Not everyone who is infected with hepatitis B virus (HBV) will experience symptoms. In the acute phase, children under 5 years old and immuncompromised adults rarely have symptoms. As many as 70 percent of people over age 5 who are newly infected with hep B do not experience any noticeable symptoms. If symptoms do occur, they generally appear around 90 days, with a range of 60 to 150 days after initial exposure. The symptoms of acute hepatitis B virus infection usually last for several weeks but may continue for as long as six months.
The symptoms of acute hepatitis B can include:
- Abdominal pain, especially around the liver
- Dark urine and/or pale stool
- Feeling tired and rundown (fatigue)
- Joint and/or muscle pain
- Loss of appetite
- Yellowing of the skin, whites of the eyes and under the fingernails (jaundice)
If an acute HBV infection does not resolve by the end of six months, then the infection is considered chronic. Many people with chronic hepatitis B do not experience symptoms unless the liver becomes severely damaged.
Some people with chronic hepatitis B experience occasional symptoms, while others experience symptoms that never seem to go away. Symptoms of chronic hepatitis B can include those typically seen in acute hepatitis B. They tend to be mild to moderate in intensity and typically come and go.
If hepatitis B progresses to serious liver damage, such as liver cancer or cirrhosis, symptoms may become more prominent. In addition to fatigue, there may be muscle weakness, bruising, poor appetite, nausea, weight loss, itchy skin, cola-colored urine, gray-colored stools, jaundice (yellow skin and whites of the eyes) and fluid accumulation in the lower extremities (edema).
Some symptoms of advanced cirrhosis are a bloated belly from fluid accumulation (ascites), bleeding from blood vessels in the digestive tract (varices) and confusion (hepatic encephalopathy).
Managing Common Symptoms
Symptoms of viral hepatitis, whether acute or chronic, should always be brought to the attention of a health care provider. Bed rest may be recommended during hepatitis B’s acute phase. If you have symptoms from cirrhosis, your health care provider will discuss a plan to manage these. Do not attempt to manage these symptoms on your own.
Appetite loss: Be sure to discuss this with your health care provider. If you are experiencing significant weight loss, you may be referred to a nutritionist or dietitian. Here are some tips to help with your appetite:
- Eat small, frequent meals of nutritious, high-calorie foods such as peanut butter, nuts, avocados, protein shakes and smoothies.
- Select a variety of foods. Vary the color, temperature, texture and type of food you eat.
- Try new foods or ones that you might not have liked in the past.
- Experiment with seasonings and spices.
- Choose foods that are high in calories and protein.
- Add powdered milk or protein powder to regular milk, milkshakes, casseroles, soups, eggs, mashed potatoes, hot cereal and puddings.
- Spread peanut butter or other nut butters on bread, tortillas, waffles, pancakes, fruit and celery.
- Add cooked beans or hard-boiled eggs to soups, casseroles and pasta.
- Try products designed to promote weight gain, such as nutritional supplements, canned formulas, protein powders, instant breakfast drinks, power bars and high-calorie puddings.
Fatigue: In the acute phase, bed rest and low physical exertion may be advised. In the chronic phase, your medical provider will likely rule out other medical conditions that may contribute to fatigue, such as depression, insomnia, pain, sleep apnea and thyroid problems. Here are some tips to help with fatigue:
- Get enough sleep. The National Sleep Foundation recommends seven to nine hours of sleep per night for adults. If sleep is a problem, discuss this with your health care provider.
- If you have chronic hep B with mild fatigue, light exercise is a good remedy. Pick an activity and do it for 10- to 15-minute intervals, two to three times daily. If you are not accustomed to physical activity, start with five-minute intervals and increase gradually. Sample activities include walking, biking, swimming, dancing, gardening, yoga and tai chi.
- Vary your activities—do not sit or stand too long.
- Drink plenty of water. According to the Institute of Medicine, men need about 13 cups (3 liters) of total beverages a day; women need about 9 cups (2.2 liters) daily. If you are drinking enough liquids, your urine will be pale yellow or colorless.
- Reduce stress and find ways to relax.
- Take short naps of 20 minutes or less. Don’t nap close to bedtime.
- Use caffeine. Coffee and tea may give you a lift, plus coffee may protect the liver. Do not drink caffeinated drinks late in the day, as this may interfere with sleep.
Fever: Ask your doctor whether you can take Tylenol (acetaminophen). However, be sure not to take more than directed because Tylenol may harm the liver if the recommended dose is exceeded.
Gastrointestinal complaints: Some people feel discomfort in the right upper part of the abdomen around the liver area. Since the liver does not have any nerve cells, the discomfort is usually caused by the capsule surrounding the liver, as well as by nearby organs. Always discuss pain with your medical provider, particularly when pain is constant, severe or interferes with your quality of life.
Call your medical provider if you have severe or chronic stomach pain. Eat small, frequent meals, as stomach pain may be caused or worsened by hunger.
If you feel nauseous, try to eat a small portion of food at regular intervals. Hunger can intensify nausea, so try eating a cracker or other small piece of food every hour or two. Ginger helps with mild to moderate nausea. Peppermint, chamomile or raspberry leaf tea may also alleviate nausea. You can also try to relieve nausea through an acupressure technique by applying pressure to the inside of your wrist, approximately two fingers above the crease where your hand meets your arm. You may also purchase wristbands developed for motion sickness sold in drugstores. If nausea is frequent, persistent or severe or if you are vomiting, talk to your medical provider.
Muscle and joint aches are common symptoms of hepatitis B; pain is not. Both require medical evaluation. Research tells us that moderate exercise and staying active are the best way to manage physical discomfort. Other tips that may provide relief are:
- Hot baths
- Massage, whether done by a friend, a professional or yourself
- Avoid prolonged sitting or reclining.
- Talk to your medical provider about taking over-the-counter pain relievers such as Tylenol (acetaminophen), aspirin, Advil/Motrin (ibuprofen) or Aleve (naproxen); Tylenol may harm the liver if the recommended dose is exceeded.
Last Revised: May 10, 2016