Ascites



Ascites is a condition that refers to the accumulation of fluid in the peritoneal or abdominal cavity. Ascites is most commonly caused by liver damage and other medical terms for this condition include peritoneal cavity fluid, hydroperitoneum or abdominal dropsy.  Ascites that is caused by liver damage is referred to as cirrhotic ascites. Ascites in the abdomen can also be traced back to other sources such as heart failure, kidney failure, and cancer.

Ascites is traditionally divided into two types or categories – exudative and transudative ascites depending on the amount of protein found in the peritoneal fluid. Another method to categorize the type of ascites is by measuring the amount of albumin in the fluid and compare this to the serum albumin found in the blood. This is referred to as the SAAG or the Serum Ascites Albumin Gradient. Ascites caused by cirrhosis or heart failure generally has a SAAG score greater than 1.1 whereas the SAAG score of ascites caused by other reasons is generally lower than 1.1.

 

Symptoms of Ascites

If you suffer from a mild case of ascites, the symptoms can be quite impossible to pinpoint. On the other hand the symptoms of severe ascites are generally obvious and can include:

  • Abdominal distention
  • Increase in the size of the abdomen
  • Visible bulging flanks of the abdomen
  • Difference in percussion note in the flanks when the patient is shifted or turned to the side
  • In severe cases, a ‘fluid wave’ can be felt when the abdomen is tapped or pushed. This wave can be felt on the opposite side of the abdomen as well.
  • Feeling of constant heaviness in the abdomen
  • Pressure in the abdomen
  • Loss of appetite
  • Feeling of fullness even after a small meal
  • Heartburn
  • Nausea
  • Constipation
  • Shortness of breath as the abdomen impinges on the diagphragm
  • Pleural effusion or accumulation of fluid around the lungs
  • Chronic cough
  • When ascites is caused by cirrhosis or liver damage, there may be complaints of bruising, swelling of the legs and gynecomastia
  • Ascites caused by cancer can lead to unexplained weight loss and chronic fatigue syndrome
  • In cases of ascites brought on by heart failure, the most common symptoms are wheezing, shortness of breath and an inability to perform any form of physical exercise
  • Hernia in the abdominal wall / the navel may be pushed out
  • Lower back pain is also common due to extra pressure put on the muscles of the back
 

Causes of Ascites

  • The most common cause of ascites remains liver disease or cirrhosis. Nearly eighty percent of all reported cases of ascites can be traced back to advanced liver damage. It is believed that the increase in pressure in the liver blood flow along with a decrease in the albumin content in the blood may be responsible for the development of abdominal ascites.
  • Salt and water retention can also contribute to the severity of ascites symptoms.
  • Congestive heart failure
  • Kidney failure / kidney damage
  • Obstruction of the portal vessel without cirrhosis such as tumors and blood clot formation
  • Certain cancers such as colon cancer, stomach cancer, lung cancer, pancreatic cancer, ovarian cancer, breast cancer and lymphoma can lead to malignant ascites
  • Chronic pancreatitis or inflammation of the pancreas caused by alcohol abuse can result in pancreatic ascites
  • Other causes of ascites include constrictive pericarditis, hepatitis, tuberculosis, and kidney dialysis
 

Remedies for Ascites

The treatment for ascites may include diuretics to reduce water retention and remove excess fluid as well as antibiotics in case there is an infection. Patients are generally advised to completely abstain from all alcoholic beverages and to reduce their sodium intake.

In the case of severe ascites, where the individual does not respond to medical treatment, more drastic measures may be necessary. These include a procedure called paracentesis, which involves placing a tube into the abdomen to remove the excess fluid or implanting special shunts that re-route blood around the liver. A liver transplant is necessary for patients who are in the last stages of liver failure.

  • Apart from these medical treatments there are also a number of natural cures for ascites. Remedies such as these can offer symptomatic relief:
  • Add half teaspoon of garlic juice to a glass of water and drink this on an empty stomach. Do this for a few days to reduce the pain and swelling.
  • Mix 25gms of bitter gourd juice with water and drink this concoction thrice a day for relief from ascites.
  • Juice half a cup of radish leaves and mix the juice with a little water. Drink this regularly as it is an effective home remedy for ascites
  • Soak a handful of fenugreek seeds in water and leave the bowl undisturbed overnight. The next morning, gently swirl the seeds and water and then strain it with a muslin cloth. Drink the liquid immediately.   
  • Mangoes are said to be beneficial in the treatment of ascites. Try to eat at least two fresh mangoes daily for the best results.
  • Drink fresh carrot juice or melon juice for quick relief from ascites symptoms.
  • Onions are a diuretic and will help to reduce water retention.
  • A light abdominal massage with castor oil may reduce bloating and gas. You will need to first discuss this with a massage therapist as well as your doctor.
  • Dandelion root or Gravel root can improve the functioning of the kidneys as they work as natural diuretics. Similarly, you can uses herbs such as buckthorn, rhubarb root, senna, and aloe for the same purpose.
  • Hot water fomentation using asafetida and warm water can help to relieve abdominal swelling.
  • The diuretic properties of Black Nightshade can help treat ascites. Parts of this plant can be toxic and so it is important to discuss this with a herbalist who is well versed with this plant.
  • Hogweed is a potent diuretic and is especially useful in treating ascites caused by cirrhosis. Boil a little hogweed in a glass of water and drink this liquid in small sips throughout the day.
 

Diet for Ascites

  • An ascites diet focuses on the reduction of your intake of sodium. Remedies and medication for ascites may have little or no effect if you have a high sodium intake. You will need to drastically reduce your salt intake – the maximum recommended intake of sodium per day should be 2000mg or 4 to 5 grams. Salt substitutes may be used but make sure they do not contain any potassium as potassium can react adversely with medications used to treat ascites.
  • You will need to avoid ready to eat meals and processed food items, especially products such as salad dressing, food mixes, and sauces as they tend to have a very high sodium content.
  • Eating a heart-healthy diet low in fatty and cholesterol rich foods is also recommended. The American Heart Association recommends meals high in fiber, vitamins, minerals, and whole grains but low in fats and refined sugars.
  • If there is too much fluid present in the abdomen, some alternative therapies suggest a milk-only diet for a few days or until the symptoms subside. Once the fluid levels in the abdomen are reduced, light meals such as vegetable soup and whole wheat bread can be slowly added back into the diet.
  • Foods that are recommended in the ascites diet include buttermilk, salads containing raw radish, honey, asafetida, and garlic.
  • Avoid starchy foods like rice, grains, and potatoes as far as possible.

Your doctor or dietician will provide you with exact instructions about what you can and cannot eat when you have ascites. However, if symptoms such as wheezing and shortness of breath continue, the excess fluid may removed with a needle or a shunt.  In such cases, the patient may need to be fed through intravenous liquids alone.

Suggestions for Ascites

In order to prevent the development of ascites, it is important to prevent the risk factors that lead to the disease. These precautions can help to prevent Ascites:

  • Avoiding alcohol can prevent liver disease and cirrhosis. Non-steroidal anti-inflammatory drugs such as ibuprofen should be used judiciously as they can aggravate liver damage and reduce the blood flow to the kidneys.
  • Before starting any alternative treatment or herbal therapy, it is very important to clear it with your doctor. Certain herbs can be dangerous if they are ingested in large amounts or others may react adversely with your regular medication.
  • Follow a regular exercise routine to improve your immunity and overall health and prevent the buildup of fluids in the abdomen.
  • Avoid sleeping during the day and immediately after a meal as this can hamper the digestive process.
  • Hepatitis B and Hepatitis C are risk factors for ascites, so you must practice safe sex to avoid hepatitis.

References

  1. http://www.nlm.nih.gov/medlineplus/ency/article/000286.htm
  2. http://www.bsg.org.uk/pdf_word_docs/ascites_cirrhosis.pdf