The Swollen Belly: Ascites

As hepatitis C virus (HCV) progresses, the risk for ascites increases. Ascites (pronounced “uh-sight-ease”) is the buildup of fluid in the belly. It can be a sign of severe liver, heart, or kidney problems.¹

Navigating life with ascites can be challenging. Over time, a lot of fluid can collect. This can make the belly very swollen and large. Ascites can make daily activities difficult and can lead to other health issues.²

Causes of ascites

Over 80 percent of all cases of ascites are caused by liver cirrhosis. Cirrhosis is scarring of the liver that cannot be reversed. It happens after the liver has been severely damaged. Causes of cirrhosis include:^1-3

• Hepatitis viruses (like hepatitis B or C)
• Heavy, long-term alcohol use
• Autoimmune hepatitis
• Nonalcoholic fatty liver disease
• Other liver conditions, including inherited conditions like Wilson disease or hemochromatosis

Cirrhosis is not the only cause of ascites. Other causes include:^1-3

• Heart failure or other heart conditions
• Cancers, especially in the organs of the belly or in the pelvis
• Infections
• Kidney failure or other kidney conditions
• Severely poor nutrition or low protein in the body

Ascites and hepatitis C

Most of the body’s blood flows through the liver. When the liver is severely damaged or scarred, blood does not flow through as easily. This slower flow can cause fluid to back up.^1-3

When fluid backs up, that is called portal hypertension. The liver’s blood vessels are also called the portal system. Hypertension means high blood pressure. Portal hypertension can push fluid outside of its normal spaces and into the belly instead. This is what leads to ascites.^1-3

Up to 50 percent of people with HCV will develop cirrhosis. And more than half of people with cirrhosis will develop ascites within 10 years of being diagnosed. Because HCV increases the risk of cirrhosis, people with long-standing HCV often have ascites, too.^4,5

What are the symptoms of ascites?

There are several signs that a person may have ascites. Many have to do with the buildup of fluid in the belly and beyond as ascites worsens. Some of these symptoms include:^1-3

• A large or growing belly
• Fast weight gain, especially without a known cause
• Ankle swelling
• Trouble breathing
• Abdominal pain or sense of fullness
• Loss of appetite
• Bloating, nausea, or vomiting
• Constipation or hemorrhoids
• Fatigue
• Back pain

These are not all of the symptoms of ascites. Talk with your doctor if you think you may be at risk. In order to diagnose ascites, your doctor will do a complete physical exam. They will also ask about your medical history. To help with diagnosis, they may take:^2,3

• Blood tests
• Images of the belly
• A sample of belly fluid

Treatment of ascites

Ascites can be treated in different ways. Each person’s case is different. So treatment will depend on what is causing their ascites and how severe their ascites is.⁵

In some cases, treating the underlying cause of the ascites may be helpful. This is true for some types of liver disease. It may also be helpful for ascites caused by cancer.

Other common ways to treat ascites include:^2,3,5

• Eating a low-salt diet
• Taking water pills (diuretics)
• Cutting back on alcohol intake
• Avoiding certain drugs, including some blood pressure drugs or non-steroidal anti-inflammatory drugs (NSAIDs, like ibuprofen)
• Going for a paracentesis (a procedure that uses a needle to remove fluid)
• Treating underlying hepatitis B or C

Your doctor can help you figure out which treatment choices to make. Talk with them before making any changes on your own.

There are also surgeries that can be performed to help ascites. These include liver transplants or getting a transjugular intrahepatic portosystemic shunt (TIPS). A TIPS procedure creates a way for blood to flow through that helps it bypass the liver and reduces backup.^2,3,5

Complications of ascites

If ascites is not managed, it can cause other health problems. These include:²

• Infection in the belly fluid (spontaneous bacterial peritonitis)
• Fluid in the lungs making it hard to breathe (hepatic hydrothorax)
• Inability to carry out daily activities due to pain or discomfort
• Hernias in the stomach or groin due to increased belly pressure
• Kidney failure (hepatorenal syndrome)

Regularly following up with your doctor can help you monitor for these complications and get them treated quickly if issues arise.