Ascites is one of the most frequent and visible complications of chronic liver diseases, especially cirrhosis. It is the abnormal accumulation of fluid inside the abdominal cavity, resulting from an alteration in portal pressure and the body’s fluid balance. Beyond its medical dimension, ascites represents a deeply limiting and distressing experience for those who suffer from it, as it compromises not only physical function but also autonomy, mental health, and family dynamics.
According to medical literature, approximately 50 to 60% of patients with cirrhosis develop ascites over the course of their disease (Wang et al., 2023). Although medical management has advanced, it remains a critical point in liver disease progression, marking the transition from compensated to decompensated cirrhosis, with a significant increase in mortality risk (Tapper et al., 2023). However, the consequences of ascites go far beyond statistics: they profoundly affect how people live and relate to others.
Symptoms and clinical manifestations
Symptoms of ascites are usually progressive and, in many cases, disabling. The most visible is abdominal distension, which can reach volumes of several liters of accumulated fluid. This increase in abdominal circumference causes pain, a feeling of pressure, and difficulty breathing, especially when lying down (Garzón Olarte, 2004). People describe the sensation as “carrying a constant weight in the abdomen” or “feeling full all the time,” which limits simple daily activities such as walking, dressing, or sleeping comfortably.
As ascites progresses, other associated symptoms appear, including:
- Leg and ankle edema caused by fluid retention.
- Extreme fatigue and loss of muscle mass, reflecting frequent protein malnutrition in advanced cirrhosis.
- Anorexia or loss of appetite due to stomach compression by the accumulated fluid.
- Nausea, dyspnea, and early satiety, which prevent adequate food intake.
- In severe cases, umbilical or inguinal hernias due to increased intra-abdominal pressure (Wang et al., 2023).
In addition to physical symptoms, ascites causes psychological distress: anxiety, insomnia, body image disturbances, and feelings of hopelessness. Visible abdominal swelling may cause shame or discomfort in social settings, affecting self-esteem and intimate life (European Association for the Study of the Liver [EASL], 2018).
Treatment and limitations in daily life
Managing ascites combines medical treatment with lifestyle changes that deeply affect the daily routine of those who live with it. Although pharmacological measures such as diuretics and sodium restriction exist, many patients must undergo frequent therapeutic paracentesis to relieve symptoms.
1. Therapeutic paracentesis and its frequency
Paracentesis is the procedure in which the accumulated fluid is removed from the abdominal cavity. It is used to relieve distension, improve breathing, and prevent complications such as spontaneous bacterial peritonitis (Runyon, 2013).
A study of over 1,000 patients reported 2,123 paracenteses in 1,041 individuals, averaging two procedures per person (Bernardi et al., 2013).
In more severe cases, such as refractory ascites, the frequency increases: a retrospective analysis of 1,218 patients recorded 4,389 paracenteses (approximately four per patient), with an average of 4.9 liters removed per session (Hassouneh et al., 2014).
Clinically, some patients require drainage every 1 to 3 weeks, depending on how quickly the fluid accumulates (European Association for the Study of the Liver [EASL], 2018).
This recurrence results in an exhausting routine: frequent trips to the hospital, recovery time after the procedure, and the emotional burden of relying on an invasive intervention to feel physically better.
2. Impact on daily life
Ascites significantly affects mobility, appetite, and social interaction. The increased abdominal volume causes pain, heaviness, and difficulty breathing or walking (Gines & Schrier, 2009).
Additionally, dietary restrictions—such as low-sodium diets and limited fluid intake—may reduce enjoyment of meals and lead to frustration or weight loss.
Constant physical discomfort is also associated with sleep disorders, anxiety, depression, and chronic fatigue, severely impairing quality of life (Silva et al., 2021).
In qualitative studies, patients describe ascites as “living with a weight that crushes you from the inside” and mention the anxiety of watching their abdomen grow day after day without control (Silva et al., 2021).
3. Medical limitations and complementary procedures
When ascites does not respond to conventional treatments with diuretics, it is classified as refractory ascites, and patients may require frequent drainage or more complex procedures such as TIPS (transjugular intrahepatic portosystemic shunt).
This procedure reduces fluid accumulation by lowering portal pressure. In one study, patients treated with TIPS required ten times fewer paracenteses than those who did not receive it (Møller et al., 2019).
However, not all patients are candidates: advanced age, hepatic encephalopathy, or heart failure may prevent its use.
Complications from paracentesis, although uncommon, are significant: bleeding, hypotension, or infection of the ascitic fluid. One study found that 27.5% of patients presented early complications and 16.8% late complications after the procedure (Hassouneh et al., 2014).
Likewise, the timing of drainage influences prognosis: performing paracentesis within the first 12 hours of hospitalization is associated with lower mortality and shorter hospital stays (Kang et al., 2021).
4. Consequences for daily and family life
Dependence on these procedures, combined with physical discomfort, affects patients’ autonomy and self-esteem. Many must organize their routine around medical appointments and dietary restrictions.
Family members also face a significant burden: accompanying patients to paracentesis, recognizing warning signs (such as fever or sudden increase in abdominal size), and adapting household meals.
Socially, ascites limits the ability to work, move around, sleep comfortably, and maintain sexual or partner relationships, generating frustration, isolation, and dependency (Silva et al., 2021).
At the healthcare system level, repeated treatment involves high hospital costs, constant use of medical resources, and continuous follow-up by hepatology and nutrition teams.
Impact on quality of life
Ascites has a profound impact on physical, emotional, social, and economic quality of life. From a medical perspective, its appearance indicates a more reserved prognosis; from a human perspective, it represents the loss of independence and normalcy.
A study by EASL (2018) states that patients with ascites present one of the lowest quality-of-life scores among all chronic liver diseases. The combination of pain, physical limitations, and fear of disease progression undermines emotional well-being. Many people report sadness, irritability, isolation, and increasing dependence on family members or caregivers.
In the family environment, the disease modifies routines and roles. Families must reorganize schedules to accompany the patient to medical appointments, monitor medication intake, or adjust meals. This can generate tension, emotional fatigue, and caregiver overload, especially when the patient requires constant assistance.
Vélez et al. (2023) found that repeated hospitalizations for hepatic decompensation—of which ascites is the main cause—lead to significant economic impact due to loss of income and additional medical expenses.
Additionally, stigma associated with liver diseases—often socially linked to alcohol consumption—can cause guilt or discrimination, even when the condition is unrelated to lifestyle habits (Garzón Olarte, 2004). This affects support networks and reinforces isolation.
Conclusions
Ascites is not only a medical manifestation of cirrhosis but a complex human phenomenon that profoundly affects daily life.
Physical symptoms—pain, swelling, fatigue, and malnutrition—intertwine with emotional and social consequences that undermine autonomy and well-being. Dependence on continuous treatment, fear of the future, and the economic burden on families make ascites a public and social health issue requiring comprehensive responses.
Understanding ascites from a more human perspective requires recognizing that behind each diagnosis is a person striving to maintain dignity and quality of life—and that care must go far beyond symptom management: it must include ongoing support, understanding, and sustained accompaniment.
References
(All references translated directly to maintain academic accuracy.)
