What do doctors do if your spleen is enlarged? A complete medical guide

September 26, 2025 •

4 min read

According to Mayo Clinic, an enlarged spleen, or splenomegaly, is a common condition often discovered during a routine physical exam and typically has no symptoms. The subsequent steps your doctor takes when your spleen is enlarged are crucial for determining the underlying cause and the most effective course of action.

Quick Summary

Doctors address an enlarged spleen by first identifying the underlying cause through diagnostic tests like blood work and imaging, with treatment focusing on the root problem rather than the spleen itself. Depending on the cause and severity, management can range from watchful waiting and lifestyle changes to prescribing medication like antibiotics or, in serious cases, surgically removing the spleen.

Key Points

Initial Step: Doctors first conduct diagnostic tests like blood work and imaging to identify the specific cause of the enlargement.
Treating the Cause: The most common approach is to treat the underlying condition, such as a bacterial infection or liver disease, to resolve the splenomegaly.
Monitoring Mild Cases: For mild or asymptomatic cases, a doctor may recommend watchful waiting, monitoring the spleen's size over time.
Surgery as an Option: In severe cases or when the cause is untreatable, a splenectomy (spleen removal) may be necessary to prevent complications like rupture.
Post-Surgery Care: After a splenectomy, patients require vaccinations and preventative measures to manage their increased risk of infection.
Lifestyle Adjustments: Regardless of the treatment path, avoiding contact sports and wearing a seatbelt is crucial to protect the enlarged spleen from rupture.

Understanding the Diagnosis

When a doctor detects a possible enlarged spleen during a physical exam, they won't jump to conclusions. An enlarged spleen, also known as splenomegaly, is a sign of an underlying medical condition, not a disease in itself. The initial medical response focuses on a precise diagnosis to pinpoint the root cause of the swelling. A doctor may perform a gentle palpation of the left upper abdomen, but will typically confirm suspicions and investigate the cause with additional tests.

Diagnostic tests a doctor may order

To understand why the spleen is enlarged, a physician will use a combination of methods:

Blood tests: A complete blood count (CBC) is standard to check the levels of red blood cells, white blood cells, and platelets. This helps rule out blood-related issues like leukemia or lymphoma.
Imaging tests: An ultrasound is often the first step to confirm the size of the spleen. A CT scan or MRI may be used to get a more detailed view, assess blood flow, and check for pressure on other organs.
Bone marrow biopsy: In more complex cases, or when a blood disorder or cancer is suspected, a bone marrow biopsy may be performed to examine a sample of bone marrow.

Treating the Underlying Cause

In most cases, treating the condition that caused the splenomegaly will cause the spleen to return to its normal size. The doctor's strategy is to manage the primary illness, which then resolves the spleen issue. The specific treatment plan is tailored to the diagnosis found during the initial investigation.

Examples of targeted treatments

Infections: If a bacterial infection, like endocarditis, is the cause, antibiotics will be prescribed. If it's a viral infection such as mononucleosis, treatment will focus on supportive care as the virus runs its course.
Liver disease: For conditions like cirrhosis that increase pressure on the blood vessels, managing the liver disease is the priority. This could involve medication, lifestyle changes, or other interventions.
Cancers: If lymphoma or leukemia is identified, treatment will involve targeted therapies such as chemotherapy or radiation, which can also reduce the size of the spleen.
Blood disorders: Certain blood conditions, including sickle cell anemia, can be managed with blood transfusions.

Watchful Waiting and Lifestyle Modifications

For mild cases without significant symptoms, a doctor may recommend a "watchful waiting" approach. This involves monitoring the patient's condition with follow-up appointments and repeat tests over several months. This strategy is also accompanied by lifestyle recommendations aimed at protecting the spleen from further damage.

Important lifestyle adjustments

Avoid contact sports: Because an enlarged spleen is more fragile, it has an increased risk of rupturing. High-impact activities like football, hockey, or martial arts should be avoided until the spleen is no longer enlarged.
Wear a seatbelt: In case of a car accident, a seatbelt provides vital protection to abdominal organs, including the spleen, minimizing the risk of rupture.
Balanced diet: A healthy diet can support overall immune health and reduce inflammation, helping the body's natural healing process.
Hydration: Staying well-hydrated supports the function of all organs, including the spleen.

Surgical Intervention (Splenectomy)

When an enlarged spleen poses a significant risk or causes severe complications, surgery may be necessary. This procedure, known as a splenectomy, involves removing the spleen entirely. It is usually considered when other treatment options have failed or are not viable.

Indications for a splenectomy

Serious complications: This includes a ruptured spleen or a high risk of rupture due to massive enlargement.
No identifiable cause: In some cases, the cause of the splenomegaly cannot be determined, and the spleen may need to be removed for diagnostic purposes.
Chronic, unmanageable symptoms: When severe pain or discomfort persists and significantly impacts the patient's quality of life.
Tumors: If the enlargement is caused by a tumor, removal may be necessary.

Life after splenectomy

Living without a spleen is possible, but it does increase the risk of certain infections. A doctor will advise on preventive measures:

Vaccinations: Patients will receive a series of immunizations, including for pneumococcal, meningococcal, and Haemophilus influenzae type b (Hib) bacteria.
Antibiotics: Prophylactic antibiotics may be recommended, especially after surgery or at the first sign of an infection.
Medical alert: It is recommended that individuals wear a medical ID bracelet to inform healthcare providers of their condition.

Comparison of Treatment Approaches


Feature	Watchful Waiting	Antibiotic Treatment	Splenectomy	Radiation Therapy
Primary Goal	Monitor condition, prevent rupture	Eliminate bacterial infection	Remove diseased/risk-causing spleen	Shrink spleen size
Spleen Size	May decrease, monitored closely	Expected to return to normal	Spleen is removed	Expected to decrease significantly
Underlying Cause	Unknown or mild, asymptomatic	Identified as bacterial infection	Serious, untreatable, or diagnostic	Untreatable conditions (e.g., myelofibrosis)
Patient Risk	Low, but requires care to prevent rupture	Low, with typical medication side effects	Increased risk of infection post-op	Possible side effects from radiation
Recovery Time	No recovery needed, ongoing monitoring	Short course of medication	Post-surgical recovery period	Short course of therapy, minimal recovery

Conclusion: A Personalized Treatment Plan

The approach a doctor takes for an enlarged spleen is never one-size-fits-all. The diagnosis and treatment plan are highly personalized, driven by a thorough investigation into the underlying cause. From simple observation and lifestyle adjustments to aggressive treatments like surgery, the goal is always to address the root problem while mitigating the risk of complications. Always follow your doctor's guidance and seek prompt medical attention for any concerning symptoms, as early intervention is key to a successful outcome.

Frequently Asked Questions

Yes, if the underlying cause is successfully treated, the spleen can often shrink back to its normal size. For example, if the enlargement was due to a bacterial infection, effective antibiotic treatment should resolve the issue.

An enlarged spleen can be caused by many conditions, including infections (like mononucleosis or malaria), liver diseases (such as cirrhosis), certain cancers (like leukemia or lymphoma), and blood disorders.

No, surgery is not always necessary. It is typically reserved for severe cases where the spleen is causing serious complications, the cause cannot be identified, or other treatments have failed. Mild or treatable cases are usually managed with medication or monitoring.

The greatest risk is a ruptured spleen. An enlarged spleen is more fragile and susceptible to damage from trauma. A rupture can cause life-threatening internal bleeding.

To prevent a ruptured spleen, you should avoid contact sports and other high-impact activities. Wearing a seatbelt is also important to protect your abdomen from injury in case of an accident.

If the cause remains unidentified, a doctor may recommend a period of "watchful waiting," involving regular checkups and imaging to monitor the condition. In rare cases, surgery may be performed for diagnostic purposes.

Doctors may first feel for an enlarged spleen during a physical exam. This is then confirmed using imaging tests like an ultrasound, CT scan, or MRI. Blood tests are also conducted to check for underlying conditions.