Medically reviewed by Dr Usman Naeem, 26 Oct 2026.
Causes
In most adults it is due to cirrhosis (scarring of the liver), often from hepatitis B or C, fatty liver or alcohol. Other causes include heart failure, kidney problems, tuberculosis of the abdomen and some cancers, which is why tests matter.
Tests
- Examination and ultrasound
- Blood tests for liver and kidney function and salts
- A small sample of the fluid taken with a needle (diagnostic paracentesis) to check the cause and look for infection
Treatment usually includes
- A low-salt diet
- Water tablets (diuretics) at doses set and monitored by your doctor, with regular blood tests
- Draining larger amounts of fluid (therapeutic paracentesis) when the belly is tight
- Treating the cause of the liver disease
- In selected patients, referral for TIPS or liver transplant assessment
Staying safe
- Do not change water-tablet doses yourself
- Avoid ibuprofen, diclofenac and similar painkillers
- Weigh yourself regularly if your doctor asks you to, and bring the record
When to seek medical help urgently
- Fever, belly pain or tenderness (possible infection of the fluid, called SBP)
- Confusion or sleepiness
- Very little urine
- Vomiting blood or black stools
- Feeling faint
In an emergency go to the nearest emergency department or call Rescue 1122. Do not wait for a WhatsApp reply.
Common questions
Should I drink less water?
Only if your doctor advises it, usually when the blood sodium is low.
Will the fluid come back after draining?
It can, unless the salt balance and the cause are controlled.
Would you like Dr Usman Naeem to look at your case?
Consultations are available in clinic in Lahore or online. Message on WhatsApp 0332-0420421 or 0334-0421313, or call or SMS 0311-4444600. The clinic will confirm a day and time.
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پیٹ میں پانی بھر گیا؟ (Ascites) 7 احتیاطیں جو ہر مریض کو معلوم ہونی چاہئیں
Watch on YouTubeSwollen Belly Due to Liver Disease? 4 Proven Ways to Manage Ascites
Watch on YouTubeجگر کے مریضوں میں بلڈ پریشر کم (Low BP) کیوں ہوتا ہے؟ 4 وجوہات
Watch on YouTubeRelated condition guides
More articles
- High SGPT (ALT) in Your Blood Test: What It Means and What to Do Next
- Fatty Liver Diet: A Practical Guide with Everyday Pakistani Food
- Blood in Stool: Common Causes, When to Worry and When a Colonoscopy Is Needed
- Hepatitis B and C in Pakistan: Which Tests You Need and How Treatment Works
- Acidity and H. pylori: Symptoms, Testing and When to See a Doctor
- When Do You Need an Endoscopy? Reasons, Preparation and What to Expect
- Cirrhosis Diet: What to Eat and What to Avoid
- Yellow Eyes (Jaundice): Causes, Tests and When to Worry
Sources and further reading
- EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. J Hepatol 2018;69:406–460. Link
- Biggins SW et al. Diagnosis, evaluation and management of ascites, spontaneous bacterial peritonitis and hepatorenal syndrome: AASLD practice guidance. Hepatology 2021;74:1014–1048. Link
General information only, not personal medical advice. Do not start or stop medicines because of this article. See the medical disclaimer.