Appendicitis Symptoms, Signs, & Treatment

• Appendicitis occurs when something blocks the appendix (an organ in the abdomen) and causes inflammation.
• Common symptoms of appendicitis include abdominal pain, nausea with or without vomiting, loss of appetite, a fever, and digestive issues, like constipation or bloating.
• It's important to get prompt treatment for appendicitis. If the infection spreads or the appendix ruptures, life-threatening complications may occur.

Appendicitis is a common cause of abdominal pain. About 5-9% of Americans will experience this condition at one point or another in their lifetime. Usually, it manifests as pain in the lower right abdomen or belly. Other symptoms may include nausea, an urge to throw up , a fever, and other digestive issues. If left untreated, the appendix can burst, causing the medical emergency known as a perforated appendix.

Continue reading to learn more about the symptoms of appendicitis, how it's diagnosed, and when to seek medical treatment.

The appendix is a small organ that's attached to the end of the large intestine. The appendix is considered a vestigial organ, meaning it may have had a function for our ancestors but currently doesn't have a purpose; however, recent research challenges this idea, suggesting it may function as a ​"safe-house " for some gut microbes. When extreme gastrointestinal events, such as diarrhea, empty the gut of good microbes, the bacteria in the appendix may be able to replace them.

No matter the role of this organ, an inflamed appendix, referred to as appendicitis, causes uncomfortable symptoms and often requires emergency surgery. The appendix typically becomes inflamed because stool, a tumor, a foreign object, or a parasite blocks it.

What Causes Appendicitis?

There are many potential causes of appendicitis :

• Blockage of stool
• Growth (cancerous or non-cancerous) blocking the opening of the appendix
• Enlarged tissues in the appendix wall, typically caused by an infection in the digestive system
• Inflammatory bowel disease (IBD), a chronic condition that results in irritation and inflammation in the intestines

Sometimes, a healthcare provider can determine the cause by a physical exam and/​or imaging, but sometimes the direct trigger of one's appendicitis is unclear .

Who Is At Risk of Appendicitis?

Anyone can experience appendicitis. That said, it is more common in teenagers and individuals in their 20s. Having an inflammatory bowel disease, like Crohn's disease or ulcerative colitis, also increases the risk.

Other risk factors include:

• A family history of appendicitis
• Probiotic use
• Antibiotic use
• Being male
• A diet low in fiber and fruit

Acute Appendicitis vs Chronic Appendicitis

When appendicitis symptoms develop rapidly and only last for a short period of time, it is labeled as ​"acute appendicitis."

In rare cases, symptoms of appendicitis are chronic or occur over a long period of time. Chronic appendicitis typically occurs when the appendix is only partially blocked, not fully blocked, as is the case with acute appendicitis. There is still inflammation and similar symptoms, though they may be less severe and last for three weeks or longer.

Typical symptoms of appendicitis include abdominal pain, nausea or vomiting, a loss of appetite, fever, and digestive issues. Symptoms typically escalate over 12 to 48 hours, and 75% of individuals experience common symptoms within 24 hours of inflammation in the appendix.

1) Abdominal Pain

Abdominal or belly pain is the most common symptom of appendicitis. This pain :

• Occurs near the belly button or the lower right part of the abdomen
• Begins suddenly
• Often feels like painful swelling
• Can wake you if you're asleep
• May feel different than any other pain in the belly that you've previously experienced
• Happens before or at the same time as other symptoms

Moving around typically makes appendicitis pain worse, as does coughing, sneezing, or taking deep breaths.

2) Nausea or Vomiting

Appendicitis may also cause nausea , a sick-to-the-stomach feeling. This may be accompanied by vomiting , but throwing up isn't present in all cases. Nausea may occur at the same time as pain in the lower abdomen or shortly after.

3) Loss of Appetite

Another common symptom is a loss of appetite , or no urge to eat, even if you haven't had a meal or snack for a while. However, many conditions are associated with a loss of appetite so this symptom alone is not enough to diagnose appendicitis.

4) Fever

Many people with appendicitis report a fever. Typically, this is a low-grade fever, between 99.1 and 104°F, but it can become more severe if complications are present. Similar to the symptom of appetite loss, a fever can be due to many other conditions, and a fever without other symptoms isn't enough to diagnose appendicitis.

5) Digestive Issues

Appendicitis symptoms may also include other digestive effects , such as:

• Constipation
• Diarrhea
• Inability to pass gas
• Bloating or swelling in the abdomen
• Feeling as if a bowel movement will relieve discomfort, even though it does not

6) Lump in the Abdomen

The appendix is a small organ you can't physically feel if you touch your abdomen. But in some cases of appendicitis, there may be a lump called an ​'appendix mass'. This lump usually consists of the inflamed appendix and fatty tissue and sits between the abdomen and bowels . An appendix mass is rare, occurring in about 7% of appendicitis cases.

If left untreated, appendicitis may lead to serious complications. Of the possible complications, the most severe is a perforated, ruptured, or ​"burst" appendix. This is when holes form in the appendix , letting bacteria leak from the appendix and into the abdomen. If the appendix bursts, it may be life-threatening and will require immediate surgery.

If the appendix is perforated, additional complications may arise:

• Pylephlebitis: A rare condition where inflammation forms in the portal vein near the appendix, disrupting blood flow.
• Pylethrombosis: An uncommon complication where a blood clot forms in the portal vein near the appendix, which can lead to death if left untreated.
• Hydroureteronephrosis: This occurs when urine flow is disrupted causing a backflow that can lead to swelling of the kidney and ureter. This can lead to urinary incontinence . In cases involving a perforated appendix, leaking bacteria cause this disruption.
• Bowel obstruction: When the bowel is obstructed, stool cannot leave the body. This can be caused by many things, including bacteria from a perforated appendix.
• Peritonitis: If the appendix is infected and bursts, the infection can spread to tissue in the abdominal cavity , a space that contains vital organs like the stomach, liver, kidney, and spleen. This can be life-threatening without treatment.
• Internal fistulae: The formation of an internal fistula , an abnormal tunnel between two abdominal or pelvic organs, may occur in rare cases when there's a ruptured appendix.

Should the appendix burst, pain may temporarily subside . Shortly after, it will worsen and expand to the whole abdomen. Perforated appendix pain becomes more painful when someone moves.

When someone suspects appendicitis, it's important to see a healthcare provider immediately. They can determine if you have developed appendicitis and differentiate it from conditions that cause similar symptoms, such as a urinary tract infection (UTI), ovarian cysts, passing a kidney stone , or endometriosis.

To diagnose appendicitis, a healthcare provider may :

• Examine your medical history, including when abdominal pain began and what it feels like.
• Conduct a physical examination, which often includes gently pressing around the abdomen to locate a potential appendix mass and gauge current pain.
• Recommend a pelvic exam or digital rectal exam, depending on an individual's symptoms.
• Order further tests to determine the cause of symptoms.

Those tests may include a blood test to look for signs of inflammation or infection, a urine test to rule out a UTI or kidney stone, and imaging tests, like a CT scan, that provide a look at the appendix. They may also order a pregnancy test if there's a chance someone is pregnant.

To treat appendicitis, a healthcare provider may recommend antibiotics. Antibiotics work in about 70% of mild appendicitis cases . They may be prescribed as an oral medication or as an intravenous antibiotic, which is when it's provided via an IV attached to a vein.

For the remaining 30% of mild cases and for moderate-to-severe appendicitis, appendectomy , the surgical removal of the appendix, is often required. Before getting the appendix removed, a patient will be prescribed antibiotics to treat any inflammation or infection.

Usually, the laparoscopic method is used for an appendectomy, which is when the surgeon makes a small cut in the abdomen and inserts a laparoscope (a thin tube with a light and camera). The laparoscope allows them to get a better view before removing the appendix. Recovery time varies from person to person, but most are fully healed in six weeks or less. After surgery, someone usually has a follow-up appointment to make sure symptoms are no longer present.

If experiencing severe pain in the lower right part of the abdomen, appendicitis may be to blame. This condition can cause life-threatening complications, and it's important to visit the emergency room or make a prompt appointment with a healthcare provider who can diagnose what's causing your symptoms and kickstart a treatment plan.

If someone suspects appendicitis, questions to ask a healthcare provider include:

• Is it possible that appendicitis is causing my abdominal pain?
• Are there any other conditions that may be causing these symptoms?
• What treatment options do you recommend?

How do I know if I have appendicitis?

Appendicitis is marked by severe pain in the lower abdomen, usually on the right-hand side. This pain usually comes on suddenly and gets worse when moving, coughing, sneezing, or taking a deep breath. It may be accompanied by other symptoms, such as nausea, fever, loss of appetite, and disruptions in the digestive system. If someone experiences abdominal pain in this region, seek medical help.

Does appendicitis pain come and go?

In the first few hours of appendicitis, pain may come and go. However, it usually progresses to an ongoing, severe pain in the lower right abdomen.

How do you rule out appendicitis at home?

Appendicitis is usually accompanied by a severe, sudden pain in the lower right abdomen that gets worse over time and when taking a deep breath, coughing, sneezing, or moving. While this is a distinct sensation, you can't diagnose or rule out appendicitis at home. Only a qualified healthcare provider can determine if appendicitis is causing symptoms.

Will I have an appendectomy if I have appendicitis?

While surgery is the most common appendicitis treatment, not every case requires it. About 70% of mild cases may be treated with antibiotics. Moderate-to-severe appendicitis cases almost always require surgery.

Can I have appendicitis more than once in my life?

If the appendix is not fully removed, someone can have appendicitis more than once. Recurring appendicitis is especially common in cases where the first-line treatment is antibiotics.

Can appendicitis go away on its own?

Appendicitis does not go away on its own. Instead, it requires prompt medical treatment. Depending on the severity, it may be treated with antibiotics, surgery, or a combination of the two.