Is your stomach getting bigger as if it's full of water? Let's talk about this abdominal swelling (ascites)

Have you ever felt like your stomach suddenly gets bigger like a water balloon, and you feel like you're gaining weight? Even the clothes you're wearing start to feel tight... This is not just a normal bloating. This condition can be serious. In medical terms, we call this ascites, or ascites. Today, we'll talk about this very simply, in a way that you can understand.

What is this abdominal fluid (ascites)?

Simply put, ascites is the accumulation of excess fluid, such as water, inside your abdomen, that is, inside your abdominal cavity. Now you may be wondering how water gets into your abdomen.

Imagine, there is a very thin membrane called "peritoneum" around the important organs in our abdomen like the liver, intestines, and kidneys. It's like a polythene sheet wrapped around vegetables. It has two layers. Normally, there is a very small amount of fluid between these two layers to prevent the organs from bumping into each other when they move around. But in the case of ascites, the space between these two layers fills up with too much water. Then the abdomen becomes swollen and looks like it has swallowed a watermelon or a basketball. This makes it very difficult to walk or even sit.

Why does this happen? What are the main reasons?

The main and most common cause of ascites in the world is cirrhosis of the liver . Cirrhosis is a condition in which the liver is damaged and scarred due to various causes, especially alcoholism, certain viral infections (Hepatitis B, C), and fatty liver. The liver becomes hard and hard like a rock and cannot function properly.

Now let's see how cirrhosis causes water retention in the stomach.

There is a main blood vessel that carries blood containing nutrients from our intestines to the liver. This is called the Portal Vein. When the liver becomes stiff due to cirrhosis, this blood vessel is prevented from carrying blood properly. Then the blood pressure inside this vein increases excessively. We call this Portal Hypertension .

This high pressure sends the wrong signal to the kidneys, which think the body needs salt (sodium) and water, and instead of expelling them, they start to retain them. Over time, the extra salt and water that accumulates in this way begin to leak from the blood vessels into the abdominal cavity due to the high pressure. This is how ascites develops.

Besides cirrhosis, there are other causes of ascites.

What are the symptoms of ascites? How do you recognize it?

There are several symptoms that a person with this condition can immediately feel and see.

• Abdominal bloating and rapid weight gain: This is the main symptom. You may gain as much as one or two kilos in a short period of time, perhaps three days.
• Swelling of the legs: Swelling, especially in the ankle area. We call this (Edema).
• Difficulty breathing: When the stomach fills with water, it pushes up on the chest. This makes it difficult for the lungs to inflate properly. You may feel wheezy and have difficulty breathing even when walking or climbing stairs.
• Digestive system problems: Bloating, stomach pain, loss of appetite, and constipation may occur because the stomach fills with water and puts pressure on the intestines.
• Back pain: The extra weight in the stomach can put pressure on the back and cause back pain.
• Fatigue: You may feel tired all the time due to physical discomfort and underlying medical conditions.

What are the complications that can occur due to this condition?

Ascites is not just a condition where the abdomen becomes enlarged. If not treated properly, it can lead to serious complications.

• Infections: There is a high chance that germs can enter the fluid that has accumulated in the abdomen and cause an infection. We call this (Spontaneous Bacterial Peritonitis). Then you may experience fever and severe abdominal pain. This is an emergency that can even be life-threatening.
• Hepatic Hydrothorax: Sometimes, fluid from the abdomen can leak into the chest and collect around the lungs, making breathing more difficult.
• Hernias: As pressure inside the abdomen increases, the intestines can protrude through weak spots in the abdomen (e.g., the navel). We call this a hernia.
• Kidney failure: When cirrhosis of the liver becomes severe, it can also affect the functioning of the kidneys and even lead to kidney failure.

How does a doctor find this?

If you have these symptoms, when you see a doctor, he will take several steps to confirm the condition.

1. Physical examination: First, your doctor will examine you. They will feel your abdomen and check for fluid. They will also check for swelling in your liver and legs.

2. Blood tests: Several blood tests will be done to check how the liver and kidneys are functioning and the amount of salt in the blood.

3. Scans: An ultrasound scan or CT scan can be done to see exactly how much water is in the stomach, what the condition of the liver is, and whether there are any other problems.

4. Paracentesis: This is a very important test. In this, the skin of the abdomen is numbed, a small needle is inserted into the abdomen, and a sample of the accumulated fluid is taken and sent to the laboratory. This can help determine whether the cause is cancer or infection.

What are the treatments for ascites?

There are two main goals of treatment. One is to reduce the amount of water that has accumulated in the abdomen, and the other is to treat the underlying disease that caused the ascites.

Initial treatment

Doctors try these methods first.

• Salt (sodium) control: This is the most important and number one treatment . Salt is the main cause of water retention in the body. Therefore, it is advised to reduce the amount of salt consumed per day to less than 2000 milligrams. This means that you need to reduce the amount of salt added to your food, and you need to completely stop eating foods that are high in hidden salt, such as dried fruits, jams, sauces, pickles, tipitips, sausages, and store-bought soups.
• Diuretics (or "water pills"): We usually prescribe medications called "diuretics" that help the body eliminate excess water and salt through urine.

Advanced treatment methods

Sometimes, even controlling salt intake and taking water pills may not reduce the amount of water in the stomach. In such cases, other treatments may be needed.

• Paracentesis: This is both a test and a treatment. A large amount of fluid (sometimes as much as 5-10 liters) in the abdomen can be removed with a needle. This provides quick relief. This can be done repeatedly if necessary.
• Transjugular Intrahepatic Portosystemic Shunt (TIPS): This is a slightly more complex treatment. It involves creating a new path (shunt) for blood to flow through the liver. It's like a bypass to bypass a traffic jam. This reduces the pressure on the liver and controls the fluid buildup. It's recommended for people who can't control it with other treatments.
• Liver Transplant: For those with very severe cirrhosis and those who have not responded to other treatments, a liver transplant may be the only solution.

When should I see a doctor?

You need to be very careful about these things.

What can I do to prevent and manage this condition?

The best way to prevent ascites is to take care of your liver.

• Avoid alcohol: Alcohol consumption should be completely stopped. Alcohol is the main thing that damages the liver.
• Avoid eating too much salt: As we discussed earlier, avoiding too much salt is essential for controlling ascites.
• Maintain a healthy weight: Controlling body weight can prevent fatty liver.
• Exercise: It is important to engage in some physical activity every day.
• Protect yourself from Hepatitis B and C: These are viruses that damage the liver. There is a vaccine for Hepatitis B. You can protect yourself from these by following safety measures.

If you already have ascites, definitely do these things.

• Weigh yourself every day: Weigh yourself every morning at the same time, without clothes or in the same clothes, and write it down in a book. If you gain more than one kilogram per day for three days in a row, tell your doctor.
• Be careful with painkillers: Avoid using non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, diclofenac, and aspirin, as these can increase water and salt retention in the body. If you need to take medication for any pain, ask your doctor about it.

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