Treating fluid in the abdomen
This page tells you about treatment for fluid on the abdomen (ascites). There is information on
Doctors call fluid on the abdomen ascites (pronounced ay-site-eez). The aim of treatment is to help control symptoms and make you more comfortable. Some treatments have side effects so you might want to ask your doctor about the risks and benefits of different treatments.
Your doctor may call this paracentesis (pronounced para-sen-tee-sis). Taking out the extra fluid helps to relieve your symptoms and can make you feel more comfortable.
How you have fluid removed depends on what is causing it to build up, the stage of your cancer, and how fit and well you are.
Draining the fluid from your abdomen is the quickest way to relieve your symptoms and make you feel more comfortable. Your doctor may call this an ascitic tap (pronounced ay-see-tic tap). It relieves symptoms in 9 out of 10 people (90%).
You need to go to hospital to have this done, but may be able to have it as an outpatient. Some people need to stay in overnight. You have an ultrasound scan at the same time to help your doctor guide the small tube into your abdomen.
You lie down on a bed and your doctor cleans your skin where they are going to put the tube in. Then you have an injection of a local anaesthetic to numb the area. Once it is numb, your doctor makes a small cut in the abdomen and puts in the small tube. They attach this to a drainage bag.
If the tube is going to stay in for a day or so your doctor may put a couple of stitches in the skin to help hold it in place. You will have a dressing over the tube which also helps to keep it in place.
How long you have the tube in depends on the amount of fluid in your abdomen. Some people may only need to have the tube in for a few hours. But you may need to stay in hospital for a few nights to allow the fluid to drain slowly. Draining several litres of fluid too quickly can sometimes lower your blood pressure and make you feel unwell.
Having the fluid drained is good for relieving symptoms in the short term. But it does not stop the fluid being made. So it will build up again in time. How long this takes varies from person to person. You can keep having fluid drained. But there can be problems.
The main problems with removing fluid in this way are
- Pain and discomfort
- Infection (peritonitis)
- Blockage of the tube
- Fluid pooling in pockets in the abdomen, making it more difficult to drain
- Fluid leaking after the tube is taken out
If you need to have fluid drained quite often, your doctor may suggest a long term tube.
If your doctor thinks you will need to have fluid drained regularly, they may suggest a tube (catheter). This can stay in for several months. There are different types of tube including a PleurX drain and a shunt.
A PleurX drain is a tube that can stay in your abdomen to allow you to have fluid drained whenever you need to. It means that you don’t need to go into hospital for your doctor to drain the fluid.
The end of the tube lies outside your body and is covered by a dressing. When the fluid builds up in your abdomen, you or a nurse can attach a drainage bottle to the tube. The drainage bottle has a vacuum that helps the fluid to drain. It usually takes between 5 and 15 minutes. Once the fluid has stopped draining, you remove the bottle, close the tube and put a clean dressing over it.
To put a PleurX drain in, your doctor cleans your skin and injects a local anaesthetic to numb the area. They make 2 small cuts in your abdomen and put the tube in. The part of the tube just under your skin has a cuff on it to help it stay in place and prevent infections. Your doctor stitches it to your skin and puts a dressing over the part of the tube that lies outside your body. You should not drain more than 2 litres (3½ pints) of fluid at any one time.
The most common problems with a PleurX tube are
- Pain when it is put in
- Infection around the tube or inside the abdomen (peritonitis)
- Blockage of the tube
A nurse will teach you how to attach the drainage bottle safely and cleanly, so that you lower the risk of infection. You may need antibiotics if you have an infection. More rarely your doctor may remove the tube.
A shunt is a tube that is totally inside your body. Your doctor may call it a peritoneo-venous shunt (pronounced pear-it-oh-nee-oh vee-nus).
This drains fluid from the abdomen into a main blood vessel. It is more difficult to put this in than a PleurX tube. So you need to be fairly well to have this done. You may need a general anaesthetic and will have to stay in hospital for a couple of nights.
There are a number of different types of drug treatment that may help you, such as
Your doctor may suggest that you take a water tablet (a diuretic, pronounced dye-yoo-ret-ik). This helps to stop fluid building up. But it will make you pass urine more often. We know from research that this helps in just under half of those who take it.
These treatments can help to control fluid in the abdomen in some people. These may help in different ways depending on what is causing the fluid to build up. If you have fluid in your abdomen because you have cancer cells irritating the lining of the abdomen they can kill those. If the fluid is caused by cancer in your liver or in lymph nodes chemotherapy or hormone therapy can help to reduce these tumours and so let the fluid drain as normal. We can’t give details about drugs or side effects here because the type of chemotherapy or hormone therapy you have depends on the type of cancer you have. You can find out more in the treatment section for your cancer type. Usually, this type of treatment is either tablets or a drip or injection into a vein.
Sometimes, your doctor may suggest chemotherapy through a tube directly into your abdomen. This can help to control the build up of fluid for some people. But doctors don’t suggest it very often because there isn’t much evidence to show that it works very well.
Putting a tube (catheter) under the skin with a pump attached
Research is still looking into this treatment so you can only have it as part of a trial. It is used if you have ascites that is difficult to treat or keeps coming back.
You have a general anaesthetic and a doctor makes 3 small cuts in your tummy (abdomen). They put a tube into your abdomen where the ascites is and connect it to a small battery powered pump. The pump sits under the skin of the abdomen.
The pump is then connected to another tube that fixes into the bladder. The fluid (ascites) is then pumped from the abdomen into the bladder. You get rid of the fluid in your urine. The pump is set to work only when needed. The doctor will programme it.
As this type of pump is still in the research stages we do not know how well it works or how safe it is yet. You can read more about it on the NICE website.
Researchers are looking into a new biological therapy called catumaxomab. This is a monoclonal antibody. It works by helping the immune system find and kill cancer cells.
Catumaxomab only works on cancer cells that have a particular protein. So, you only have it if your cancer cells have this protein. You have it as a drip directly into your abdomen. Your doctor first drains any fluid and then attaches the drip of catumaxomab. In trials of catumaxomab the most common side effects were
- A high temperature (fever) and chills
- Feeling and being sick
- Abdominal pain
- Redness around the site of the tube
Depending on what is causing your ascites, it may help to reduce the amount of salt in your diet. This can be difficult to do and doesn’t work for everyone. Talk to your doctor or specialist nurse before you make any changes. They may refer you to a dietician if they think this could help you.
Because of feeling full, many people lose their appetite when they have fluid on the abdomen. The dietician may be able to help with this too.
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