Ascites

Ascites can be a symptom of different types of cancer. It can also be caused by other conditions, such as advanced liver disease and heart failure.

Ascites may develop when:

• cancer cells irritate the lining of the tummy, causing it to make too much fluid
• lymph nodes in the tummy become blocked and the fluid cannot drain properly
• cancer that has spread to the liver raises the pressure in nearby blood vessels, which forces fluid out
• the liver is damaged and cannot make enough blood proteins, so fluid leaks out of the veins into the tummy.

Ascites is usually managed by draining the fluid. Your doctor may also suggest some tablets to help your body get rid of the extra fluid. If cancer is causing the ascites, treating the cancer may help.

Removing the excess fluid from the tummy is a common and effective treatment for ascites. The procedure is called ascitic drainage or paracentesis. It is done by putting a tube (catheter) into the tummy to drain the fluid. This relieves symptoms and helps you feel more comfortable.

You usually have this procedure as a day patient. You usually have to be at the hospital for at least 6 hours. You may want to bring something to help pass the time, such as something to read, watch or listen to. You might need to stay in hospital overnight.

A specially trained doctor or nurse does the procedure. You lie down on a bed or in a reclining chair. The doctor or nurse cleans the skin of the tummy. Then they inject some local anaesthetic into the area to numb it.

The doctor or nurse makes a very small cut in the skin of the tummy and inserts the tube. They might use an ultrasound scan to help them position it. The fluid drains out of the tummy and collects in a drainage bag. The doctor or nurse may put some stitches in to hold the tube in place.

If you have any pain or discomfort, tell your doctor or nurse. You can have painkillers if you need them.

Fluid being drained from the tummy (ascitic drainage)

The fluid is usually drained over a few hours, but this depends on:

• the amount of fluid that needs to be drained
• what is right for you – for example, if you have low blood pressure, fluid may be drained more slowly.

After the tube is removed, a small amount of fluid may leak until the hole heals. You will have a dressing or drainage bag over the area until this stops. Your doctor or nurse can tell you more about this.

Possible problems

Most people do not have any serious problems from having ascitic drainage. These are some of the possible problems: 

• Your blood pressure may drop as the fluid drains. Your nurse will check your blood pressure regularly so they can treat this problem if it happens.
• There is a small risk of bleeding when the catheter is put in, but any bleeding usually stops on its own without treatment.
• You might need to have a catheter in more than 1 place if there is fluid in different places in the tummy.
• The catheter can become blocked, which stops the fluid from draining. Changing your position or sitting upright may help if this happens.
• Fluid may leak around the catheter. The dressing around the catheter will be changed regularly. Any leaking usually stops after the fluid has been drained.
• The catheter site can become infected, but this is not common. Your nurse will check your catheter site regularly for signs of infection, which is treated with antibiotics.
• Rarely, there is a small risk of hitting the bowel when putting in the catheter. Your doctor or nurse can tell you more about this.

The fluid may build up again. You may need to have it drained more than once. Sometimes doctors suggest putting in a catheter that stays in place long term.

Some people need a long-term or permanent catheter put into the tummy. This stays in place after the fluid has drained. It helps to manage ascites that builds up again quickly after drainage. When the catheter is not being used, it is closed and covered by a dressing.

When the fluid builds up, a drainage bottle or bag is attached to the catheter. The catheter is then opened so that it drains fluid from the tummy. Your doctor or nurse can tell you more about this. They can show you, or a family member or friend, how to look after the catheter and how to drain it at home. Or they can arrange for a nurse to visit you at home to drain it.

Most people cope well with long-term or permanent catheters at home.

Some people have a tube called a shunt put into the tummy. Doctors call this a peritoneovenous shunt. It drains the fluid directly into a large vein.

Peritoneovenous shunt

You need to be well enough to have this procedure. Before the doctor puts the shunt in, you will be given a sedative to make you drowsy. Or you may have a general anaesthetic.

One end of the shunt goes into the fluid in the tummy. The other end goes into a vein in the neck. A valve in the shunt means the fluid can only flow in 1 direction – from the tummy into the vein in the neck.

You will need to stay in hospital for a short time while the hospital staff check the shunt is working properly. The shunt stays in permanently. Your doctor and nurse can give you more information about this.

If you have ascites, the way you think and feel about your body (body image) may change. We have more information about managing body image concerns. You may find it helpful to: 

• talk to our cancer support specialists for free on 0808 808 0000
• find support organisations in your area – our cancer support specialists can help with this
• talk to supportive family or friends about how you feel – they can listen and give you support.