Understanding Ascites: Causes, Symptoms, Treatment and Prevention

Ascites is an abnormal buildup of fluid in the abdomen. It can cause the belly to swell, increase body weight and make everyday activities uncomfortable. Although several health conditions can cause abdominal fluid buildup, ascites is most commonly associated with cirrhosis, a condition in which the liver becomes permanently scarred and damaged. Other possible causes include heart failure, kidney disease, infection and cancer.

Ascites is a common complication of cirrhosis and an important sign that liver disease may be progressing. Each year, an estimated 5% to 10% of people with compensated cirrhosis—a form of cirrhosis that has not yet caused certain major complications—develop ascites. In a patient with cirrhosis, new or worsening fluid in the abdomen should be evaluated by a physician because it may indicate that the liver disease has become more advanced.

What Is Ascites?

Ascites is the accumulation of fluid in the space surrounding the organs inside the abdomen (peritoneal cavity). Small amounts of fluid normally help tissues and organs move smoothly against one another. With ascites, however, excess fluid collects in this space and may cause noticeable abdominal swelling.

Ascites is different from ordinary bloating or weight gain. Bloating is often related to gas or digestive changes and may come and go. Ascites fluid can continue to accumulate because of an underlying medical condition. As fluid accumulates, the waistline may expand and the abdomen may feel full or tight. Rapid weight gain can also occur. More significant fluid buildup can make the abdomen visibly enlarged and may eventually interfere with eating, movement or breathing.

Ascites may be described according to the amount of fluid in the abdomen:

Mild ascites – May be detectable only through an imaging test such as an ultrasound
Moderate ascites – Causes noticeable, symmetrical swelling of the abdomen
Large or severe ascites – Causes marked abdominal swelling and may significantly affect comfort and daily activities

Ascites may also be described by how it responds to treatment. Recurrent ascites repeatedly returns despite treatment, while refractory ascites cannot be adequately controlled or quickly returns despite appropriate medical treatment.

The course of ascites varies from person to person and depends largely on its underlying cause. When ascites occurs because of cirrhosis, it is considered a form of hepatic decompensation, meaning the damaged liver is beginning to cause significant complications. This does not necessarily mean the liver has completely stopped working. However, abdominal swelling from liver disease is an important development that may require changes in treatment and, in some cases, consideration of a liver transplant evaluation.

What Causes Ascites?

Ascites develops when an underlying health condition disrupts the body’s normal balance of fluid and pressure, allowing excess fluid to collect in the abdomen. Cirrhosis and the resulting increase in pressure within the blood vessels around the liver, known as portal hypertension, are the most common causes. However, ascites can also develop because of conditions affecting the heart, kidneys or abdominal cavity.

Possible causes of ascites include:

Cirrhosis and other forms of advanced liver disease – Scarring from cirrhosis can change blood flow through the liver and lead to portal hypertension and fluid retention.
Heart failure – If the heart is unable to pump blood effectively, pressure can build in the veins and contribute to fluid accumulation, including fluid in the abdomen.
Kidney disease – Severe kidney problems can interfere with the body’s ability to regulate sodium and fluid levels, potentially contributing to fluid buildup.
Cancer – Certain cancers, particularly those involving organs or tissues in the abdomen, can cause cancer-related ascites.
Infection or inflammation – Infections and inflammatory conditions affecting the abdominal lining can sometimes cause ascites.
Other conditions – Less common causes include problems with blood flow through the liver, pancreatic disease and certain conditions that affect protein levels or the lymphatic system.

Identifying the underlying cause of ascites is important because treatment for abdominal fluid buildup can vary depending on the condition responsible for it.

What Causes Fluid to Build Up in the Abdomen?

Fluid can accumulate in the abdomen when changes in blood vessel pressure, fluid balance or organ function cause fluid to move out of the bloodstream and into the abdominal cavity. The kidneys may also retain additional sodium and water, adding to the buildup.

The exact process depends on the underlying condition. With cirrhosis, for example, increased pressure in the portal venous system and changes in circulation can cause the body to retain sodium and water. Heart failure can cause pressure to back up in the veins, while kidney disease can make it more difficult for the body to remove excess fluid. Cancer or infection may cause fluid to accumulate through different mechanisms involving inflammation, the abdominal lining or the lymphatic system.

How Does Liver Disease Cause Fluid Buildup?

Cirrhosis causes scar tissue to replace healthy liver tissue. This scarring can make it more difficult for blood to flow normally through the liver. As a result, pressure may rise in the portal vein, a major blood vessel that carries blood from the digestive organs to the liver.

Portal hypertension is a major reason ascites develops in patients with cirrhosis. At the same time, changes in circulation can signal the kidneys to retain more sodium and water. Together, increased pressure and fluid retention can allow ascites fluid to accumulate in the abdominal cavity.

Abdominal swelling from liver disease is not simply the result of the liver “holding” fluid. Instead, it reflects changes in blood flow, pressure and the way the body regulates sodium and water as liver disease progresses.

Is Ascites a Sign of Liver Failure?

Ascites can be a sign of advanced liver disease, but having ascites does not always mean the liver has completely failed. Ascites can have causes unrelated to the liver, and even when cirrhosis is responsible, liver function can vary considerably.

For patients with cirrhosis, however, developing ascites is an important change. It is considered a sign of decompensated cirrhosis, meaning liver disease has progressed to the point of causing significant complications. Other complications of decompensated cirrhosis can include internal bleeding from enlarged veins (varices) and hepatic encephalopathy, which can cause confusion and cognitive changes.

New, worsening or recurrent ascites in a patient with cirrhosis warrants medical evaluation. Treatment can help manage the fluid buildup and its complications, while an evaluation of the underlying liver disease can help determine whether more advanced treatments, including liver transplant evaluation, should be considered.

What Are the Risk Factors for Ascites?

Because cirrhosis is the most common cause of ascites, factors associated with advanced or worsening liver disease can increase the likelihood of developing abdominal fluid buildup. The risk generally rises as liver scarring progresses and portal hypertension becomes more severe.

For patients with cirrhosis, factors that may increase the risk of developing or worsening ascites include:

Progression of liver disease – More advanced cirrhosis and worsening portal hypertension make ascites more likely.
High sodium intake – Too much sodium can contribute to fluid retention and make existing ascites more difficult to control.
Kidney dysfunction – Changes in kidney function can interfere with the body’s ability to regulate sodium and water, contributing to fluid retention.
Certain medications – Some medicines, particularly nonsteroidal anti-inflammatory drugs (NSAIDs), can affect kidney function and make it more difficult for the body to eliminate sodium and water.
Infections and other acute illnesses – In patients with cirrhosis, an infection or another significant illness can worsen liver function and contribute to complications, including ascites.

A patient with cirrhosis should work with a physician to monitor for signs of decompensation, including new or worsening abdominal swelling, and manage factors that could contribute to fluid retention.

What Are the Potential Complications of Ascites?

Ascites can lead to complications, particularly when it is caused by advanced cirrhosis. As ascites fluid accumulates, it can cause increasing discomfort, limit movement and make eating or breathing more difficult. Cirrhosis-related ascites can also occur alongside other complications of advanced liver disease and portal hypertension.

Other possible complications include:

Spontaneous bacterial peritonitis (SBP) – Ascites fluid can become infected without an obvious source of infection. SBP is a serious complication that requires prompt medical treatment.
Breathing difficulties – A large amount of fluid in the abdomen can push upward on the diaphragm, making it harder to breathe comfortably.
Hepatic hydrothorax – In some patients with cirrhosis, fluid can move through small openings in the diaphragm and collect in the space around a lung. This can cause shortness of breath and other respiratory symptoms.
Kidney problems – Advanced cirrhosis and changes in circulation can reduce blood flow to the kidneys. In severe cases, a serious form of kidney dysfunction known as hepatorenal syndrome may develop.
Electrolyte imbalances – Cirrhosis, ascites and some treatments for fluid retention can affect levels of sodium and other electrolytes in the blood.
Umbilical hernia – Increased pressure in the abdomen can contribute to a hernia near the belly button, particularly when ascites is severe or persistent.
Malnutrition and muscle loss – Abdominal fullness may reduce appetite or make it difficult to eat enough food, contributing to inadequate nutrition and loss of muscle mass.

The potential for these complications is one reason ongoing medical care is important for patients with cirrhosis-related ascites. Treatment focuses not only on reducing fluid in the abdomen but also on monitoring liver and kidney function, preventing or treating infection and addressing the underlying liver disease.

When Does Ascites Become Serious?

Ascites becomes particularly concerning when fluid accumulates rapidly, repeatedly returns after treatment, does not respond adequately to medication or causes significant discomfort or breathing problems. It also requires prompt medical attention when there are signs of infection or other complications.

For a patient with cirrhosis, the development of ascites is itself an important sign that the disease has progressed from compensated to decompensated cirrhosis. Recurrent or difficult-to-control ascites may indicate more advanced disease and can prompt consideration of additional treatments or evaluation for liver transplantation.

What Are the Warning Signs and Symptoms of Ascites?

Ascites symptoms can range from mild abdominal fullness to significant swelling that affects eating, movement and breathing. When only a small amount of ascites fluid is present, there may be few noticeable symptoms. As fluid in the abdomen increases, symptoms generally become more apparent.

Early or common symptoms may include:

Increasing abdominal size or a growing waistline
Abdominal fullness, pressure or tightness
Bloating that persists or worsens
Unexplained or rapid weight gain
Abdominal discomfort
Reduced appetite or feeling full after eating a small amount

As more fluid accumulates, symptoms may become more pronounced, such as:

Significant abdominal swelling or distention
Difficulty moving or performing everyday activities comfortably
Shortness of breath, particularly when a large amount of fluid pushes upward against the diaphragm
Swelling in the legs, ankles or feet (edema)

The progression of ascites depends on its underlying cause and severity. Fluid may accumulate gradually or become noticeable over a shorter period. Symptoms can also overlap with other conditions. For example, early abdominal swelling may initially seem like ordinary bloating or weight gain. Unlike temporary bloating, however, ascites tends to persist or increase as fluid continues to accumulate.

When Should You Seek Medical Care for Ascites?

New or rapidly worsening abdominal swelling should be evaluated by a physician, particularly in a patient with cirrhosis or another form of chronic liver disease. Prompt evaluation can determine whether the swelling is caused by ascites and identify complications that may require treatment.

It is important to seek immediate medical attention for concerning symptoms, including:

Fever or chills
New or worsening abdominal pain or tenderness
Sudden or severe shortness of breath
New confusion, unusual sleepiness or difficulty thinking clearly
Rapidly increasing abdominal swelling
Dizziness, fainting, vomiting blood or black or bloody stools

In a patient with ascites, fever and abdominal pain can be signs of spontaneous bacterial peritonitis, a serious infection of ascitic fluid. Confusion may indicate hepatic encephalopathy or another complication of advanced liver disease. Severe breathing difficulty or signs of gastrointestinal bleeding also require immediate medical attention.

How Is Ascites Diagnosed?

Ascites is diagnosed through a combination of clinical evaluation and, when needed, imaging and testing of the fluid in the abdomen. The diagnostic process also focuses on identifying the underlying cause of the fluid buildup and checking for complications such as infection.
Diagnostic steps may include:

Medical history and symptom review – The physician may ask about changes in abdominal size, recent weight gain, shortness of breath and other symptoms. The evaluation may also include questions about liver disease, heart or kidney conditions, cancer, infections, medications and other factors that could help identify the cause.
Physical examination – The physician will examine the abdomen for swelling, tenderness and other signs that fluid may be present. They may also look for leg swelling and other signs of liver disease and fluid retention.
Blood and urine tests – Lab testing can provide information about liver and kidney function, electrolyte levels and other factors that may help identify the cause of ascites or guide treatment.
Imaging tests – An abdominal ultrasound can detect fluid in the abdomen, including smaller amounts that may not be obvious during a physical examination. A computed tomography (CT) scan or magnetic resonance imaging (MRI) may be used in certain situations to provide additional information about the liver, blood vessels or other structures in the abdomen.
Paracentesis and ascitic fluid analysis – A sample of ascites fluid may be removed with a needle and sent to a laboratory for testing. The results can help determine why the fluid accumulated and whether an infection or another complication is present.

For new-onset ascites, analyzing the abdominal fluid is an important part of determining its cause. The physician may compare the amount of albumin, a type of protein, in the blood with the amount in the ascites fluid. This measurement, called the serum-ascites albumin gradient (SAAG), can help determine whether portal hypertension is contributing to the fluid buildup. Other tests can evaluate the fluid for infection and provide additional clues about the underlying condition.

When Is Paracentesis Needed for Ascites?

Paracentesis involves inserting a thin needle or catheter through the abdominal wall to remove ascites fluid. This procedure may be performed for diagnosis, treatment or both.

Diagnostic paracentesis is generally recommended when ascites develops for the first time. It may also be needed when a patient with cirrhosis and ascites is hospitalized or develops symptoms that could indicate an infection or another complication, such as fever, abdominal pain, confusion, low blood pressure or worsening kidney function.

During diagnostic paracentesis, a small amount of fluid is removed and analyzed. Testing may include a cell count, protein and albumin levels and, when appropriate, a culture to check for bacterial infection. These results can help distinguish portal hypertension-related ascites from fluid buildup caused by another condition and identify spontaneous bacterial peritonitis.

Paracentesis can also be used as a treatment when a large amount of ascites fluid causes significant abdominal pressure, discomfort or difficulty breathing. A large volume of fluid may be drained to help relieve symptoms. Because ascites can return if the underlying condition persists, paracentesis may need to be repeated.

How Is Ascites Treated?

Ascites treatment focuses on reducing fluid in the abdomen, relieving symptoms and addressing the condition causing the fluid buildup. When ascites is related to cirrhosis, treatment also aims to manage complications of advanced liver disease and determine whether additional therapies may be appropriate.

Treatment for cirrhosis-related ascites may involve several approaches depending on the amount of fluid, the patient’s symptoms and their response to treatment.

These may include:

Limiting sodium – Reducing sodium intake can help decrease fluid retention. The physician or a dietitian can recommend an appropriate daily sodium limit while helping ensure nutritional needs are met.
Diuretics – These medications, sometimes called water pills, can help the kidneys remove sodium and water from the body. Spironolactone and furosemide are commonly used to treat ascites related to cirrhosis. Kidney function, electrolyte levels and body weight may be monitored during treatment.
Paracentesis – If a large amount of ascites fluid causes significant swelling, discomfort or breathing difficulty, the physician may drain the fluid through a needle or catheter. Large-volume paracentesis may be needed for severe or difficult-to-control ascites.
Transjugular intrahepatic portosystemic shunt (TIPS) – For some patients with recurrent or refractory ascites, TIPS may be considered. During this procedure, the physician creates a channel in the liver to redirect blood flow and reduce portal hypertension. TIPS is not appropriate for every patient, so the healthcare team will carefully consider its potential benefits and risks.
Liver transplant evaluation – Because ascites can indicate decompensated cirrhosis, evaluation for liver transplantation may be appropriate when liver disease is advanced or ascites is clinically significant, recurrent or difficult to control.

Treatment may also involve managing the underlying cause of liver disease and addressing complications such as infection. Patients with cirrhosis generally require ongoing monitoring for other complications of liver disease, including liver cancer.

Can Ascites Come Back After Treatment?

Yes. Ascites can return after treatment, particularly if the underlying condition causing the fluid buildup persists. Paracentesis, for example, removes fluid from the abdomen and can relieve symptoms, but it does not correct the portal hypertension or advanced liver disease that may be causing the ascites.

If fluid repeatedly returns, the healthcare team may adjust sodium intake recommendations or medications, perform additional paracentesis procedures or consider other treatment options. Ascites that cannot be adequately controlled with sodium restriction and diuretics, or that quickly returns after treatment, may be considered refractory ascites.

Recurrent or refractory ascites can be a sign of more advanced liver disease. In these cases, the healthcare team may consider whether TIPS or liver transplant evaluation is appropriate based on overall liver function, other health conditions and the potential risks and benefits of treatment.

When Would a Liver Transplant Evaluation Be Considered for Ascites?

A liver transplant evaluation may be considered when ascites develops as a complication of cirrhosis because it is a sign of hepatic decompensation. Referral may be particularly important if ascites repeatedly returns despite treatment, does not respond adequately to sodium restriction and diuretics, requires repeated paracentesis procedures or occurs alongside other complications of advanced liver disease, such as hepatic encephalopathy, bleeding from varices or kidney dysfunction.

Referral for liver transplant evaluation does not mean a transplant will necessarily be needed. Instead, it allows a specialized transplant team to assess the severity of the patient’s liver disease, overall health and other factors that can affect whether transplantation may be appropriate. Early evaluation can also help the team plan for future care before liver function declines further.

What Is the Prognosis and Long-Term Outlook for Ascites?

The long-term outlook for ascites depends largely on its underlying cause, severity and response to treatment. Some causes of ascites may improve when the underlying condition is treated. When ascites develops because of cirrhosis, however, it is an important sign that liver disease has progressed and requires ongoing medical care.

Cirrhosis-related ascites can often be managed with sodium restriction, medications, paracentesis and other treatments, but the fluid may return. Recurrent or refractory ascites can indicate more advanced liver disease and may increase the risk of complications. In these cases, the healthcare team may consider additional treatment options and liver transplant evaluation.

Regular monitoring can help the healthcare team assess whether ascites is improving or worsening and identify potential complications. Depending on the patient’s individual needs, managing ascites over the long term may include:

Monitoring body weight – Sudden or unexpected weight gain can indicate increasing fluid retention. The healthcare team may recommend periodic weight checks and tracking changes.
Watching for changes in abdominal swelling – An expanding waistline, greater abdominal tightness or rapidly worsening swelling should be reported to the healthcare team.
Following sodium recommendations – Limiting sodium as directed by the healthcare team can help reduce fluid retention. Dietary recommendations should be individualized to support adequate nutrition.
Taking medications as prescribed – Diuretics and other medications should be taken according to the treatment plan. Doses should not be changed without guidance from the healthcare team.
Keeping follow-up appointments – Blood tests and other evaluations can help monitor liver and kidney function, electrolyte levels and the response to treatment.
Reporting new or worsening symptoms – Symptoms such as fever, abdominal pain, confusion, difficulty breathing or rapidly increasing swelling may signal a serious complication and require prompt medical attention.

For a patient with cirrhosis, managing ascites is one part of the broader treatment of advanced liver disease. Close follow-up with a liver specialist can help manage complications, assess how well treatment is working and determine whether advanced therapies or liver transplant evaluation should be considered.

How Can Ascites Affect Daily Life?

Ascites can affect more than physical health. Abdominal swelling, discomfort and other symptoms may interfere with everyday activities and affect emotional well-being, particularly when fluid buildup is severe, keeps returning or requires repeated treatment.
Possible mental, emotional and social effects of ascites include:

Difficulty with everyday activities – A swollen or uncomfortable abdomen can make walking, bending, sleeping and other activities more difficult.
Changes in eating and nutrition – Abdominal fullness can reduce appetite or cause the patient to feel full after eating only a small amount, which may make it harder to maintain adequate nutrition.
Concerns about appearance – Noticeable abdominal swelling and changes in body shape may affect self-confidence or cause discomfort in social situations.
Emotional stress – Living with recurrent ascites or advanced liver disease may contribute to worry, frustration, sadness or uncertainty about health and treatment.
Changes in work or social activities – Symptoms, medical appointments and procedures such as repeated paracentesis may interfere with work, travel, hobbies or time with family and friends.
Greater need for support – Difficult-to-manage symptoms may create a need for help with transportation, household responsibilities or other daily activities.

A patient who is having difficulty coping with the physical or emotional effects of ascites should discuss these concerns with the healthcare team. Support may include adjustments to symptom management, nutritional guidance and other resources to help maintain quality of life throughout treatment.

Can Ascites Be Prevented?

Ascites cannot always be prevented. Because it develops as a complication of an underlying condition, reducing the risk often depends on preventing or slowing the progression of that condition. For a patient with chronic liver disease, early treatment and ongoing medical care may help limit further liver damage and reduce the risk of complications such as cirrhosis, portal hypertension and ascites.

Steps that may help protect liver health and reduce the risk of cirrhosis-related complications include:

Treating underlying liver disease – Managing conditions such as chronic hepatitis B or hepatitis C, metabolic dysfunction-associated steatotic liver disease (MASLD) and other liver diseases may help slow or prevent additional liver damage.
Avoiding alcohol when advised – Alcohol consumption can cause additional liver damage. Patients with cirrhosis should avoid alcohol use.
Taking medications as directed – Following the prescribed treatment plan can help manage liver disease and related conditions. A patient with cirrhosis should also talk with the healthcare team before taking new prescription or over-the-counter medications, supplements or herbal products.
Keeping regular medical appointments – Ongoing monitoring can help identify changes in liver function and complications that may require treatment.

Once ascites has developed, the focus shifts from prevention to controlling fluid buildup and reducing the likelihood that it will worsen or return. Following individualized sodium recommendations, taking prescribed diuretics and monitoring for changes in weight or abdominal swelling can help manage cirrhosis-related ascites.

Even with careful management, ascites may recur as liver disease progresses. New or worsening abdominal swelling should be discussed with the healthcare team so the cause can be evaluated and the treatment plan adjusted when necessary.

The TGH Difference for Ascites

Ascites can be more than uncomfortable abdominal fluid buildup. When it develops as a complication of cirrhosis, it can signal that liver disease has progressed and requires specialized care. At Tampa General Hospital, patients with ascites have access to specialists who can diagnose the cause of fluid in the abdomen, manage complications and determine when advanced treatment may be appropriate.

The Comprehensive Liver Disease & Transplant Center at the TGH Transplant Institute provides specialized care for acute and chronic liver disease, complications of cirrhosis and other complex liver conditions. Our experts take a multispecialty approach to care, with treatment options for ascites ranging from medical management and paracentesis to TIPS and, when appropriate, liver transplant evaluation.

For patients with advanced liver disease, TGH is also home to one of the nation’s highest-volume liver transplant programs. TGH has performed more than 3,000 liver transplants and offers both deceased donor and living donor liver transplantation. This depth of experience allows our team to care for patients throughout the progression of liver disease, from managing complications such as ascites to evaluating whether transplantation may be an appropriate next step.

TGH is also nationally recognized for specialized care. In 2026, Newsweek named Tampa General one of America’s Best Hospitals for Specialized Care across all seven specialties evaluated, including gastrointestinal care, which ranked No. 48 in the nation.

If you have new or worsening abdominal swelling, recurrent ascites or concerns about advanced liver disease, turn to Tampa General Hospital for personalized evaluation and treatment. Contact our Comprehensive Liver Disease & Transplant Center to learn more or schedule an appointment.