Treatment and Medications for Ascites

Ascites is painful and drains you of energy. Naturally, a person with ascites wants to minimize how much ascites affects them. In this video, I discuss how to get ascites under control. I explain a procedure called paracentesis, that drains ascites to provide relief and further evaluate the fluid. I then discuss how to prevent ascites reaccumulation. To effectively keep ascites away often requires both dietary changes and medications. When these therapies do not work, I discuss next steps to control ascites. These include liver transplant and a TIPS procedure which can essentially cure ascites.
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DISCLAIMER: While I am a Gastroenterologist, I am not acting as your Gastroenterologist. The information provided on this channel is intended to be general educational content and not directed towards any one individual. If you believe you have a medical condition that deserves attention please seek care from your healthcare provider. If you are experiencing a life threatening emergency, call 911.

[@ki33ys]

My ascites stopped. My doctor recently lowed my dose of these medication’s. I survived alcoholic hepatitis.. I have liver disease /early cirrhosis. I feel great now. Staying positive.

[@MarkCooperMD]

That’s great. As the inflammation of alcoholic hepatitis subsides the liver will be less swollen and therefore resistance to blood flow decreases towards normal. As the pressure lowers the ascites will improve. Congratulations on surviving alcoholic hepatitis. Thanks for sharing your success as an inspiration for others!

[@kothapallichaitu8414]

Hello karen

[@kothapallichaitu8414]

Can I contact u I got acitis and detected in ultrasound I m worried so much that I have to go for liver transplant

[@ganeshlokhande2081]

​@@kothapallichaitu8414 does the fluid get drained naturally in your case or are you going directly for a transplantation?

[@shujapeerpeer170]

Is acities effect male sex power

[@blastofo]

My belly was the size of a 7 months pregnant woman from Ascites a year ago. Caused by fatty liver disease. The junk I was eating and the quantity was unbelievable. The diagnosis scared me straight. I eliminated 90% of the salt and sugar from my diet. Joined a gym and exercised daily. Now my belly is slimmer than it was before these health issues. I weigh less than I have in 20 years. Didn't need a paracentesis or meds.

[@MarkCooperMD]

Awesome. Thanks for sharing. You’re a great example for the fact that many cases of ascites can be improved with radical lifestyle change.

[@engeneeringvehicle507]

I have ascites now due to fatty liver, it hasn't go away for like 3 months, I did take the fluid out many times but it fill right back in again in no time, I'm lack of exercise that's mean I need to exercise

[@anthonypilla2788]

This is the first time I’ve seen your video, and I am on both the medication you discussed. I really enjoy the way you explained how it works and now I have a better understanding of why I’m taking it. Thank you very much for the information.

[@10Cnote]

Thanks very much Doctor Mark I appreciate the information.

[@Siggy4844]

Great, easy to understand video, very informative. Thank you! I'm a stage 4 pancreatic cancer patient with metastatic liver cancer. Liver function is at a bare minimum at this point and I'm permanently jaundiced. I'm in home Hospice care, so going to the doctor or hospital is not allowed under Hospice rules because it is considered "seeking aggressive treatment" and it would require me getting off hospice. I have recently developed edema in my feet (puffy/swollen) and ascites fluid build-up in my lower abdomen making me look pregnant. I feel heavy, sluggish, fatigued and itchy. A surgical scar from a hysterectomy over 20 years ago has suddenly popped up like the ridge on a Klingon's forehead and looks pink. I was put on 20mgs of Lasix twice a day and a potassium supplement. I was told to reduce sodium intake as much as possible and to drink less water. I'm also on other medications that require me to do the exact opposite, to drink more fluids to help my kidneys and to flush out toxins and bilirubin. So how do I balance the water issue? Before the ascites I was drinking four 16oz bottles of water daily plus herbal teas. Reducing sodium is very difficult, just as with sugar for my type 2 diabetes. American food has so much sodium and sugar in almost everything. I was born and raised in Europe and this was something I immediately noticed when I came to the US in the 1980s.

[@MarkCooperMD]

Thanks for watching. I hope you have done well over the past weeks. I don’t always recommend patients with ascites limit their water intake and usually reserve that for patients whose sodium level on labs is low.

[@shreyasitambraparni5713]

Finally, something real!

[@KidistAsfaw-yx8jt]

It's helpful .

[@MarkCooperMD]

Thanks for watching!

[@janaprasanna.g]

Can a stage V ckd patient take these two medicines for the treatment of ascites?

[@Fallenlyrics218]

Of 9 videos on ascitess this one I could understand and gave me assurance and knowledge. The others who explained had such thick foreign accents I couldn’t concentrate on the jnfo more on trying to understand thru such heavy accents. Thank you. I’m 38 and everything so far is narrowing down to non-alcoholic ascities likely from hepc. It’s so hard to breathe,walk,even laying down is uncomfortable,on top of barely gettin a deep. Breath. I’m a side sleeper so when I wake up all the fluid has amassed to the side I slept in and is firm and tender. Furosemide was prescribed,but I get really painful scary hamstring,shin,to of my foot cramps. It’s one thing or another. The leg,ankle&foot swelling wooo that’s another one I won’t even crack into. I hope I can find more informed info for when the time comes to redo bloodwork n all the fun stuff😏. Thank you 🙏🏼

[@hawraa.a.m2434]

And now how you feel my Mom 😢 like you

[@slickdan619]

Thank you for all of the amazing videos! I have a question that doesn’t go with this video. For the past 2 years I have had a foul odor coming out of my left nostril. I have bad pollen allergies that make my sinuses swell so I figured it was that. Went to a allergy doctor they did a CT scan to see if there was any polyps or fungal balls and there was nothing. I recently went on a 40 day water only fast and the foul odor completely disappeared even while still having pollen allergies throughout that duration of time. It has been almost 25 days off of the fast and sadly the foul odor has just now returned. I am starting to wonder if it is something from my diet causing this. Have you heard of any similar instances? Thank you so much!

[@MarkCooperMD]

Thanks for watching Dan. That’s crazy you’ve been dealing with this symptom. The CT of your sinuses sounds reasonable. I wonder if you’re actually smelling something that you absorb - sort of like garlic makes your breath smell not because it lingers in your mouth but is absorbed in your blood. It may be that some part of your diet or something else you ingest is causing this smell. Though the fast you describe would seem to break that. It’s conceivable that the culprit compound was in your fat stores and as they break down it’s being released. Overall a very unusual symptom that’s difficult to pinpoint a reason for it. It sounds like the CT excluded something concerning, which is good news. I hope you find relief.

[@slickdan619]

@@MarkCooperMD thank you so much for your insight! I really appreciate you responding. Hoping to get to the bottom of this soon!

[@1charlastar886]

Cacosmia (bad smell when none is externally present) can sometimes be helped by homeopathic Belladonna 30x potency taken 1-2 times a day until the sensation passes or for up to a week. Homeopathic Belladonna is not toxic.

[@user-bp8wq8rd8i]

Hello Doctor, I am following you from Iraq. I have gastroesophageal reflux symptoms. I want to ask what tests should I do to realize that I have a hiatal hernia?

[@MarkCooperMD]

Thanks. Please check out the videos on hiatal hernia which address this.

[@melodymatteleonpolpol2665]

Please I hope you will answer my question it's really big help ..my son has a result of minimal ascites?? Is this dangerous?

[@abdulsamad.]

Is he oknow?

[@MermaidMoney]

My liver is healthy yet I think I have ascites. What could the infection be from? I've been on a low sodium diet my whole adult life because I heard salt isn't good for asthma. My blood pressure is always normal if not low. I suffer from genetic angioedema and the ascites started a year and a half ago

[@herbiekruger]

I have ascites and was getting a drain approx every 4/6 weeks. Typical quantity of fluid was 10 to 12 litres each time, they increased my spironolactone to 100mg tablets X4 a day and my furosemide 40mg once a day. My legs are not as swollen now as previously and my belly seems to be more in control, it has now been an over a good 2 months since my last drain. They have spoken about getting a TIPS done but i don’t know when. I was really really struggling before with all the added weight, 14kg once. I struggle to do anything though as i am constantly going to the toilet

[@MarkCooperMD]

If you can control ascites with diuretics then you may not need a TIPS which comes with risk of hepatic encephalopathy. Which I have a separate video covering. Depending on your lab values it’s possible to increase lasix considerably from where you’re at.

[@herbiekruger]

@@MarkCooperMD Thanks for the reply and i'll look that video up. i don't mind the tablets but i can't really go anywhere as it is really hard to hold the urine in, made even worse with the furosomide

[@engeneeringvehicle507]

I have ascites for about 4 months the fluid hasn't go away yet even when already drained like 20 litter out of my belly, but I don't get those meds that's why I fill up again

[@GDNebula_]

I’ve had this issue for many years where it feels like my stomach slightly pops forward under my lung when I breath occasionally, my stomach can sting in that area on occasion during episodes, under my lung and the lining of my stomach on my left side is slightly raised and higher than my right, and I can hear and feel fluid running in that area 24/7. Is it possible that this could be ascites? I’ve spend thousand at different doctors mostly non gi and none have recommended this or other possibilities. Any info would be greatly appreciated!

[@philipcoffman4372]

no

[@rrcammy1967]

Yes I’m going thru this now

[@anshul9921]

Hi Dr, my father developed chylous ascites post radiation treatment and nimatazumab injections for esophegus cancer. This has become refractory now , kindly let us know what should we do in terms of diagnosis and treatment . Fluid showed no malignancy and no TB, high triglycerides and high lymphocytes

[@sharmilap8483]

How him now

[@vibhaskshirsagar9787]

Can you suggest for CA OVARY, Metastasis & Malignant Ascites?

[@angellaurio964]

Just out from hospital ..coz.of ovary Ascites🙏

[@westfield90]

My dad who has been recently diagnosed with CHF. He now gets water build up. The legs get swollen first. Then he gets GI issues where he gets constipation and extreme fatigue and extreme hunger where he feels he needs a meal immediately. After a yogurt or small snack he feels fine. His blood was tested before and after meals and was always fine so these episodes of fatigue and extreme hunger don’t seem related to his blood sugar but alway happens once his fluid builds up. Is this Ascities.? Once he takes Lasix and the fluid is drained the GI symptoms go away. Is is ok to take lasix everyday so he doesn’t have the fluid build up?

[@AVSCITY]

Same issue

[@ninaboston4714]

My dad has heart failure he was in end stage and put in Hospice he got better no longer in end stage he was and is on lasix 80mg once a day. Also when when he had excessive build up they gave him metolozne 2.5mg and 30 min after he took oasis for a week and all his fluid was gone. Ask the doctor about that pill if your dad ever get excessive build up.

[@trapstar_1386]

Hey doctor what if your in perfect shape, exercise daily, and do intermittent fasting. But have this bulge that sticks out in my lower belly. It’s so obvious. Skinny fit girl and I got abs on top and this hard bulge on my lower stomach. My stomach is usually flatter than a board. But I been drinking way to much water,creamer,coffee,vitamin water drinks instead of food to make it go down. It didn’t work. I fasted 3 days and my stomach finally got flat. I then finally ate. And I ate a lot because I was starving for days. My stomach was flat for 1 day. And I messed it up by eating too much and then drinking wayyyy to much water. I remember waking up out of my sleep multiple times just drinking soooo much water. And woke up and it was back :( and now it won’t go away. I’m running multiple times a day. Even do sauna sessions to sweat it out. Plus intermittent fasting. It goes down and then gets bigger after I drink or eat something.I guess the only way to get rid of it is starving. Aka fasting. At least 3 days. Plus very little water. 😢

[@zombiekush760]

Would a sauna help expel excess fluid?

[@trapstar_1386]

Iv tryed that. It worked. But you gotta really dedicate yourself for this. First you need to fast.(2 or 3 days)Then you need to run. Make sure you sweat when you run. Then go to Sauna for 2 hours. Take brakes but you need to sweat like crazy. Whole body sweating even your face. Only drink a little bit of water. Like sips. Don’t jug it. Then repeat next day all those steps. And then brake your fast on the 2nd or 3rd day with watermelon. Don’t eat nothing else for at least 2 hours. The watermelon will make you pee a lot. Which is good because it will take all the water retention out. Watermelon is a natural diuretic.

[@quinn2014]

I have mild ascites right now from liver transplant rejection and theyre not draining it. They said it'll go away on its own. This rejection episode was brutal.

[@MarkCooperMD]

Rejection episodes are brutal. Did you get thymo? What’s your CMV status? Hope things go well.

[@quinn2014]

@@MarkCooperMD Not sure if I got thymo. It's all been a blur especially with my lung collapse and the ascites and cardiomegaly and such. They have me on a lot of really intense medication right now though I'm just hoping the ascites goes away with time because it hurts and it makes it hard to perform other health and hygiene tasks.

[@quinn2014]

@@MarkCooperMD luckily no CMV but they do have me on ValCyte

[@1charlastar886]

How about INCREASING potassium, either through lots of potassium-rich foods (NOT sugary bananas) or potassium citrate to assist in balancing sodium.

[@MarkCooperMD]

Yes this will improve balance. Avocado is a great option as well as many vegetables.

[@philipcoffman4372]

@@MarkCooperMD yes , but it won't do anything with sodium in the system ... i think if she's looking for something just potassium without anything else , supplements work . i take potassium cause i have cirrosis and i had ascities bad . im talking about cankles , pinapple size manhood , 9 mo pregnant looking belly etc . i dont have it anymore and im pretty healthy , although still have a cirrosis , just not as bad due to tips procedure and healthy lifestyle . avocados are good because of fats too , but i can agree on potassium levels because im an althetic dude and did sports all my life , so i can feel any slight change in my body . i even feel if i take too much vitamin c . so if my potassium goes low , i can start feeling the difference in my heart rythm and i feel tiny heart spasms

[@nimunguronald8286]

I have ascites please help me how did you stop u'res it's very painful

[@mark70s29]

Im on spironolacton and furosemide. When I first was taken to hospital i was on an IV and within a few minutes was passing liquid. Same when i came out and using the pills. Now a year and a half later they don't appear to have the same effect? I still get bloating and full even though i don't consume much foo.

[@thatnorachick]

Would ascites come up on a ct scan or how would it be diagnosed? I have a lot of bloating and abdominal distension however none of my doctors or gastroenterologist has recommended I get checked for this.

[@MarkCooperMD]

It would be readily apparent on physical exam and on CT.

[@cwie2968]

I have the same issue. Bloated but nothing came up on 2 CAT scans I've had

[@danajacobs9097]

Yes

[@mrmrlee]

I have fluid retention in my legs and I believe in my belly as well. It is abnormally distended, yet my arms neck and face are very slim, no bodyfat noticeable at all. I eat extremely healthy (pescatarian) and go to the gym. I eat less then 2000 cals a day, yet I weigh 300 lbs and have gained 50 lbs in 2 years. My liver doctor just keeps saying my bloodwork and liver and thyroid function seem normal, yet my sonogram examiner says I have fatty liver (NAFLD). Do I need to see another doctor?

[@MarkCooperMD]

If you’re asking this question on KZbin then the question answers itself. Yes. Something seems off. Keep a good dairy of food intake and track calories - people underestimate portions.

[@Dr.Jas-AyurvedaExpert-se9mi]

Ascites can occur alone or as a complication of chronic liver diseases like cirrhosis. I prescribe my patients Planet Aurveda’s Indian Echinacea, Phyllanthus niruri, Yakrit Plihantak Churna, and liver detox capsules to my patients

[@MarkCooperMD]

By patients you mean “marks” since you’re a con man selling fake treatments.

[@yaminishekhawat1690]

Hi I doctor my mother is diagnosed with ovarian cancer, she was recently diagnosed with ascites as well. The doctors have attached a urine bag to continue the flow of water from her belly. She is very weak her weight is almost 30 kgs. We have been trying to control ascites with diet. Should we start these medicines as well which you mentioned in the video?

[@MarkCooperMD]

I’m sorry for your mother and your family. I’m concerned this is a late stage ovarian cancer. The medicines discussed in this video would risk hurting the kidneys and not provide relief beyond what the drain provides. The drain is considered a palliative measure to provide comfort.

[@RohitSharma-eh4hr]

wat about tips procedure

[@MarkCooperMD]

It’s great for the right patients and warrants a separate video.

[@danidean6411]

So I'm curious what happens when a patient has ascites post cancer removal surgery but also REQUIRES a SUPER HIGH SODIUM DIET due to POTS (postural orthostatic tachycardia syndrome)??? 😢

[@MarkCooperMD]

It sounds like you may have ascites more related to lymphatic obstruction (the storm drains are clogged) rather than portal hypertension (there’s more rainfall). POTS may be helped by fludrocortisone-please discuss with your managing doc.

[@danidean6411]

@@MarkCooperMD thank you for responding! So this my husband's condition. Unfortunately he's currently battling suicidal manic episodes due to fludrocortisone!! He's a Veteran with severe PTSD so steroids are a horrible option for him. Plus the steroids made him retain more fluid!

[@MichaelaCizkovaCZ]

Hello, can you have ascites from other problem not liver atc? Like leg injury, no movements,stress, trauma, bloating. Hard belly. Thank you

[@MarkCooperMD]

It’s usually due to liver, kidney, heart disease, can less commonly be due to cancers that clog or trauma that disrupts the drainage of the belly. But a leg injury would not be expected to. More likely a leg injury if treated with opiates will cause constipation and then bloating. Sounds like you would benefit from being evaluated by a doctor in person.

[@saadahaq6234]

And I have developed renal as well

[@asmakhurram8853]

My brother is diagnosed with liver cirrhosis due to hepatitis c,,now he get his hepatitis medicine..he has moderate as cites and grade 1 esophageal varices..can these be cured after hepatitis treatment??his body responds well to hepatitis medicine,,swelling of feet and legs is now reduced

[@MarkCooperMD]

The cure rate for hep C is phenomenal. Patients who have cirrhosis will likely continue to. However the risk for progression is decreased substantially. So it’s great he’s being treated. What is he taking.

[@asmakhurram8853]

@@MarkCooperMD doctor gave viktana tablet for hepatitis c,,alongwith diuretics,,rifaxa for hepatic encephalopathy..he asked him to take liquid less than one litre daily,,we cut off all salt from his diet,,give him betroot,carrot,,pomegranate juices,,and soft food…unfortunately he is epileptic patient from childhood and also take epival (anti epileptic) tablet along with these tablets..his age is 33 years…🥺

[@saadahaq6234]

I need ur help suffering from ascites from 26 months

[@markpalavosvrahotes5575]

What is your illness?

[@sharmisthabaruah8168]

My mom has liver cirrhosis and she has ascites, doctor had to take out lot of water from her stomach 2 months back. After that she is taking medicines as per doctor’s suggestion but now the ascites is back. :(

[@zameerahmadshah6477]

What medicine please send me all 💊 name

[@ArtTheSinger]

What’s her diet? I have ascites and I changed my diet. No salt, No sugar, No bread, no dairy, no meat, working out and fasting is a must. The body can heal itself if it’s given proper nutrition and rest to heal. I don’t have the large amount of fluid anymore, I can see my abs again, and I feel great. It will take time to heal but she has to take the steps. I’m actually thinking of coming out with a program to help relieve and heal ascites naturally, it’s working for me so far.

[@nimunguronald8286]

❤❤❤❤

[@nimunguronald8286]

Medicine name please help I'm doing bad

[@meghanaalla4391]

@@ArtTheSingerplease do ❤

[@GLS911]

Will one time draining ascites fluid will cure the stomach tumor ? , or we should drain it for lifetime , my ascites fluid is 1 litre ! Pls reply 🙏

[@MarkCooperMD]

Ascites is a chronic condition. If it’s related to a tumor then it’s not a cure for the tumor.

[@sweetnestpolpol4476]

hello hope you can give an attention regarding of my worries as a mom..my son 9 years old having a resuly of MINIMAL ASCITES,,,and says minimal anechoic fluid collection noted in pelvic region,,,hope you can help about the meaning of his diagnose regarding his ultrasound

[@MarkCooperMD]

I’m sorry you’re having these worries. Nowadays results are released to your online chart sooner than your physician sees them. I’m sure the person who ordered the test will interpret it more fully given the complete report and clinical context than I possibly can here. Thanks for watching, and I hope you gain some clarity shortly. As a general practice radiologists alert the physician who ordered the test if there’s a concerning result.

[@nimunguronald8286]

My sister has swollen stomach ASCITES she was diagnosed with invasive adenocarcinoma stomach cancer stage 3 few days ago...she haa started intermittent prolonged fasting but stomach is growing every single day ....i want to put her on potassium gluconate oh potassium chloride to try ans ballace the fluid and hopefully it shrinks ..help me doctor please

[@MarkCooperMD]

I’m sorry to hear this. Very often ascites in this situation reflects stage 4 disease. Please work with your cancer doctor and be ready for a difficult prognosis.

[@ari-jv]

Is lactulose good? Btw you look like Ben affleck

[@MarkCooperMD]

Lactulose is effective for hepatic encephalopathy

[@rajmiglani9153]

My father diagnosed liver cirrhosis and ascites What are medicine for ascites and get relief from fluid in stomach I am from india kindky help me out sir My father has one ltr of fluid in stomach and has Ada infection in fluid

[@danajacobs9097]

Doctor I have a 16x12cm mass and I'm afraid I'm afraid help. I'm crying

[@MarkCooperMD]

Sorry to hear that. Where do you live?

[@danajacobs9097]

@@MarkCooperMD Brooklyn I went to south Brooklyn health which used to be called Coney island hospital. First they said it was a dermoid now I'm reading the paper and it says patient with a large mass with ascites

[@abdulsamad.]

​@@danajacobs9097r u ok now?

[@gidgetruiz9990]

What about a one month newborn. Doctor's dont know what to do. He has fluid in his stomach only. But every thing else is fine

[@sandilobianco6734]

Does lymphedema cause Ascitis?

[@MarkCooperMD]

Yes it can.

[@Saf_Ibn_Sayyad_Bacon]

Car accident and nsaids gave me this crap

[@maryacheampong6226]

Hello I’ve had water pumped from my abdomen this whole week but my doc says I should increase my salt intake

[@MarkCooperMD]

Why? Is it that your sodium level is low? That usually represents total body salt is high and water is even higher.

[@maryacheampong6226]

@@MarkCooperMD I don’t know doctor , but it’s been more than a week since my egg retrieval and my tummy keeps getting bloated no matter how much they drain from it

[@kitbunbun]

Please get a better mic please so hard to hear you!

[@Princesss9010]

Is this cured ? Or its permanent 🤔

[@MarkCooperMD]

Generally it’s permanent, but ascites can be controlled. Once controlled the therapies usually have to continue (so not cured), otherwise ascites will likely return.