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What Is Ascites?

Ascites (ah-SITE’-eez) is extra fluid built up in the abdomen. It causes the belly to swell and stretch out. Pancreatic cancer patients may have ascites at any time, but it is especially common in patients whose cancer has metastasized, or spread.

Causes of Ascites

Cancer causes about 10 percent of ascites cases. It is most common in breast, ovarian, colon, stomach and pancreatic cancer. Ascites can happen several ways:

  • When cancer spreads to the abdominal lining, it can cause irritation and stimulate the lining to create extra fluid.
  • When the cancer spreads to the liver or the vein that carries blood to the liver, blood pressure can rise. This limits circulation and causes a buildup of fluid in the abdomen.
  • If the liver is damaged, it may produce less blood protein. This disrupts the body’s balance, causing fluids to build up in body tissue.
  • If the cancer blocks the lymphatic system, extra fluid cannot be drained well and causes fluid buildup in the abdomen.

Signs and Symptoms of Ascites

Small amounts of fluid in the abdomen rarely cause symptoms, or signs of a problem. As the amount of fluid increases, symptoms start to show. The abdomen swells, the skin stretches tightly across the stomach area and the belly button becomes flat or pushed out. This puts pressure on the stomach and lungs and can cause other symptoms.

Possible signs of ascites are:

  • Swelling, discomfort, pressure or pain in the stomach area
  • Increased waist size or weight gain
  • Difficulty breathing
  • Lowered appetite
  • A sense of fullness
  • Indigestion
  • Fatigue – a tired, weak feeling all over
  • Constipation – hard, dry bowel movements, often with discomfort in passing stools or infrequent passing of stools
  • Nausea
  • Ankle swelling

Tell your doctor if you develop these problems or if you have been treated for ascites and these symptoms have come back.

Treatments for Ascites

Extra fluid in the abdomen and its effects can usually be controlled in several ways:

  • Treating the tumor
  • Diuretics (water pills)
  • Paracentesis
  • Relieving related symptoms

Treating the Tumor

Successful treatment of the cancer through chemotherapy or surgery may lower the fluid buildup in the abdomen.


Diuretics (water pills) cause the kidneys to release more water into the urine. This may slow the buildup of fluid in the abdomen.


Paracentesis is a procedure to drain extra fluid and make you more comfortable. A doctor puts a needle attached to a tube into the abdominal cavity to drain the fluid. This can be used in medium to serious cases of ascites.

The time the procedure takes depends on how much extra fluid there is. Sometimes you can have a small amount of fluid drained in an outpatient setting with no hospital stay. If there is a lot of fluid, you may need to stay in the hospital for the procedure.

Paracentesis can help symptoms for a time, but the extra fluid often returns. If this happens, your doctor may do paracentesis again. For patients who produce a lot of extra fluid, a catheter that drains the ascites continuously may help.

Relieving Related Symptoms

Common problems with ascites that keeps coming back are leg swelling, breathing difficulty and intestine blockage. Resting in a reclined position with the feet up lowers pressure on the internal organs, improves blood flow and helps drain the fluids.

The fluid that builds up is often heavy, so it can cause the bowel to not move properly. It is important to prevent or control constipation, especially in a patient who is taking opioids for pain or has other risks for constipation.

Ascites can also slow the movement of food leaving the stomach. This can lead to nausea and vomiting. The stomach empties to the right, and many patients have less nausea when laying on their right side.  There is also medicine that can help with this problem.

Patients should talk to their doctor to prevent and control symptoms.

Seeing healthcare professionals who focus on symptom management and supportive care improves outcomes and is critical for your quality of life. The Pancreatic Cancer Action Network strongly recommends that symptom management and supportive care should be provided early in your diagnosis as well as during and after treatment.

PanCAN Patient Services can help you learn more about symptoms and supportive care to control them.

We’re Here to Help

For more information on ascites or for free, in-depth and personalized resources and information on pancreatic cancer, contact a PanCAN Patient Services Case Manager.

Information reviewed by PanCAN’s Scientific and Medical Advisory Board, who are experts in the field from such institutions as University of Pennsylvania, Memorial Sloan-Kettering Cancer Center, Virginia Mason Medical Center and more. Information provided by the Pancreatic Cancer Action Network, Inc. (“PanCAN”) is not a substitute for medical advice, diagnosis, treatment or other health care services. PanCAN may provide information to you about physicians, products, services, clinical trials or treatments related to pancreatic cancer, but PanCAN does not recommend nor endorse any particular health care resource. In addition, please note any personal information you provide to PanCAN’s staff during telephone and/or email communications may be stored and used to help PanCAN achieve its mission of assisting patients with, and finding cures and treatments for, pancreatic cancer. Stored constituent information may be used to inform PanCAN programs and activities. Information also may be provided in aggregate or limited formats to third parties to guide future pancreatic cancer research and education efforts. PanCAN will not provide personal directly identifying information (such as your name or contact information) to such third parties without your prior written consent unless required or permitted by law to do so. For more information on how we may use your information, you can find our privacy policy on our website at