When fluid builds up in the abdomen — a condition called ascites, an abnormal accumulation of fluid in the peritoneal cavity, often caused by liver cirrhosis. Also known as abdominal fluid retention, it’s not just uncomfortable — it can lead to breathing trouble, infection, and worsening liver damage. Diuretics for ascites are the first-line treatment because they help your body get rid of that extra fluid through urine. But not all diuretics are the same, and using them wrong can cause serious problems like low potassium, kidney stress, or confusion.
Most doctors start with spironolactone, a potassium-sparing diuretic that blocks aldosterone, a hormone that makes the body hold onto salt and water. Also known as Aldactone, it’s usually the first drug prescribed because it works slowly but steadily, reducing fluid without dumping too much potassium too fast. If that’s not enough, they add a loop diuretic, a fast-acting class of drugs like furosemide that act on the loop of Henle in the kidney to push out sodium and water. Also known as water pills, they kick-start fluid loss but need careful dosing to avoid dehydration or electrolyte crashes. Together, these two types form the standard combo — spironolactone for steady control, and a loop diuretic for faster results. The goal isn’t to drain every drop of fluid, but to lose about 0.5 to 1 kg per day without making you dizzy or weak.
People with ascites often have liver disease, so their bodies handle these drugs differently. Too much diuretic can drop blood pressure, hurt kidney function, or trigger hepatic encephalopathy — a brain fog caused by toxins the liver can’t clear. That’s why doctors monitor sodium levels, kidney tests, and weight daily at first. You’ll also need to limit salt, drink less fluid, and avoid NSAIDs like ibuprofen, which can make ascites worse.
What you won’t find in most guides? Why some patients don’t respond at all. About 10% of people with ascites are resistant to diuretics, meaning their bodies just won’t let go of the fluid no matter how much they take. That’s when doctors consider paracentesis — draining fluid with a needle — or even liver transplant evaluation. But for most, the right diuretic combo, paired with lifestyle changes, brings relief without surgery.
Below, you’ll find real-world insights from patients and providers on how these drugs are used, what side effects to expect, and how to stay safe while taking them. No fluff. Just what works — and what doesn’t — when your body is holding onto too much fluid.
Ascites management relies on sodium restriction and diuretics, but new research challenges old guidelines. Learn how much salt to really limit, which diuretics work best, and what to do when they fail.
