You may not have any symptoms when you first develop cirrhosis.

In the early stages, the liver can function normally despite being damaged.

You tend to get noticeable symptoms as the liver becomes more severely damaged.

The main symptoms include:

• tiredness and weakness
• nausea 
• loss of appetite resulting in weight loss
• reduced sex drive

As the condition progresses, you may also have:

• yellowing of the skin and whites of the eyes (jaundice)
• fever and shivering attacks
• vomiting
• diarrhoea 
• itchy skin
• stomach pain, or a swollen or bloated stomach
• dark, tarry-looking poo
• a tendency to bleed or bruise easily
• tiny red lines (blood capillaries) on the skin above waist level
• swelling in the legs, ankles and feet caused by a build-up of fluid (oedema), which can cause breathing problems
• difficulty maintaining weight
• personality changes, confusion, difficulty concentrating, memory loss, or hallucinations
• in women, abnormal periods
• in men, enlarged breasts, a swollen scrotum (the loose sac of skin that contains the testicles) or shrunken testicles

See your GP if you think you may have cirrhosis.

Cirrhosis cannot be cured, so treatment aims to manage the symptoms and any complications, and stop the condition getting worse.

How you can help stop cirrhosis getting worse

Making healthy lifestyle changes can help stop cirrhosis getting worse. It can also reduce your risk of developing further health problems.

Lifestyle changes

There are a number of things you can do to help stay healthy and reduce your chances of developing further problems:

• avoid alcohol if your liver problems are alcohol-related
• lose weight if you're overweight or obese
• take regular exercise to reduce muscle wasting
• practise good hygiene to reduce your chances of developing infections
• speak to your GP about vaccinations you may need, such as the annual flu vaccine or travel vaccines
• speak to your GP or pharmacist if you're taking over-the-counter or prescription medications, as cirrhosis can affect the way some medicines work

Dietary changes

Malnutrition is common in people with cirrhosis, so it's important you have a balanced diet to help you get all the nutrients you need.

Cutting down on salt can help reduce your risk of developing swelling in your legs, feet and tummy caused by a build-up of fluid.

The damage to your liver can also mean it's unable to store glycogen, which provides short-term energy.

When this happens, the body uses its own muscle tissue to provide energy between meals, which leads to muscle wasting and weakness. This means you may need extra calories and protein in your diet.

Healthy snacking between meals can top up your calories and protein. It may also be helpful to eat 3 or 4 small meals a day, rather than 1 or 2 large meals.

Medicine

The medicine you need will depend on the specific cause of the damage to your liver. For example, if you have viral hepatitis, anti-viral medication may be prescribed.

Easing symptoms

Treatments to ease the symptoms of cirrhosis include:

• a low-salt diet or tablets called diuretics to reduce the amount of fluid in your body
• tablets to reduce high blood pressure in your portal vein, the main vein that transports blood from the gut to the liver
• creams to reduce itching

Managing complications

If you have advanced cirrhosis, complications caused by the condition may need treatment.

Swollen veins in the oesophagus

If you vomit blood or have blood in your poo, the veins in your oesophagus (gullet), the tube that carries food from the throat to the stomach, may be swollen and leaking blood. These are known as oesophageal varices.

You need urgent medical attention if you have oesophageal varices. See your GP or go to your nearest accident and emergency (A&E) department immediately.

An endoscopy is used to help diagnose oesophageal varices. A number of treatments can also be carried during the procedure to stop the bleeding and reduce the swelling.

The Chesterfield Royal Hospital has more information about treating oesophageal varices (PDF, 360kb).

You may also be given a type of medicine called a beta-blocker, such as propranolol or carvedilol, to reduce the risk of bleeding.

Fluid in the tummy and legs

A build-up of fluid around your stomach area or legs and ankles is a common complication of advanced cirrhosis.

The main treatments are cutting salt in your diet and taking diuretic tablets, such as spironolactone or furosemide.

If the fluid around your stomach becomes infected, you may need antibiotics. In severe cases, you may need to have the fluid drained from your tummy with a tube.

Encephalopathy

People with cirrhosis can sometimes develop problems with their brain function (encephalopathy).

Symptoms include confusion, drowsiness and problems concentrating. This happens because the liver is not clearing toxins properly.

The main treatment for encephalopathy is lactulose syrup. This acts as a laxative and helps clear the toxins that have built up. Resistant cases may be treated with a type of antibiotic called Rifaximin.

Bleeding

Cirrhosis can affect the liver's ability to make the blood clot, leaving you at risk of severe bleeding if you cut yourself.

In emergencies, vitamin K and a blood product called plasma can be given to treat bleeding. You'll need to apply pressure to any cuts that bleed.

You should get specialist advice before having medical procedures, including any dental work.

Liver transplant

Your liver may stop functioning if it's severely damaged by scarring. In this situation, a liver transplant is the only option.

This is a major procedure that involves removing your diseased liver and replacing it with a healthy donor liver.

You'll probably have to wait a long time for a liver transplant as there are more people waiting for a transplant than there are donors.

You will not be able to have a liver transplant if you're still drinking excessive amounts of alcohol.

The NHS Blood and Transplant Organ Donation website has more information about transplants and joining the Organ Donor Register.

Cirrhosis and diabetes

Your diabetes may get worse if you have type 2 diabetes and develop cirrhosis.

This is because cirrhosis can increase your resistance to insulin, a hormone produced by the body to control blood sugar levels.

If this happens, you should discuss the implications with your GP.