bigger and bloated. Your pants will start to feel tight.

Below are some symptoms that can help you clearly identify this condition. See if you have one or more of these.

What are the main causes of ascites?

As we mentioned earlier, the main cause is cirrhosis of the liver. But how does this happen?

Think of our liver as a filter. It is the main blood purifier in the body. The main vein that brings blood to the liver is called the Portal Vein. When the liver is damaged due to cirrhosis, the blood flow through this vein is obstructed. Just like when a water pipe gets stuck in the middle, the blood cannot flow through the liver and the pressure increases.

This increased pressure can also affect the kidneys over time. When the kidneys are unable to properly remove the extra salt from the body, water begins to accumulate in the body. That extra water leaks out of the blood vessels and accumulates in the stomach.

Other reasons:

• Cancer: Some cancers that occur in the abdomen can also cause fluid to accumulate in the abdomen. The cancer cells themselves release fluid into the abdominal cavity.
• Heart failure: In some severe heart failure conditions, the heart is unable to pump enough blood. The body then produces hormones to try to retain fluid. This fluid can also accumulate in the abdomen.

How to diagnose this condition?

When you go to the doctor, he will examine you and ask about your symptoms. Then, he may do some tests to confirm the condition.

• Paracentesis: This involves the doctor inserting a very fine needle into the abdomen and taking a small amount of fluid that has collected there for testing. This fluid can be tested to see if there are any infections or cancer cells.
• Blood tests: These can help determine if you have other medical conditions, such as diabetes, or if you have an infection.
• Imaging tests: An X-ray, ultrasound scan, or CT scan can clearly see the condition of the organs inside the abdomen.
• SAAG test: This is a special test. It compares the levels of a protein called albumin in your blood and the fluid in your stomach. Albumin is a type of protein made by the liver. If this value is high, it means that the pressure in the veins that bring blood to the liver is increased.

What are the treatments for ascites?

Treatment depends on the cause of ascites. However, the general goal is to reduce the amount of fluid that accumulates in the abdomen.

1. Sodium reduction: Salt is a major cause of water retention in the body. Your doctor or nutritionist will advise you on a low-salt diet.

• Reduce packaged foods, store-bought foods, and sauces as much as possible.
• Eat more fresh vegetables and fruits.
• Use spices (turmeric, pepper, cumin) instead of salt to flavor food.

2. Diuretics: Your doctor will prescribe medications that help you get rid of excess water and salt in your body through urine. Two of the most commonly used are Furosemide (Lasix) and Spironolactone (Aldactone). These should only be taken under medical supervision.

3. Paracentesis: This is both a test and a treatment. If there is a lot of fluid in the abdomen, a needle is inserted to remove the fluid to reduce swelling. However, this can cause the fluid to build up again.

4. Shunts and surgery: If other treatments fail to control the condition, your doctor may resort to these options.

• TIPS (Transjugular intrahepatic portosystemic shunt): This involves placing a small mesh tube (stent) inside a vein in the liver to facilitate blood flow.
• Liver transplant: If the liver has become almost completely dysfunctional due to cirrhosis, the last resort is a transplant of a healthy liver.

How can this situation be protected and controlled?

There are several things you can do to prevent ascites from occurring and to control its worsening if the condition is present.

• Stop drinking alcohol completely:Alcohol is the main thing that damages the liver.
• Limit salt: Doctors advise not to consume more than 2,000-4,000 milligrams of salt per day.
• Maintain a healthy weight: Obesity is a risk factor for ascites. If you have ascites, weigh yourself every morning and record your weight. If you gain more than 1 kilogram (2.2 pounds) per day for three consecutive days or if you suddenly gain more than 4.5 kilograms (10 pounds), tell your doctor right away.
• Healthy lifestyle: Eat a balanced diet, exercise, and avoid smoking.
• Safe sex: Viral infections such as Hepatitis B and C can occur. These can damage the liver and lead to cirrhosis.

When should you see a doctor?

Seek medical advice immediately if you have these symptoms:

• If you suddenly gain weight
• If the stomach gets bigger
• If you have new or worsening stomach pain
• If you have a fever

In the following severe cases, go to a hospital's Emergency Department (ETU) immediately:

• If you have severe difficulty breathing
• If you vomit blood or something that looks like coffee grounds

Ascites is a serious condition. It means your liver is not working properly. So don't ignore the symptoms. With proper treatment and lifestyle changes, you can control this condition, prevent possible complications, and stay healthy.