Category: Liver Health

ABSTRACT

Ascites refers to the abnormal buildup of fluid in the abdominal cavity. It often signals an underlying systemic disorder. It is frequently linked to liver cirrhosis, though it can also result from conditions such as cancer, nephrotic syndrome, heart failure, or infections. The development of ascites involves several interrelated processes, including increased pressure in the portal circulation, renal retention of sodium, and low serum albumin levels. Ayurveda presents a large scope to treat this condition. Focusing on restoring the balance of the Doshas (Body’s energy). Ayurveda provides herbal treatments and detoxification techniques such as Panchakarma, and dietary guidance to alleviate fluid retention. It improves digestion, and enhances overall well-being. In this article we will discuss various Ayurvedic therapies, including the use of medicinal herbs.

INTRODUCTION

Ascites is an abnormal buildup of fluid in the abdomen. In this condition there is more than 25 ml of fluid in the peritoneal cavity. It develops when there is an imbalance between the production and absorption of fluid in the peritoneal cavity. It is often caused by elevated pressure in the portal vein (Portal hypertension), low levels of protein (Especially albumin) in the blood, and changes in the kidney’s ability to process sodium and water. It is a common complication of liver cirrhosis and occurs in about 50% of patients. Mortality in this disease increases from complications such as spontaneous bacterial peritonitis and hepatorenal syndrome.

Types OF ASCITES

Ascites can be classified into different types based on the fluid’s characteristics, underlying cause, and the severity of the fluid accumulation.

1. Transudative Ascites

This type is generally caused by changes in pressure within blood vessels or reduced albumin production.

1. Common Causes
   • Liver cirrhosis
   • Heart Failure
   • Nephrotic syndrome
   • Low albumin levels
2. Fluid Characteristics
   • Clear fluid
   • Low protein concentration (Less than 2.5 g/dL)
   • Low specific gravity
   • Low white blood cell count

2. Exudative Ascites

This type results from conditions causing inflammation or malignancy, leading to leakage of fluid from the peritoneal lining.

1. Common Causes
   • Peritoneal cancer (Carcinomatosis)
   • Tuberculosis
   • Pancreatitis
   • Bacterial peritonitis
2. Fluid Characteristics
   • Cloudy or milky in appearance
   • High protein concentration (Greater than 2.5 g/dL)
   • High white blood cell count

3. Chylous Ascites

This condition results from the accumulation of lymphatic fluid, often due to obstruction or leakage in the lymphatic system.

1. Common Causes
   • Trauma or surgery
   • Lymphoma or other cancers
   • Congenital lymphatic abnormalities
2. Fluid Characteristics
   • Milky or opaque appearance due to the presence of fat particles (Chylomicrons)
   • High triglyceride levels in the fluid

4. Hemorrhagic Ascites

This type involves the presence of blood in the ascitic fluid.

1. Common Causes
   • Trauma
   • Tumor rupture
   • Advance liver cirrhosis with portal hypertension
   • Infections such as tuberculosis
2. Fluid Characteristics
   • Red or pinkish in appearance due to the blood content
   • High red blood cell count

5. Malignant Ascites

This type of ascites results from cancer spreading to the peritoneal cavity.

1. Common Causes
   • Ovarian cancer
   • Pancreatic cancer
   • Colon cancer
2. Fluid Characteristics
   • Typically exudative, with a higher protein content
   • Presence of cancer cells in the fluid

6. Bacterial Peritonitis-Related Ascites (Spontaneous Bacterial Peritonitis or SBP)

This type occurs when the ascitic fluid becomes infected, often in individuals with cirrhosis and ascites.

1. Common Causes
   • Bacterial infections such as E. coli, Klebsiella pneumoniae
2. Fluid Characteristics
   • Cloudy appearance
   • Elevated white blood cell count, particularly neutrophils
   • Positive bacterial culture from the fluid

Causes

Ascites result from high pressure in certain veins of the liver (Portal hypertension) and low blood levels of a protein called albumin. The causes of ascites can be classified into different categories, depending on the underlying mechanism of fluid accumulation.

1. Liver Disorders

• Cirrhosis
• Hepatitis
• Fatty liver disease (NAFLD/NASH)
• Liver cancer (Hepatocellular carcinoma)

2. Heart Conditions

• Congestive heart failure
• Right-sided heart failure

3. Kidney Disorders

• Nephrotic syndrome
• Chronic kidney disease (CKD)

4. Cancer

• Liver metastasis
• Peritoneal carcinomatosis
• Pancreatic cancer
• Ovarian cancer

5. Infections

• Tuberculosis
• Spontaneous bacterial peritonitis (SBP)

6. Malnutrition

• Low blood albumin levels (Hypoalbuminemia)

7. Pancreatic Disorders

• Pancreatitis
• Pancreatic cancer

8. Other Factors

• Hypothyroidism
• Portal vein thrombosis

Signs and Symptoms

Symptoms can occur slowly or suddenly, depending upon the cause of ascites. Symptoms are not seen if there is a small amount of fluid in the abdomen. It depends upon the amount of fluid present and the underlying cause. Some common indications include:

Signs of Ascites

• Abdominal Swelling: The abdomen may become visibly enlarged or distended due to the accumulation of fluid. It progressively worsens as more fluid builds up.
• Prominent Veins: The veins near the belly button may become more prominent due to the increased pressure on the abdominal area.
• Bulging Sides: The sides of the abdomen may appear to be bulging out when the person is lying down. It reflects the presence of fluid.
• Shifting Dullness: It is a physical examination in which, when the patient lies on their back and tapping on the abdomen produces a dull sound, and when the patient turns on their side, the sound shifts. It indicates the presence of fluid.
• Fluid Wave: It may be detected by tapping on one side of the abdomen while another person places their hand on the opposite side. This suggests the presence of fluid in the abdomen.
• Firm or Tight Abdomen: The abdomen may feel tight or firm due to fluid buildup, mostly in advanced stages.

Symptoms of Ascites

• Abdominal Pain or Discomfort
• Breathing Difficulty
• Fatigue and Weakness
• Nausea and Loss of Appetite
• Swelling in the Legs and Ankles
• Changes in Urine Output

Severe Symptoms

In more severe cases, or when complications such as infection of the ascitic fluid (Spontaneous bacterial peritonitis) occur, additional symptoms can include:

• Fever
• Jaundice (Yellowing of the skin and eyes)
• Confusion or altered mental status (Due to liver disease or hepatic encephalopathy)
• Severe abdominal pain or tenderness

Possible Complications

• Spontaneous bacterial peritonitis (SBP): An infection of the ascitic fluid which can cause fever, worsening pain, and rapid health deterioration.
• Hernias: Increased abdominal pressure from ascites can lead to hernias, particularly around the belly button.

Diagnosis

The diagnosis of ascites typically involves a combination of clinical evaluation, imaging studies, and laboratory tests.

1. Clinical Evaluation

• Medical History: Review medical history to identify underlying causes of ascites, such as liver disease, heart failure, kidney disease or cancer.
• Physical Examination: Examine the abdomen for signs of ascites, such as tenderness, abdominal distension or the presence of visible veins.

2. Imaging Studies

• Ultrasound: It allows us to visualize the amount of fluid in the peritoneal cavity and helps us to identify any underlying causes, such as liver disease, tumors, or infections.
• CT Scan or MRI: CT scan or MRI can be performed to provide more precise imaging of the abdominal organs that could help to identify the cause of the ascites, such as tumors, liver cirrhosis, or heart failure.

3. Paracentesis (Ascitic Fluid Analysis)

4. Blood Tests

• Liver Function Tests: Elevated liver enzymes (ALT, AST), bilirubin, and low albumin levels can suggest liver disease or cirrhosis as a cause of ascites.
• Kidney Function Tests: Blood urea nitrogen (BUN) and creatinine levels can provide insight into kidney function and help identify kidney-related causes of ascites.
• Prothrombin Time (PT) and INR: These tests assess blood clotting and may be elevated in cases of liver dysfunction or cirrhosis.
• Complete Blood Count (CBC): A CBC can help identify signs of infection (such as an elevated white blood cell count) or anemia.
• Electrolyte Levels: Sodium, potassium, and other electrolytes are measured to evaluate fluid balance and kidney function.

Treatment

Treatments for fluid build-up may include lifestyle changes:

• Avoiding alcohol
• Limiting salt intake (Less than 1,500 mg/day of sodium)
• Limiting water or fluid intake

Medications include

• “Water pills” (Diuretics) to eliminate extra fluid
• Antibiotics

Surgery includes

• TIPS (Transjugular Intrahepatic Portosystemic Shunt)
• Surgical Shunts or Drainage

Ayurvedic Overview

According to Ayurveda, ascites is correlated with Jalodar. In which Jala means fluid/water and Udar means abdomen. It comes under the broad spectrum of Udara Roga (Disease of abdomen). Jalodar is one of the critical diseases among Udara Roga.

It is basically of two types:

1. Swatantra (Independent or primary)
2. Paritantra (Due to any other disease or secondary)

According to Acharya Sushruta, all Udarroga (Disease of abdomen) are considered as Mahagada (Difficult to treat). Among all tridosha, prakupita (Increased) Vata gets accumulated in Twak (Skin) and Mansa (Muscle). Because of Malasanchya (Accumulation of bodily waste products) and Dosha sanchaya (Accumulation of Doshas), there is a Srotorodha (Obstruction in channels) of Udakvaha (Channel that transport body fluids) and Rasa Vaha Srotas (Channel that transport plasma through the body). Then it disturbs prana (Heart), Apana (Renal), Agani (Liver) and ultimately causes accumulation of Udaka (Fluid) in the body, mainly in the abdomen, which is the cardinal symptom of Jalodar.

Causes

According to Ayurveda, causes of Jalodara are:

• Accumulation of Toxins (Ama)
• Disruption of Digestive Fire (Agni)
• Liver and Spleen Imbalance
• Obstruction of Fluid Pathways (Srotas)
• Poor Dietary Habits and Malnutrition
• Chronic Diseases
• Emotional Stress

Ayurvedic Treatment for Ascites (Jalodara)

Treatment in Ayurveda focuses on restoring balance. Ayurveda addresses both the physical and mental factors contributing to the condition.

1. Dietary Modifications

• Take a light, easily digestible diet that is warm and dry, and avoid heavy, oily, salty, and spicy foods.
• Consume diuretic foods like pomegranate and cucumbers, which help in reducing fluid retention.

2. Herbal Remedies

• Punarnava (Boerhavia diffusa): It is known for its ability to reduce fluid retention and detoxify the body.
• Gokshura (Tribulus terrestris): It helps in kidney function and fluid balance.
• Triphala: A traditional Ayurvedic formula for detoxification and improving digestion.
• Turmeric and Ginger: These herbs support liver health and help in digestion, reducing inflammation and fluid build-up.

3. Panchakarma (Detoxification)

• Virechana (Purgation therapy): It helps in eliminating toxins from the body.
• Basti (Medicated enemas): It is used to balance the doshas and remove accumulated toxins.
• Swedana (Steam therapy): It helps to promote sweating and detoxification, improving fluid elimination.

4. Lifestyle Adjustments

• Regular physical activity, such as light exercises, walking, or yoga, to promote circulation and prevent fluid stagnation.
• Practice stress management techniques, including meditation and breathing exercises (Pranayama) to balance the doshas and improve overall well-being.

5. Therapies

• Abhyanga (Oil massage): Massage with herbal oils can stimulate the body’s circulation and aid in reducing fluid retention.

Herbal remedies for Ascites by Planet Ayurveda

Planet Ayurveda is an Ayurvedic herbal medicine manufacturing company. It is GMP certified. They offer a wide range of natural remedies made from 100% pure, chemical-free, and preservative-free ingredients. All their formulations are prepared under the supervision of MD (Ayurveda) scholars. These formulations have been prepared after much research from age-old formulas from ancient Ayurvedic textbooks to restore health and save humans from the worst side effects of chemical-based treatments. They deal with all complicated to serious and chronic diseases. They provide the combination of the best herbal drugs which are effective in ascites. Planet Ayurveda has an Ascites care pack which is a combination of the best herbal drugs. This pack offers relief with no side effects.

1. Punarnava Capsules
2. Water-Ex Tablet
3. Rencure Formula
4. Liver Detox Formula
5. Jalodarari Ras

Products Description

1. Punarnava Capsules

Punarnava capsule is the standardized pure extract of Punarnava (Boerhaavia diffusa). Punarnava (Boerhaavia diffusa) is also known as Punarbhu, Katika, Shilatika, etc. It is known for its diuretic, anti-inflammatory, and rejuvenating properties. It is often used in liver-related diseases, thus it can help in liver-related ascites. It also helps to balance Vata and Kapha in the body.

Dosage: 2 capsules twice daily with lukewarm water after a meal.

2. Water-Ex Tablet

This tablet is a pure extract of various herbs. These herbs include Punarnava (Boerhaavia diffusa), Varun (Crataeva nurvala), Gokshura (Tribulus terrestris), etc. This herbal formulation helps to manage water retention, support kidney health, and urinary health. Punarnava (Boerhaavia diffusa) acts as a diuretic and helps in reducing fluid retention. Gokshura (Tribulus terrestris) promotes urinary tract health and helps in fluid retention issues. These tablets help in ascites as they all have diuretic, anti-inflammatory, and rejuvenating properties.

Dosage: 2 tablets thrice daily with warm water after meals.

3. Rencure Formula

Rencure Formula Capsules contain a pure extract of various herbs such as Punarnava (Boerhaavia diffusa), Varun (Crataeva nurvala), Palaash (Butea monosperma), Kasni (Cichorium intybus), and Gokshur (Tribulus terrestris). It provides better urinary tract health and is a useful remedy for kidney disease. These herbs have diuretic and anti-inflammatory properties. It helps to flush out toxins and waste products from the body. It also has anti-infective properties which help in painful urination.

Dosage: 1 capsule twice daily with warm water after a meal.

4. Liver Detox Capsules

Liver Detox Formula is a capsule containing a pure extract of various herbs such as Katuki (Picrorhiza kurroa), Punarnava (Boerhaavia diffusa), Kalmegh (Andrographis paniculata), Biranjasipha (Achillea millefolium-Yarrow), Jhavuka (Tamarix gallica), Himsra (Capparis spinosa), Makoy (Solanum nigrum), Haritaki (Terminalia chebula), and Kasni (Cichorium intybus). It helps maintain proper levels of hormones in the liver. It also helps to cleanse and strengthen the liver, thereby removing toxins from the body, reducing liver inflammation, and improving liver function tests.

Dosage: 2 capsules twice daily with warm water.

5. Jalodarari Rasa

Jalodarari Rasa is in the form of tablets and is a standardized pure extract of Tamra Bhasam (Copper), Pippali (Piper longum), Maricha (Piper nigrum), Haridra (Curcuma longa), and Jayaphala (Croton tiglium). It helps to balance Dosha, especially Kapha, which is responsible for fluid retention. It detoxifies the body by removing harmful toxins. It has antioxidant effects which help to protect liver cells, making it beneficial in liver-related ascites.

Dosage: 1 tablet twice daily with warm water after meals.

Conclusion

Ascites refers to the buildup of fluid in the abdominal cavity. It is commonly associated with liver disease, heart failure, kidney issues, and other conditions. In Ayurveda, the treatment for ascites aims to restore balance in the body’s doshas, particularly Kapha, while enhancing digestion and promoting detoxification to address fluid retention. Planet Ayurveda’s approach is holistic, focusing not only on alleviating the symptom of fluid accumulation but also on tackling the root cause of the condition.