Treatment for ascites

Cancer can sometimes cause a build up of fluid in the tummy (abdomen). The medical name for this is ascites (pronounced aye-site-eez). Treatments to remove the fluid or prevent it from building up include:

• having a tube put in your abdomen to drain the fluid
• medicines to help get rid of the fluid
• treatments to help control the cancer, which may stop the fluid building up

Having a tube to drain the fluid (paracentesis)

Your doctor can put a small tube into your abdomen to drain off the fluid. This is called an abdominal paracentesis (pronounced para-sen-tee-sis). It reduces the swelling and makes you feel more comfortable.  

Draining the fluid relieves symptoms in 90 out of 100 people (90%).

Sometimes the fluid can collect in little pockets in your abdomen instead of one big collection. This is called loculated ascites. If there are too many pockets of fluid, your doctor may not be able to drain it. If this happens they will talk to you about other treatments.

What happens when you have the ascites drained?

Your doctor or nurse will tell you how to prepare for the procedure. You will normally have some blood tests. This is to make sure your blood is clotting normally.

Your nurse helps you get comfortable on the bed. Once you’re laying down, your doctor might do an ultrasound scan of your abdomen. This helps them find the right place for the tube. They clean the skin on your abdomen and give you a local anaesthetic injection to numb the area.

Once the area is numb, your doctor makes a small cut in your abdomen and puts a thin tube into the fluid. They attach a drainage bag to the end of the tube. The fluid flows into the bag. They might also put a couple of stitches in your skin to hold the tube in place. And you’ll have a dressing over the tube. This also helps stop it moving.

You might only need to have the tube in for a few hours. If you have more than a couple of litres of fluid in your abdomen you might have the tube in for a few days. 

You can normally go home after the tube is taken out.

The diagram below shows ascites being drained in a woman.

Possible side effects and complications

As with any medical procedure there are possible side effects or complications. Your doctor will make sure that the benefit of the treatment outweighs these risks.

Everyone is different and side effects can vary from person to person. You may not have all the effects mentioned. Side effects can include:

Low blood pressure

Your blood pressure may drop and make you feel ill if the fluid drains too quickly. Your nurses will check your blood pressure and pulse regularly.

Kidney problems

Draining a large amount of fluid from your abdomen may affect how well your kidneys work. Your doctors and nurses will check that your kidneys are working properly.

Pain and discomfort

Your nurse can give you painkillers if you need them. They can also help you change your position to make you comfortable.

Infection in your abdomen (peritonitis)

Peritonitis isn’t common but it can be serious. So, it’s important to tell your doctor or nurse if you have a high temperature. Treatments include antibiotics through a drip.

Tube blockage

If the tube become blocked it might stop draining. Changing your position or sitting upright can sometimes get rid of the blockage. If not, your doctor might need to replace the tube.

Fluid leak after the tube is taken out

Your nurse puts a dressing on the wound after the tube is taken out.

Sometimes you might get fluid leaking onto the dressing. If there’s a lot of fluid you may have a collection bag instead of a dressing. If it carries on leaking you might need to have some stitches put in the wound.

If fluid builds up again

Sometimes the fluid can start to build up again after you’ve had it drained. You might be able to have it drained again. Or your doctor might talk to you about having a long term drain.

Medicines to help get rid of the fluid

Medicines to help get rid of the fluid are called diuretics. This is pronounced dye-yoo-ret-iks. They make you pee more often. Some people call them water tablets. Research shows diuretics might stop the fluid building up in some people with ascites.

Treatments to help control the cancer

Your doctor might recommend chemotherapy, targeted cancer drugs or hormone therapy to help shrink or control the cancer. The aim is to stop what is causing the ascites. Unfortunately, these treatments aren’t suitable for everyone as it depends on:

• the type of cancer you have
• what treatments you have had already
• how well you are

Your doctor or nurse specialist (CNS) will talk to you about cancer drug treatments if they are an option for you.

How you might feel

Coping with ascites can be extremely difficult. Talking to others can help. As well as family and friends, there are plenty of people at the hospital and in your community who can help support you.

Some people find it helpful to find out more about their cancer and the treatments they might have. Many people find that knowing more about their situation can make it easier to cope.