Ascites Treatment: How Doctors Manage Fluid Buildup in the Abdomen
Ascites refers to abnormal fluid buildup in the abdomen, most commonly caused by advanced liver disease, although heart failure, kidney disease, infections, and certain cancers can also lead to it. The swelling can feel uncomfortable and frightening, especially when it becomes hard to breathe, move, or eat normally.
While ascites is a sign of an underlying medical problem, effective treatments are available. The right approach depends on the cause, severity, and overall health of the patient.
This guide explains the treatment options for ascites, why it develops, and when to seek urgent care.
What Causes Ascites?
Ascites occurs when pressure and inflammation disrupt normal fluid balance inside the body. Several conditions can trigger this shift.
Most common cause:
-
Cirrhosis and chronic liver disease
Other causes include:
-
Heart failure
-
Kidney failure or nephrotic syndrome
-
Pancreatitis
-
Abdominal cancers (ovarian, liver, pancreatic)
-
Severe infections such as tuberculosis
Regardless of the cause, fluid leaks into the abdominal cavity, creating swelling, discomfort, and pressure.
Symptoms of Ascites
Ascites may develop slowly or rapidly. Symptoms include:
-
Abdominal swelling or tightness
-
Difficulty breathing, especially when lying down
-
Reduced appetite or early fullness
-
Nausea
-
Swollen ankles or legs
-
Weight gain over a short time
-
Umbilical or groin hernias
Severe or infected ascites may cause fever, abdominal pain, or confusion.
Read on in our full guide to at-home liver tests to learn what your results really mean.
Treatment Options for Ascites
Effective treatment focuses on controlling fluid buildup and managing the underlying cause. Most patients need a combination of lifestyle changes, medications, and procedures.
Read on to explore our complete guide to at-home kidney function testing and how it works.
1. Low-Sodium Diet
Sodium causes the body to retain fluid. Reducing salt intake is usually the first-line treatment for ascites.
Recommendations:
-
Limit sodium to 1500 to 2000 mg per day.
-
Avoid processed foods, fast foods, canned soups, and salty snacks.
-
Cook with herbs instead of salt.
-
Read nutrition labels carefully.
Even small improvements in sodium intake can reduce symptoms.
2. Diuretics (Water Pills)
Diuretics help remove excess fluid through urine.
Common medications include:
-
Spironolactone
-
Furosemide (Lasix)
Doctors usually prescribe a combination to maintain electrolyte balance and prevent complications.
Patients taking diuretics require:
-
Regular blood tests
-
Monitoring of potassium, sodium, and kidney function
-
Daily weight checks
3. Paracentesis (Fluid Removal)
For moderate to severe ascites, especially when causing difficulty breathing or intense abdominal pressure, doctors may perform paracentesis.
During this procedure:
-
A thin needle is inserted into the abdomen.
-
Excess fluid is drained safely.
-
Large-volume paracentesis can remove several liters at once.
Some patients may need this procedure repeatedly.
When large amounts of fluid are removed, doctors may give albumin through an IV to help maintain blood pressure and kidney function.
4. Treating the Underlying Cause
Long-term control depends on addressing the root problem.
For cirrhosis:
-
Avoid alcohol completely.
-
Manage hepatitis if present.
-
Treat fatty liver disease with weight management and metabolic care.
-
Control portal hypertension with medications.
For heart failure:
-
Optimize heart medications.
-
Follow a low-sodium diet.
For kidney disease:
-
Control blood pressure and blood sugar.
-
Adjust medications as needed.
For cancer-related ascites:
-
Chemotherapy or tumor-directed therapy may reduce fluid buildup.
Read on in our UTI testing guide to better understand symptoms and treatment.
5. Antibiotics for Infected Ascites
Ascites can become infected, a condition called spontaneous bacterial peritonitis (SBP).
Warning signs include:
-
Fever
-
Confusion
-
Severe abdominal pain
-
Worsening swelling or fatigue
SBP requires immediate treatment with antibiotics and hospital monitoring.
Read on in our article about glucose in urine to learn about causes and symptoms.
6. TIPS Procedure (Transjugular Intrahepatic Portosystemic Shunt)
For patients who do not respond to medication or paracentesis, the TIPS procedure may help.
TIPS works by creating a pathway inside the liver to reduce pressure in the portal vein. This can significantly decrease fluid buildup in ascites caused by cirrhosis.
However, it may increase the risk of confusion (hepatic encephalopathy), so physicians weigh the benefits and risks carefully.
7. Liver Transplant
For patients with severe cirrhosis and recurrent ascites that does not respond to treatment, a liver transplant may be the only long-term solution.
Transplant evaluation may be recommended if ascites becomes:
-
Persistent
-
Difficult to control
-
Associated with kidney problems or infections
Lifestyle Tips to Help Manage Ascites
Alongside medical treatment, lifestyle habits support better outcomes.
Helpful strategies include:
-
Reduce sodium in your diet.
-
Avoid alcohol completely.
-
Limit NSAIDs like ibuprofen unless approved by a doctor.
-
Weigh yourself daily to track fluid changes.
-
Elevate your legs to reduce swelling.
-
Eat small, frequent meals for comfort.
These habits support liver and kidney health and improve overall comfort.
Read on in our overview of the Ribbon Checkup urine test to see how home testing can support your health.
When to Seek Immediate Medical Care
Go to the emergency room if you experience:
-
Severe abdominal pain
-
Vomiting blood
-
High fever
-
Confusion or changes in mental state
-
Difficulty breathing
-
Rapid abdominal swelling
These could indicate infection, bleeding, or worsening liver function.
The Bottom Line
Ascites is a sign of an underlying medical condition, most commonly cirrhosis. While fluid buildup can be uncomfortable and alarming, there are effective treatments. Managing sodium intake, taking diuretics, and undergoing procedures like paracentesis or TIPS can provide relief.
The most important step is addressing the root cause, whether liver disease, heart failure, kidney problems, or cancer.
With proper care, many people manage ascites successfully and maintain a good quality of life.
Concerned about swelling or possible ascites?
You can take an at-home liver, kidney, and metabolic panel test through Ribbon Checkup and get results in days.
Explore liver and metabolic tests
Related Resources
-
Liver Pain Location: Understanding Its Causes and Symptoms – Spot the main causes and symptoms.
-
What Can Be Mistaken for Liver Pain? – Conditions that mimic liver discomfort.
-
Gallbladder Pain vs. Liver Pain – How to tell them apart.
References
Adebayo, D. (2024). Recent advances in ascites and acute kidney injury. Alimentary Pharmacology & Therapeutics. https://doi.org/10.1111/apt.17972
Aithal, G. P., et al. (2021). Guidelines on the management of ascites in cirrhosis. Gut, 70(1), 9–28. https://doi.org/10.1136/gutjnl-2020-322246
Angeli, K. L., et al. (2010). EASL clinical practice guidelines on the management of patients with decompensated cirrhosis. Journal of Hepatology, 53(3), 742–751. https://doi.org/10.1016/j.jhep.2010.04.006
Asim, M., Naqvi, N., Karmani, V. K., Tahir, A., Banatwala, U. E. S., Rehman, S., ... Khan, F. (2024). Advancements in ascites management: A comprehensive narrative review of the Alfa Pump system. Egyptian Liver Journal, 14, Article 68. https://doi.org/10.1186/s43066-024-00373-0
Ginès, P., et al. (2004). Management of cirrhosis and ascites. The New England Journal of Medicine, 350(16), 1646–1654. https://doi.org/10.1056/NEJMra035021
Lai, J. C.-T., Dai, J., Liang, L. Y., Wong, G. L.-H., Wong, V. W.-S., & Yip, T. C.-F. (2025). Pharmacological treatment of ascites: Challenges and controversies. Pharmaceuticals, 18(3), 339. https://doi.org/10.3390/ph18030339
Mustapha, S. K., et al. (2020). Cirrhotic ascites: A review of pathophysiology and current management. North American Journal of Gastroenterology & Hepatology, 10, 105–113. https://doi.org/10.1097/NGH.0000000000000471
Pocha, C., & Rios-Perez, C. (2025). Ascites – the old, the current, and the future ways of management. Current Hepatology Reports, 24, Article 19. https://doi.org/10.1007/s11901-025-00690-x
Runyon, B. A., et al. (2021). Diagnosis, evaluation and management of ascites, spontaneous bacterial peritonitis and hepatorenal syndrome: Practice guidance by the American Association for the Study of Liver Diseases. Hepatology, 74(2), 1014–1048. https://doi.org/10.1002/hep.31884
Wong, F., Vargas, H., Reddy, K. R., Pagadala, M., Pocha, C., Sundaram, V., ... et al. (2023). Innovative approaches to the management of ascites in cirrhosis. Journal of Hepatology, 78(S1), S242. https://doi.org/10.1016/S0168-8278(23)00800-0
