Abdominal Fluid Retention (Ascites) in Women

Abdominal Distention During Periods

Most women experience some degree of abdominal distention particularly before and during menstruation. It can be a temporary inconvenience for many, although some women will experience recurrent episodes of distention throughout the month irrespective of menstruation. There is often a misconception that this distention, referred to as menstrual bloating, is due to fluid. In fact many women may complain of retaining water in the abdomen and some may even use water pills to counteract the bloating. However, abdominal distention during menstrual periods is unlikely to be caused by fluid retention. It most instances it is actually functional bloating – a condition that occurs by an unknown mechanism apparently in response to hormonal changes. Functional bloating is not related to any underlying disease and will resolve spontaneously with no need for medical attention. Fluid retention in the abdomen, however, is not as innocuous.

Causes of Abdominal Fluid Retention

The organs of the abdomen are lined with a membranous layer known as the visceral peritoneum which is continuous with the parietal peritoneum that lines the inner abdominal wall. Between these two peritoneal layers is a potential space known as the peritoneal cavity. It contains a very small amount of peritoneal fluid that aids with lubrication. Women may find that the amount of peritoneal fluid can increase with changes in the menstrual cycle – this may increase to as much as 20mL. However, it causes no signs and symptoms. In fact for fluid retention to be detectable by diagnostic investigation, it needs to be around 100mL to 200mL. For this fluid retention to be visible, it needs to be above 500mL and for it to cause a massive increase in abdominal girth, the fluid volume needs to exceed 1,000mL.

Fluid retention in the abdominal cavity, or more correctly the peritoneal cavity, is known as ascites. It is a medical condition that needs to be assessed, treated and managed appropriately. Most causes of ascites are related to liver conditions like cirrhosis, hepatitis and other liver diseases including liver cancer. It may also be associated with inflammation of the peritoneal layers (peritonitis), pancreatic, heart, blood and kidney disease and malignancies in the area. Less commonly, ascites may be seen with thyroid dysfunction, systemic lupus erythematosus (SLE), ovarian dysfunction and tuberculosis among other conditions.

Treatment of Ascites

Ascites (fluid retention in the abdomen) needs to be investigated in order to identify the underlying cause. Treatment is then directed at the specific cause. However, some measures such a low sodium diet, diuretics (‘water pills’) and manually withdrawing the fluid (therapeutic paracentesis) may be undertaken to ease the fluid accumulation. These measures are not necessary for menstrual bloating which is usually temporary. Functional bloating is largely due to unknown factors and therefore the appropriate treatment cannot be decided upon. There is some evidence to suggest that functional bloating, which can even vary in severity within hours, may be due to intestinal gas in certain cases. It is less likely to occur or is minimal in a person with firm abdominal muscles, regular but not excessive bowel movements and in a person who is more active. However, this bloating is not significant if temporary before or during the menstrual periods and does not need to be treated.

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