Water is found in almost the entire human body. It makes up a large part of the weight of the human body. Water is also a normal component in many organs.
In addition, however, water can also be found in the free abdominal cavity, i.e. outside the organs. In this case, this is a deviation from the normal state and the cause should be sought, as it is often serious illnesses that lead to water accumulation in the abdomen. If there is an accumulation of water, one speaks of a water belly. In medical terminology this is called ascites. However, this is not a disease in itself, but merely a symptom of another underlying disease.
These can be the causes
There are many different causes that lead to a water belly. On the one hand, the condition of malnutrition can lead to the leakage of water into the free abdominal cavity. This is especially the case if not enough protein is taken in with the food.
This condition is called hypalbuminemia. This phenomenon can often be observed in third world countries. The most common cause of water retention in the abdomen is a chronic liver disease, such as cirrhosis of the liver.
In this case, the liver is very limited in its function due to a strong restructuring of the connective tissue. The blood in the large blood vessel supplying the liver, the so-called portal vein (vena portae), becomes congested and high blood pressure develops. In technical terminology this is called portal hypertension.
The increased pressure forces water from the blood vessels into the surrounding tissue, where it collects in the abdominal cavity. Heart disease can also lead to blood congestion in the liver and cause a water belly. This is often the case with heart failure of the right heart.
Another possible cause is kidney disease. Renal insufficiency can lead to water accumulation in the free abdominal cavity. Even if there is an inflammation in the abdominal cavity, such as peritonitis or inflammation of the pancreas, water often accumulates in the abdomen.
The reason for this is that during the course of the inflammatory reaction there is increased permeability of the blood vessels. Water can then easily leak into the abdominal cavity. Infections, such as tuberculosis, can also lead to a water belly.
Often, in the course of a tumor disease affecting the abdominal cavity, the peritoneum is also affected by cancer cells (peritoneal carcinoma) and this can also lead to a water belly. This can be caused, for example, by colon cancer, pancreatic cancer or ovarian cancer. In this case, if a malignant disease is underlying the disease, it is called malignant ascites.
A local ascites, colloquially “water in the belly”, can occur as a consequence of a burst cyst. A cyst is generally understood to be a cavity of cell epithelia embedded in the tissue of the surrounding organs. Depending on the cause, the cyst interior is filled differently.
Besides pus, blood, urine, mucus or air, cysts can also contain tissue fluid. Cysts either exist from birth or form reactionary in the course of infectious events, chronic diseases or injuries. Cysts of the abdominal organs are common: In most cases, these do not show any symptoms.
They only become symptomatic in the form of severe pain when they grow excessively and burst shell structures. Bleeding can also occur. A burst cyst is harmless as long as no blood vessel is injured.
However, if this is the case, immediate action must be taken and an emergency operation performed.
- Liver cyst
- Renal cyst
- Ovarian cyst
In about one third of all patients with cancer, ascites, an accumulation of fluid in the abdomen, develops as the disease progresses. There are various causes for this symptom, which is usually associated with a distended abdomen.
Increased pressure on the surrounding organs as well as discomfort due to reduced protein synthesis by the liver are serious complications, but they do not directly threaten the patient’s life. If tumor cells settle on the peritoneum, this is called peritoneal carcinomatosis. The daughter tumors (metastases) produce fluid that accumulates in the abdominal cavity.
More rarely, the liver is the cause of the ascites that develops.If the liver is affected by some metastases, the blood from the abdominal organs can no longer flow unhindered via the portal vein into the liver. The blood accumulates and the pressure on the vessel walls increases. This is known as portal hypertension.
The increase in pressure causes fluid to be pressed into the abdominal cavity, which is further intensified by the body’s own regulatory mechanism of the circulation. A further, even rarer cause is the tumor-induced impression of the largest lymphatic drainage pathway. This is the thoracic duct, which transports the lymph to the left vein angle.
An amount of ascites of about one liter can be objectively determined during the physical examination. Puncture alleviates symptoms and serves to clarify the cause. The therapy depends on the cause and may include the administration of medication in addition to symptom relief.
Pancreatic cancer is a tumor disease of the pancreas that is often discovered late. Often, the first symptoms are unspecific upper abdominal pain and a painless yellowing of the sclera (the white of the eye) and the skin. Nausea, vomiting and loss of appetite may also be present.
In more advanced stages, the cancer cells most frequently spread to the liver. The accumulation of water in the abdomen usually indicates an advanced stage of cancer and can indicate either the pancreatic cancer itself or liver involvement. Ovarian cancer is a disease that typically affects older women.
Often, the disease occurs at a time when menstruation is no longer regular (menopause or after), so ovarian cancer does not initially cause any noticeable symptoms. Often, it is therefore only discovered when it has grown so large that the mass is visible through the abdominal wall. In most cases, ascites does not develop until the ovarian cancer is very large.
The presence of water in the abdomen in ovarian cancer therefore indicates an advanced disease. Alternatively, scattering of the tumor cells, for example in the liver, can also cause these symptoms. After an operation in the abdominal cavity, the peritoneum is usually affected for some time.
Just as it happens in other areas of surgery, the body begins a defensive reaction to repair the tissue damage caused by the operation. This typically manifests itself through swelling and water retention. Depending on the size of the surgical procedure in the abdominal cavity, a pronounced accumulation of water is possible. Therefore, most abdominal surgery is attempted laparoscopically (only through small skin incisions and instruments inserted through these skin incisions), as this is less traumatic for the abdomen. In very large operations, the water in the abdomen cannot be bypassed, so the abdominal wall is occasionally left slightly open at one point to prevent an uncontrolled increase in pressure in the abdomen.