Managing edema in liver disease: Tips for daily living

Last updated Oct. 24, 2025, by Agata Boxe
Fact-checked by Marta Figueiredo, PhD

 

Living with liver disease often involves dealing with edema, or swelling, due to fluid buildup, which can cause a lot of discomfort.

The swelling — which tends to affect the legs, ankles, and feet — occurs because liver disease, especially in its advanced stages, can impair the body’s ability to maintain fluid balance. As a result, fluid can leak from your bloodstream into the surrounding tissues.

Your healthcare team can advise you on how to reduce swelling from liver disease. For example, for less severe cases of edema, your doctor may recommend certain lifestyle adjustments, like dietary changes.

Why does swelling happen?

In addition to other symptoms of liver disease, like fatigue or jaundice, swelling can make living with the condition challenging. Edema is particularly common among people with advanced liver disease, including cirrhosis (irreversible liver scarring), chronic liver failure, and acute liver failure, which occurs without pre-existing liver disease or cirrhosis. It may occur for several reasons, including having low levels of specific proteins and changes in how your body retains water.

• A damaged liver can’t produce enough albumin, a protein that helps keep fluid within your blood vessels.
• Damage to your liver can also indirectly change how your kidneys process water and sodium, causing too much fluid to be stored.
• Hormonal changes that occur because of the disease can also make you retain more water and sodium, leading to swelling.
• In advanced liver disease, greater pressure in the portal vein, which manages blood flow from the intestines to the liver, can cause fluid to leak out of the blood vessels and accumulate in the legs and the abdominal cavity.

Some liver diseases that can progress to cirrhosis and/or liver failure, making them prone to edema, include:

• fatty liver disease
• viral hepatitis
• primary biliary cholangitis
• primary sclerosing cholangitis

Genetic diseases like Wilson disease can also cause liver damage and scarring, thereby increasing the risk of edema.

Signs to watch for

A common symptom of edema in people with liver disease is swelling in the legs. First, you may notice that your ankles look and feel puffy. Then, the swelling may progress up your legs.

You may also experience swelling around your belly due to ascites, a fluid buildup in the abdominal cavity. It is the most common complication of cirrhosis.

Unexplained weight gain may also indicate that your body has retained extra fluid.

Additionally, watch out for red flags such as shortness of breath and severe leg swelling. If you experience trouble breathing, it may mean that fluid from ascites is pushing against your diaphragm — the muscle that separates your chest cavity from your abdomen — and impacting the capacity of the lungs.

Contact your doctor if you think you are experiencing swelling from liver disease. They may choose to do the following tests or checkups:

• a physical exam to assess the swelling
• a CT scan to examine you for potential ascites
• blood tests to measure the levels of albumin and assess liver function
• diagnostic paracentesis — a procedure that removes and examines fluid from the abdominal cavity — to identify the cause of ascites or rule out infections.

Lifestyle & dietary modifications to reduce swelling

Sometimes, lifestyle changes are enough to manage fluid retention in liver disease.

These include following a low-sodium diet for liver disease and other recommendations your doctor may make that are specific to your symptoms.

Follow a low-sodium diet

The World Health Organization recommends no more than 2,000 mg of sodium per day — equal to about one teaspoon of table salt. Consuming these or even lower amounts of sodium may help prevent your body from retaining too much water.

One way to reduce your sodium intake is to eliminate from your diet foods with high levels of sodium, such as:

• processed meats
• canned soups
• salty snacks
• restaurant meals

As difficult as it can be, avoid seasoning your meals with salt. Instead, try adding flavor with spices, herbs, and marinades.

Other lifestyle modifications

Consider weighing yourself at the same time daily to capture any changes that may be due to fluid retention. This can help your doctor understand how much your weight fluctuates due to edema or ascites.

Avoiding alcohol is crucial for anyone with liver disease, as it prevents further liver damage. Depending on your specific case, your doctor may recommend that you limit the amount of fluid you drink. However, do not restrict your fluid intake without consulting your provider first.

Finally, your doctor may make specific recommendations regarding protein intake. Because protein plays a role in the production of albumin, following their advice is crucial for managing your edema.

Medications and procedures for edema

While lifestyle changes may be sufficient to control some cases of edema and liver disease, others may require a different approach.

Your doctor may prescribe medications, such as those that help the kidneys eliminate excess sodium and water, or they may administer intravenous albumin infusions to reduce swelling if your albumin levels are low.

For severe ascites, your doctor may recommend therapeutic paracentesis to remove a large amount of abdominal fluid. Another possibility is TIPS (transjugular intrahepatic portosystemic shunt), a procedure that can reduce pressure in the portal vein.

In cases of severe liver failure that no longer respond to other treatments, a liver transplant may be the only viable, long-term solution.

Preventing complications & long-term management

Beyond causing discomfort, edema and ascites can lead to complications if left untreated, including life-threatening bacterial infections in the abdominal fluid and breathing problems. As such, it is important to know when to see a doctor for swelling with liver disease.

Liver disease tends to get worse over time, so you should be under the constant care of a hepatologist, a doctor who specializes in treating liver conditions. Regular checkups are essential for preventing and detecting possible complications.

You should also let your doctor know if you experience:

• swelling that is getting worse rapidly
• fever
• abdominal pain
• trouble breathing
• mental confusion

Managing swelling with liver disease is not always easy, but your care team can find ways to treat it as well as possible.

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