Jalodara or ascites is an extremely dangerous problem often leading to death. This problem could be a symptom of cancer, and so it is a very serious condition which needs urgent medical attention. However, all ascites is not due to cancer.

Ascites is the condition in which fluid builds up in the peritoneal cavity of the abdomen. Sometimes the fluid buildup is mild and cannot be detected externally. But in extreme cases, the fluid builds up to such a large extent that it causes severe abdominal distention. The condition is quite painful and the person suffering from it finds it extremely inconvenient to even move around.

Also, the condition is socially unappealing. People suffering from ascites have bloated abdomens due to which they find it ungainly to make an appearance in public. In severe cases, finding clothes of the right size also becomes a major issue.

However, that is perhaps the least of the concerns for people suffering from ascites. That is because ascites could be one of the symptoms of several kinds of abdominal cancers. If that is so, then urgent medical attention is required. Even otherwise, fluid buildup in the peritoneum can occur due to several other ailments such as cirrhosis, heart failure, pericarditis, veno-occlusive disease, etc. Hence, any kind of ascites is a serious condition requiring medical attention.

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The abdomen consists of several visceral organs. In order to protect these organs, the abdomen is lined with a double-membrane called as the peritoneum. The two layers of the peritoneum are such that one of the layers communicates with the inner abdominal wall and the other layer drapes the visceral organs. In between the two membranes, there is the peritoneal fluid, which is provided for protection of the visceral organs.

In normal conditions, the peritoneal fluid is up to a specific quantity, just enough to provide the necessary protection. But in some cases, the volume of this fluid can increase drastically. This is what leads to ascites.

There are several causes that can lead to ascites, and accordingly ascites is classified into different forms. The following is a list of them:-

Increased Fluid Pressure in the Peritoneum

• Cirrhosis of the liver
• Budd-Chiari Syndrome, i.e. Hepatic Vein Occlusion
• Congestive Heart Failure
• Constrictive Pericarditis
• Occlusion of the Inferior Vena Cava

Decreased Colloid Pressure in the Peritoneum

• Malfunction of protein synthesis in the liver
• Protein loss accompanying the Nephrotic Syndrome
• Enteropathy causing protein loss
• Malnutrition, especially of proteins

Increased Permeability of the Capillaries in the Peritoneum

• Complications due to Tuberculosis
• Complications due to Bacterial Infections
• Cancers of the Peritoneum

Leakage of Fluids into the Peritoneal Cavity

• Leakage of bile into the peritoneal cavity, i.e. Bile Ascites
• Leakage of urine into the peritoneal cavity, i.e. Urine Ascites
• Leakage of chyle into the peritoneal cavity, i.e. Chylous Ascites
• Leakage of pancreatic juice into the peritoneal cavity, i.e. Pancreatic Ascites

Other Causes

• Meig’s Syndrome, which is a disease of the ovaries in females
• Myxedema
• Chronic Hemodialysis

Ayurveda goes into much detail when discussing the causative factors of ascites. According to Ayurvedic science, the contributing factors for ascites are:-

• Low digestive fire, i.e. pitta dosha
• Low production of ama
• Obstruction in sweat and water carrying systems
• Vitiation of the Prana and Apana Vata

There are in all eight types of jalodara as described in Ayurveda – those due to vitiation of vata, pitta and kapha, those due to vitiation of the dual doshas and those due to liver and spleen disorders.

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The first and most prominent symptom of ascites is that of abdominal distention. As the fluid accumulates in the peritoneal cavity, the abdomen can reach abnormally large sizes, making life very difficult for the person. The person finds it extremely difficult to walk, stand, sit and even lie down. Apart from that, there is a constant feeling of heaviness in the abdomen, which results into pain in the flanks and limbs.

The symptoms of ascites can be divided into three grades as follows:-

(i) First Grade Symptoms

In this stage, the fluid accumulation is to a very low level. In this condition, the abdomen is not distended and there is no swelling apparent from the outside. At this stage, it is very difficult to even understand that there is abdominal swelling. Only an ultrasound can help detect the abnormal accumulation of the peritoneal fluid.

(ii) Second Grade Symptoms

Here the fluid accumulates to a greater extent. A slight distention is observed from the outside. Hence this case is easier to detect. There are other symptoms felt such as pain in the flanks and a fluidity of the abdomen when touched. There is a shifting dullness when physically examined.

(iii) Third Grade Symptoms

This is the worst scenario of ascites. Here the abdominal distention is quite easily observed. The abdomen can reach very large sizes and make locomotion very difficult for the person. The ascites fluid exerts pressure on the diaphragm which leads to respiratory complications, such as shortness of breath and gasping. A fluid trill or fluid wave test can confirm the presence of fluid accumulation in the abdominal cavity.

On dosha principles, the following are the symptoms of the different types of ascites:-

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Ascites itself is a symptom of several serious problems. The presence of ascites may indicate heart failure, pericarditis, hepatitis and even cancers. Hence it is very necessary to seek a medical diagnosis and arrive at the root of the issue.

The following are some of the complications that are caused by ascites itself (without taking into account the disease that has caused ascites):-

Abnormal fluid retention in the kidneys which will lead to kidney failure

Activation of the sympathetic nervous system, which can affect the sensory faculties of the person

Problems in excretion due to increased production of renin

In extreme cases, there may be impairment of the renal blood vessel leading to the hepato-renal syndrome

Spontaneous bacterial peritonitis can occur

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Ascites is not an infectious or contagious condition. Hence it cannot be transmitted from one person to another.

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The following people are very high risk of ascites:-

• People who consume excessive alcohol are at very high risk of developing cirrhosis, which may cause ascites. In such people, the beer belly is actually a slang term for ascites.
• People who drink water excessively may develop ascites.
• Lack of exercise is also linked with ascites.
• People leading a sedentary lifestyle and sleeping in the daytime can suffer from ascites later in their lives.

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Ascites can be kept at bay by taking care of certain factors.

• Avoid drinking. Alcoholism is singly responsible for 83% of ascites-related problems in the world.
• Lead an active lifestyle. Exercising helps the abdominal muscles to build up. This prevents the accumulation of fluids in the peritoneal cavity.
• Avoid sleeping in the daytime. Keep regular timetables for going to bed and rising up in the morning.
• Do not consume water excessively, if you feel you have mild ascites

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There are several helpful and harmful foods for people who are suffering from jalodara. The following is a list of foods that must be taken and must be avoided:-

Foods that are helpful for ascites:

• Butter milk and milk of the camel
• Horse gram soup
• Diet of old (aged) rice
• Salads containing dry radish as the prime component
• Spices such as garlic and asafetida
• Honey

Foods that are harmful for ascites:

• Diet of excessive starchy components, such as rice, wheat, etc
• Salt

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