Ursachen von Aszites

Warum kommt es zur Flüssigkeitsansammlung im Bauchraum?

Aszites, umgangssprachlich oft als „Bauchwasser“ oder „Wasser im Bauch” bezeichnet, ist eine krankhafte Ansammlung von Flüssigkeit in der Bauchhöhle. Normalerweise enthält dieser Raum zwischen den Bauchorganen nur eine geringe Menge Flüssigkeit, die als Schmiermittel dient, damit sich die Organe reibungslos bewegen können. Wenn jedoch mehr Flüssigkeit produziert wird, als der Körper abbauen kann, kommt es zur Ansammlung – der Bauch wird größer und kann Beschwerden verursachen. Aszites ist dabei keine eigenständige Krankheit, sondern ein Hinweis darauf, dass eine andere Grunderkrankung vorliegt, die sorgfältig untersucht werden muss.

Causes of ascites

Why does fluid accumulate in the abdominal cavity?

Ascites, often referred to as “fluid in the abdomen,” is a build-up of fluid in the abdominal cavity. Normally, this space between the organs contains only a small amount of fluid, which helps the organs move smoothly.

When more fluid is produced than the body can absorb, it begins to collect. As a result, the abdomen may increase in size and symptoms can develop.

Ascites is not a condition on its own, but rather a sign of an underlying condition that should be assessed by a doctor.

Overview

The development of ascites is influenced by several processes in the body. Changes in blood circulation and fluid balance often play an important role.

For example, if the pressure in certain blood vessels increases or the level of proteins in the blood decreases, fluid can leak from the vessels into the abdominal cavity. Conditions that affect the liver, kidneys, or heart can also lead to this build-up of fluid.

There are essentially two main types of ascites:

Low-protein fluid (transudative ascites)

This type of ascites is often associated with liver disease.

High-protein fluid (exudative ascites)

This type of ascites is more often linked to inflammation or cancer.

Common causes of ascites

Below is an overview of common causes of ascites. You can find more detailed explanations further down the page.

Liver cirrhosis

One of the most common causes of ascites is advanced liver damage. This is often linked to long-term alcohol use, viral infections such as hepatitis, or other chronic liver conditions.

Over time, healthy liver tissue is gradually replaced by scar tissue. This can affect blood flow through the liver and increase pressure in the blood vessels. As a result, fluid may leak into the abdominal cavity and begin to build up.

You can find more information about liver cirrhosis here.

Inflammation

Ascites can also be caused by inflammation. For example, infections of the lining of the abdomen (peritonitis) or inflammation of the pancreas can irritate the abdominal area and lead to a build-up of fluid.

Cancer

In some cases, ascites can be linked to cancer. This may happen if cancer cells affect the lining of the abdomen or block the lymphatic system, which normally helps drain fluid. When this flow is disrupted, fluid can begin to build up in the abdomen.

Severe kidney disease

Severe kidney disease can also play a role, as the kidneys may no longer be able to remove excess fluid from the body effectively.

Heart failure

Heart failure can cause fluid to build up in the body – not only in the legs, but also in the abdomen.

You can find more information about heart failure here.

Vorgehen und Behandlung

Da Aszites oft ein Zeichen für eine schwerwiegende Erkrankung ist, ist eine gründliche ärztliche Untersuchung erforderlich. Um die genaue Ursache festzustellen, wird häufig eine Probe der Flüssigkeit aus dem Bauch entnommen und untersucht. Dabei werden unter anderem der Eiweißgehalt, die Anzahl der Zellen und mögliche Hinweise auf Infektionen oder Krebszellen analysiert. Auch Ultraschall oder eine Computertomographie (CT) können wichtige Hinweise auf die zugrunde liegende Erkrankung liefern. Die Behandlung richtet sich dann nach der Ursache – oft kommen Medikamente, eine spezielle Ernährung oder in manchen Fällen auch eine Drainage zum Einsatz, um die Flüssigkeit zu entfernen und Beschwerden zu lindern. Eine frühzeitige Diagnose und gezielte Therapie sind entscheidend, um schwerwiegende Komplikationen zu vermeiden und die Lebensqualität zu verbessern.

Procedure and Treatment

Da Aszites oft ein Zeichen für eine schwerwiegende Erkrankung ist, ist eine gründliche ärztliche Untersuchung erforderlich. Um die genaue Ursache festzustellen, wird häufig eine Probe der Flüssigkeit aus dem Bauch entnommen und untersucht. Dabei werden unter anderem der Eiweißgehalt, die Anzahl der Zellen und mögliche Hinweise auf Infektionen oder Krebszellen analysiert. Auch Ultraschall oder eine Computertomographie (CT) können wichtige Hinweise auf die zugrunde liegende Erkrankung liefern. Die Behandlung richtet sich dann nach der Ursache – oft kommen Medikamente, eine spezielle Ernährung oder in manchen Fällen auch eine Drainage zum Einsatz, um die Flüssigkeit zu entfernen und Beschwerden zu lindern. Eine frühzeitige Diagnose und gezielte Therapie sind entscheidend, um schwerwiegende Komplikationen zu vermeiden und die Lebensqualität zu verbessern.

Cirrhosis of the liver

The most common cause of ascites is advanced liver cirrhosis – a serious condition in which healthy liver tissue is gradually replaced by scar tissue. As this happens, the liver can no longer function as it should, which affects the whole body.

One of the liver’s key roles is to filter and process blood coming from the digestive system. When the liver becomes scarred, the blood can no longer flow through it easily. Instead, it builds up in the portal vein – a large blood vessel that carries nutrient-rich blood from the intestines to the liver. This increased pressure in the portal vein (portal hypertension) causes fluid to leak from the blood vessels into the abdominal cavity.

Liver cirrhosis also has another important effect: it reduces the production of albumin, a protein that normally helps keep fluid inside the blood vessels. When albumin levels in the blood are low, even more fluid leaks out into the surrounding tissues and into the abdominal cavity, contributing to the development of ascites.

Because the liver plays a central role in the body’s metabolism, cirrhosis can also lead to other symptoms. These may include jaundice (yellowing of the skin and eyes), increased tiredness, or a higher risk of infections.

In many cases, the disease develops slowly over several years and may go unnoticed at first, until symptoms begin to appear – including ascites.

Early treatment of liver cirrhosis can help slow down the progression of the disease and reduce the risk of developing ascites. This includes treating the underlying cause, such as avoiding alcohol in alcohol-related cirrhosis or using antiviral medication in cases of hepatitis infection.

If ascites has already developed, treatment options such as diuretics (medications that help remove excess fluid) or draining the fluid (paracentesis or an indwelling catheter) can help relieve symptoms.

Other symptoms that may occur with ascites caused by liver cirrhosis:

Yellowing of the skin (jaundice)

Weight loss and muscle wasting

Enlarged veins on the abdominal wall (Caput medusae)

Fatigue and difficulty concentrating

Malignant ascites

Fluid retention caused by cancer

Not only liver diseases, but also cancer can lead to the development of ascites. When the fluid build-up is caused by cancer, it is referred to as malignant ascites. This most commonly occurs in cancers such as colorectal cancer, stomach cancer, ovarian cancer, or pancreatic cancer.

In these cases, cancer cells may spread to the peritoneum – a thin layer of tissue that lines the abdominal cavity and surrounds the organs.

One of the main causes of malignant ascites is damage to or blockage of the lymphatic vessels. These vessels normally help remove excess fluid from the abdominal cavity. When they are blocked or affected by tumors, the fluid can no longer drain properly and instead builds up in the abdomen.

Another contributing factor is increased permeability of the blood vessels. Certain tumor cells can release signaling substances that make the vessel walls more permeable, allowing fluid to leak more easily into the abdominal cavity.

This makes the vessel walls more permeable, allowing fluid to leak more easily into the abdominal cavity.

People affected often notice a sudden increase in abdominal size, along with a feeling of pressure, digestive problems, and sometimes pain. As the underlying cancer is often at an advanced stage, treatment usually focuses on relieving symptoms.

To reduce the build-up of fluid, different options may be used, such as draining the fluid (paracentesis), indwelling catheter systems, or medications that help slow down cell growth. In some cases, chemotherapy may also help control tumor growth and reduce fluid accumulation.

Because malignant ascites is often associated with a general weakening of the body, comprehensive palliative care is important to help maintain the best possible quality of life.

Signs of malignant ascites:

Rapid recurrence following a puncture

Increasing waist circumference despite weight loss

Pain and digestive problems

General weakness and loss of appetite

Heart failure

When the heart can no longer pump effectively

In addition to liver disease and cancer, heart failure (a weakened heart) can also lead to the development of ascites. The heart’s role is to pump blood throughout the body, supplying organs with oxygen and nutrients.

When the heart is weakened and cannot pump effectively, blood can build up in the veins – especially in the large blood vessels that carry blood back to the heart.

This backflow in the veins causes fluid to leak from the blood vessels into the surrounding tissues. At first, swelling is often seen in the legs and ankles (oedema). Over time, fluid may also build up in the abdominal cavity, leading to ascites.

This type of fluid build-up is most common in more advanced stages of heart failure, when the heart is no longer able to effectively pump oxygen-poor blood from the body to the lungs.

Typical symptoms associated with ascites caused by heart failure include swelling in the legs, an increasing feeling of pressure in the abdomen, and shortness of breath (dyspnoea). The shortness of breath may become more noticeable when lying down, as the fluid puts more pressure on the diaphragm, leaving less room for the lungs to expand.

People affected often feel low in energy, become easily tired, and may gain weight – although this is not due to fat, but to fluid build-up in the body.

Treatment is primarily aimed at addressing the underlying cause of the heart failure. Medications such as diuretics (water tablets) can help remove excess fluid from the body and relieve symptoms. A low-salt diet may also help reduce fluid retention.

In more severe cases, it may be necessary to relieve the ascites by draining the fluid. As heart failure is a chronic condition, long-term treatment with heart medications, exercise therapy, and, in some cases, support of heart function with a pacemaker or other interventions may be needed to help stabilise the condition.

Typical symptoms of ascites caused by heart failure:

Shortness of breath, especially when lying down

Declining physical stamina

Fluid retention in the legs (leg edema)

Weight gain due to water retention

Conclusion

Ascites as a warning sign of serious illnesses

In most cases, ascites is a sign of a serious underlying condition, particularly affecting the liver, the heart, or the abdominal area. A thorough medical evaluation is important to identify the cause and to start the most appropriate treatment.

Treatment depends on the underlying condition and may include medication, drainage of the fluid, or, in more severe cases, surgical procedures.

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Fazit

Aszites als Warnsignal für ernste Erkrankungen

Aszites ist in den meisten Fällen ein Zeichen für eine schwerwiegende Erkrankung, insbesondere der Leber, des Herzens oder des Bauchraums. Eine genaue ärztliche Abklärung ist entscheidend, um die Ursache zu identifizieren und die bestmögliche Therapie einzuleiten. Die Behandlung richtet sich nach der Grunderkrankung und kann medikamentös, durch eine Drainage oder in schweren Fällen durch chirurgische Maßnahmen erfolgen.

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