Ascites (water belly) – causes, symptoms & therapy

Ascites is the abnormal accumulation of fluid in the abdominal cavity. It is colloquially called abdominal dropsy or simply water belly. The term derives from the Greek word askites, which means “hose”.

In medicine, a distinction is made between inflammatory and non-inflammatory ascites. The accumulated liquid is cloudy in the inflammatory, but clear in the non-inflammatory. A growing abdominal circumference, which is due to the increase in fatty tissue, is not referred to as ascites.

causes

In most cases, non-inflammatory ascites is a consequence of a serious illness. These often affect the liver, such as in cirrhosis of the liver , which is the most common cause of non-inflammatory ascites. These ensure that portal hypertension develops, which means that there is too much pressure on the large portal vein of the liver, which causes fluid to leak into the abdomen.In rarer cases, however, a tumor or a weakening of the heart can also be the trigger. Especially in developing countries, non-inflammatory ascites can also be caused by an undersupply of protein , which is due to malnutrition . A protein deficiency can also be caused by malfunctions in the kidneys or the gastrointestinal tract.

Inflammatory ascites, on the other hand, is usually the result of inflammation or injury to organs in the abdomen. Bacterial inflammation, such as peritonitis , can also be a possible trigger. The so-called chylous ascites, which can occur as a result of disturbed lymphatic drainage, is less common.

When to the doctor?

The question of when medical treatment is required and therefore a visit to the doctor is indicated can only be answered on a case-by-case basis. A patient should identify and balance all relevant issues. If there is sufficient suspicion of ascites, regardless of the possible cause, a doctor should always be consulted. Severe consequences of this disease can lead to spontaneous inflammation of the peritoneum (peritonitis) or shortness of breath.

However, not every increase in abdominal circumference necessarily indicates ascites. In the majority of cases, there is simply a digestive problem that does not require treatment or simple flatulence . If this is the case, the symptoms will disappear by themselves after a few days. Before visiting a doctor, harmless reasons for the symptoms should be ruled out in healthy people. Only when the increase persists for a long time and reaches a certain intensity does the sufficient suspicion of a water belly arise.

Small accumulations of water in the abdominal area often go unnoticed and are initially harmless, so they do not yet require treatment. Ascites is particularly common in people who have already suffered from severe liver or heart disease. Cancer patients are also increasingly reporting a water belly. Members of these risk groups should be particularly careful and seek medical help at an early stage.

symptoms and course

Typical symptoms of water belly:

• waist circumference increases

• Nabelbruch

• shortness of breath

Before a water belly becomes noticeable, the symptoms of the underlying disease that triggers it first appear. The actual water belly is then expressed by an increase in abdominal circumference, sometimes faster, sometimes slower. The abdominal wall bulges further and further outwards, so that at some point neither pants nor belts fit anymore.

In the final stage, the transition from the abdomen to the navel can disappear or a dangerous umbilical hernia can occur, which can lead to other serious symptoms. As a consequence of ascites, the peritoneum can also become inflamed or acute shortness of breath can occur, which is triggered by the pressure of the accumulated fluid on the lungs.

Diagnose

Since the underlying disease, which ultimately causes the development of ascites (water belly), is usually already known when it occurs, a diagnosis can be made quickly and clearly in most cases. In addition to knowing about the underlying disease, the abdomen can be palpated or tapped. For a definitive and absolutely reliable diagnosis, however, an ultrasound examination is essential.

This allows the accumulation of fluid to be precisely identified and its quantity and possible influence on the surrounding organs to be determined. Finally, the type of ascites is determined, i.e. whether it is inflammatory or non-inflammatory. For this purpose, a puncture is carried out in the left lower abdomen and the fluid taken from the ascites is examined for consistency, color and bacterial content .

complications

The water belly leads to a strong increase in the abdominal circumference. This can primarily have a negative effect on the aesthetics of the patient, since they are often ashamed of the large abdominal circumference and feel uncomfortable with it. It also leads to the formation of inferiority complexes and reduced self-esteem. It can also lead to shortness of breath and, in the worst case, to an umbilical hernia. In addition to shortness of breath, most patients also suffer from a panic attack . Many people also experience depression or other psychological problems as a result of having water in their stomach.

Diagnosis of the disease occurs relatively quickly, so early treatment is possible. In most cases, this is causal and is primarily aimed at the underlying disease that is responsible for the abdominal water. The patient usually has to stick to a strict diet to reduce the discomfort and symptoms. In severe cases, the fluid can also be taken directly from the abdomen. In the worst case, poisoning can occur if the function of the liver is impaired by the abdominal water. It can also damage the brain.

treatment and therapy

When treating ascites, the underlying disease should be treated first in order to combat the trigger and prevent further progression of the increase in abdominal circumference. There are various methods of treating abdominal water, but they all aim to reduce the amount of fluid in the abdominal cavity.

A salt-free diet in connection with the intake of diuretics , which have a diuretic effect, and a reduced intake of liquid is an option that is used when the water belly is not yet particularly pronounced.

Another is the gentle removal of fluid from the abdominal cavity using a cannula or catheter. In emergencies, the last measure that can be considered is the establishment of a short-circuit connection between the vena cava and the portal vein in order to direct the blood past the liver. Since the liver can no longer detoxify the blood, other side effects such as damage to the brain can occur, which are often worse than the ascites itself.

prevention

In order to prevent the development of ascites (water belly), the disease causing it should be diagnosed as soon as possible. As a result, the development of a water belly and, above all, its symptoms can be detected early on and countermeasures can be taken at an early stage.

These are mostly in the reduced intake of table salt, a conscious diet with whole foods, as well as a lot of bed rest, since the blood is distributed differently when lying down than when standing and this signals the kidneys to excrete more fluid and thus ascites does not develop in the first place to let.Ascites is therefore almost always the result of a mostly serious illness and in most cases a bad sign and a symptom to be taken very seriously that should be examined by a doctor immediately.