Ascites vs. Beer Belly

A large, bloated belly can be a sign of either ascites or a beer belly.

The definition of ascites is an abnormal accumulation of fluid in the space between the organs in the belly and the wall of the belly. In the U.S., the most common cause of ascites is cirrhosis of the liver.

The definition of a beer belly is simply a large, protruding belly. It is also called a potbelly, a spare tire, or referred to as apple shaped. A beer belly is an accumulation of a large amount of visceral fat (the fat that surrounds your abdominal organs). Visceral fat pushes your abdomen outward as it builds up, but because it is underneath the muscle, the belly feels hard. This is in contrast to subcutaneous fat, which is located just under the skin's surface and results in a soft belly.

Both ascites and beer belly result in a large, protruding hard belly that can resemble that of a pregnant woman's belly. Ascites often results in a rapid weight gain in contrast to a more gradual gain with beer belly development. Some patients with ascites may develop spontaneous bacterial peritonitis, hernias, and fluid in the chest. Tests like ultrasound, CT, or paracentesis (test and/or treatment for ascites fluid or fluid removal) usually diagnose ascites in contrast to a clinical diagnosis of belly fat that does not produce detectable abdominal fluid.

However, the causes of the large belly are different for ascites and beer belly and are presented below.

Symptoms of ascites that are different from beer belly include

• belly pain,
• difficulty breathing, and a
• feeling of fullness after eating only a small amount.

If the fluid in the belly becomes infected, symptoms may include

• worsening belly pain,
• fever,
• confusion, and
• low blood pressure.

If you have been diagnosed with ascites and have these symptoms, see your doctor immediately.

Ascites and beer belly appear similar outwardly. Symptoms and signs of ascites and beer belly that are similar include a

• large, distended belly/abdominal bloating,
• hard belly, and
• weight gain.

The most common cause of ascites is cirrhosis of the liver, which is responsible for about 80% of cases.

Other conditions that can cause excess abdominal fluid buildup include the following:

• Portal hypertension (increased pressure in the blood flow to the liver)
• Salt and water retention
• Congestive heart failure
• Advanced kidney failure
• Certain cancers, such as colon cancer, pancreatic cancer, breast cancer, stomach cancer, lung cancer, ovarian cancer, or lymphoma
• Chronic pancreatitis
• Urologic injury
• Rare causes: pregnancy, Whipple disease, and sarcoidosis

Beer belly isn't generally caused by drinking too much beer but rather taking in too many calories. That said, a standard 12-ounce beer contains about 150 calories, so drinking a lot of beer can contribute to weight gain and a beer belly.

Causes of beer belly include

• consuming excess calories and a
• sedentary lifestyle

Males are more likely to develop beer belly because men tend to gain weight in their mid-section while females tend to gain weight in the hips, thighs, and buttocks.

Drinking beer (or other liquor) doesn't directly cause ascites, but excess consumption of beer may lead to ascites for the following reasons:

• The most common cause of ascites is cirrhosis of the liver.
• The most common cause of cirrhosis is alcoholic liver disease.
• Alcoholic liver disease can result from alcohol abuse.
• Thus, excessive consumption of beer may lead to ascites.

To diagnose ascites, tests to detect fluid in the belly include the following:

• Ultrasound
• CT scan
• Paracentesis: A medical professional inserts a needle into the belly to remove a sample of fluid and then sends it to a lab. This can help diagnose the cause of the fluid buildup and if the fluid is infected.

Beer belly in itself is not a medical condition, but abdominal obesity increases the risk of certain conditions such as heart attack, stroke, diabetes, and erectile dysfunction.

For men, a waist circumference of 40 inches or greater, and for women, a waist measurement above 35 inches, increases the risk of health problems.

Treatment for ascites depends on the cause and severity.

If cirrhosis is the cause of ascites, treatment may include the following:

• Avoiding alcohol consumption
• Low salt diet
• Taking a diuretic (water pill)
• Avoiding nonsteroidal anti-inflammatory drugs (NSAIDs) that can harm the liver such as aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve)
• Monitoring your weight daily

If symptoms of ascites are severe, treatment may include the following:

• Drain fluid using paracentesis.
• A doctor may implant a transjugular intrahepatic portosystemic shunt (TIPS) in the liver to help reduce fluid build-up.
• Liver transplant, if liver disease is severe

Treatment for beer belly involves weight loss. This involves good old-fashioned diet and exercise.

The prognosis for ascites depends on the cause and severity. If ascites is due to heart failure, patients may live for many years if treated promptly and managed appropriately.

However, ascites due to cirrhosis usually indicates advanced liver disease, and the outlook is not as good.

If a patient has malignant ascites (ascites in patients with cancer), the prognosis is poor, and the mean survival time is between 20-58 weeks.

Beer belly in itself is not deadly, however, it can increase the risk for serious illnesses that can be deadly, such as diabetes, heart attack, and stroke.

Preventing ascites involves preventing the conditions and risk factors that can lead to fluid buildup in the abdomen.

• Avoiding alcohol or reducing alcohol intake may help prevent cirrhosis, the main cause of ascites.
• Patients with existing liver disease should also avoid nonsteroidal anti-inflammatory drugs (NSAIDs) that can harm the liver.
• Follow a low-salt diet as advised by your doctor or nutritionist.
• Take diuretics (water pills) as advised by your doctor.

It's possible to prevent a beer belly by following a healthy diet and exercising regularly to keep your weight in check.