Many people with chronic hepatitis C have no symptoms of liver disease. That is, they don't necessarily feel or look sick. If symptoms are present, they are usually mild, aren't very specific (some people simply say they're feeling "blah"), and tend to come and go. These symptoms may include fatigue, "brain fog," pain in the upper-right portion of the gut, nausea, decreased appetite, and muscle and joint pains. Some people have more severe symptoms. The degree of symptoms does not correlate with liver damage, so someone with severe symptoms could have minimal liver damage, and vice versa.
If hepatitis C causes serious liver damage 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
Appetite loss is not a common symptom of hepatitis C, so if you are experiencing a loss of appetite, be sure to discuss this with your medical provider. If you are experiencing significant weight loss, your doctor may refer you 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.
Brain fog is the term patients use to describe when it is difficult to think well and be alert. The mind feels like it is shrouded in fog. It can be difficult to concentrate and there can be short-term memory loss. Not everyone with hepatitis C gets brain fog, and those who do have a wide range of experiences. If you do, talk to your medical provider, so other causes of cognitive dysfunction can be ruled out. Be sure to let you doctor know if you take medication, over-the-counter drugs, supplements, or recreational substances. Tips for managing brain fog:
- Engage in physical activity on a daily basis. Exercise is an enemy of brain fog. An ideal goal is to include aerobic exercise, strength training, and stretching.
- Get enough sleep. The average adult needs seven to nine hours of sleep each night.
- Eat a nutritional diet and don't skip meals. Aim for a good balance between all of the basic food groups, including whole grains, proteins, dairy, fruits, vegetables and fats—making sure to keep the fats in your diet to a minimum.
- Drink plenty of water.
- Manage stress. Meditation and relaxation techniques can help you think more clearly.
- Avoid alcohol and other substances that interfere with clear thinking.
- Get organized. Use electronic devices and daily/weekly pill containers to remind you to take your medicine. Record important events in a calendar or journal. You can also use this to keep track of your medical appointments. Use sticky notes to remind yourself of medical appointments and medication schedules.
- Set the alarms on your smart phone, watch, alarm clock, or electronic device to remind you about medication and appointment times.
- Create habits and daily routines.
- Write things down and keep your lists in the same place.
- Do one task at a time. Multi-tasking tends to increase brain fog.
Fatigue is one of the most common symptoms of hep C. Fatigue has many causes, so be sure your medical provider has ruled out other medical conditions if you experience these symptoms. Some common causes of fatigue are 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.
- Light exercise is a good remedy for fatigue. 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.
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.
- Abdominal discomfort may occur with hepatitis C, as well as other causes. 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.
- Nausea is not a common hep C symptom, but it may occur. Hunger can intensify nausea, so eat 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 C; 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)
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.
Last Revised: July 23, 2015