Appendicitis happens when the appendix becomes inflamed. Early symptoms can vary between age groups, but severe and sudden abdominal pain is usually the first symptom of appendicitis.

The symptoms can be uncomfortable, painful, and potentially life-threatening if left untreated, so it is important to be able to recognize them.

Sudden appendicitis is the most common cause of acute abdominal pain requiring surgery in the United States (U.S.), with over 5 percent of the population developing appendicitis at some point.

It most commonly occurs during the teenage years and the 20s, but it can develop at any age.

Fast facts on appendicitis:

  • Early symptoms include a pain near the belly button that may shift toward the lower right-hand side of the abdomen.
  • If treatment for gas does not solve the problem, prompt medical attention should be sought.
  • Many people with suspected appendicitis will go directly to the emergency department.
  • Early treatment is usually successful, but untreated appendicitis can lead to fatal complications.
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Appendicitis can cause pain in the lower, right-hand side of the abdomen.

The appendix is about 4 inches long and is situated on the right, lower side of the abdomen. It is a tube-shaped piece of tissue that is closed at one end. It is attached to the cecum, a pouch-like portion of the colon, or large intestine.

Severe and sudden abdominal pain is usually the first symptom of appendicitis.

The pain often begins near the belly button. As it worsens, it will likely shift to the lower right side of the abdomen.

The feeling may become more intense within the next few hours and be worsened by moving around, taking deep breaths, coughing, or sneezing.

Other classic symptoms of appendicitis are:

  • nausea
  • vomiting
  • loss of appetite
  • constipation or diarrhea
  • inability to pass gas
  • low-grade fever and chills
  • a temperature between 99° and 102° Fahrenheit
  • stomach swelling
  • wanting to have a bowel movement to relieve discomfort

However, these symptoms appear in only 50 percent of cases.

Some patients may experience symptoms such as stomach pain very slightly or not at all. Others may have less common symptoms.

Symptoms in children and infants

Children and infants may not experience pain in one specific area. There may be tenderness throughout the body, or there may be no pain.

Children and infants may have less frequent or no bowel movements. If diarrhea occurs, this may be a symptom of another illness.

While children and infants may not experience precise pain as older patients do, research suggests that abdominal pain is still the most common symptom of appendicitis symptom for this age group.

Symptoms in older adults and during pregnancy

Older adults and pregnant women may also experience different symptoms. The stomach pain may be less severe and less specific. Possible symptoms include nausea, vomiting, and fever.

During pregnancy, the pain may shift upward toward the upper right quadrant after the first trimester. There may also be some back or flank pain.

If there is stomach pain, this may result from another condition.

Other conditions with similar symptoms

Abdominal pain can be a symptom of other conditions that seem like appendicitis.

Examples include:

  • stomach lesions
  • constipation
  • inflammatory bowel diseases (IBD), including Crohn’s disease and ulcerative colitis
  • stool, parasites, or growths that clog the inside of the appendix
  • damage or injury to the abdomen

When to see a doctor

Appendicitis can be life-threatening, and it requires immediate medical care. It is likely to worsen the longer it is left untreated. Initial symptoms may feel like gas.

If over-the-counter (OTC) medications do not relieve the gas, or if there is severe and worsening pain, the individual should see a doctor at once. It may be advisable to go straight to the emergency room.

Treating appendicitis as soon as symptoms appear will prevent it from worsening and causing further complications.

A healthcare provider will normally diagnose appendicitis by doing the following:

Reviewing the symptoms

The patient will be asked to provide details about what symptoms they are experiencing, how severely, and for how long.

Reviewing the patient’s medical history

To rule out other potential health issues, the doctor will want to know details about the patient’s medical history.

These include:

  • any other medical conditions or surgeries the patient has or has had in the past
  • whether the patient takes any medications or supplements
  • whether the patient drinks alcohol or takes any recreational drugs

Doing a physical exam

The doctor will do a physical exam to find out more about the patient’s stomach pain. They will apply pressure to or touch certain areas of the abdomen. Pelvic and rectal exams may also be used.

Ordering laboratory tests

Blood and urine tests can help confirm an appendicitis diagnosis or detect signs of other health issues. A doctor may also ask for blood or urine samples to check for pregnancy.

If necessary, the doctor may also order imaging tests, such as an abdominal ultrasound, MRI exam, or CT scan.

These imaging tests can show:

  • an enlarged or burst appendix
  • inflammation
  • a blockage inside the appendix
  • an abscess

Treatment normally begins with antibiotics and intravenous fluid. Some mild cases of appendicitis can be treated completely with fluids and antibiotics.

The most common next step is surgery, known as an appendectomy. Removing the appendix decreases the risk of it rupturing. Early treatment is important to reduce the risk of complications, which can lead to death.

Two types of surgery are possible:

Laparoscopic surgery

Surgeons make several small incisions and use special tools to remove the appendix through them.

Benefits of laparoscopic surgery include:

  • a lower risk of complications, such as hospital-related infections
  • shorter recovery time

Patients should limit their physical exercise for the first 3 to 5 days after surgery.

Laparotomy surgery

Surgeons remove the appendix through a single incision made in the lower right area of the abdomen. This may be necessary for a burst appendix.

It allows the surgeon to clean the inside of the abdomen to prevent infection.

Patients should limit their physical activity for the first 10 to 14 days after a laparotomy surgery.

Delaying treatment can seriously increase the risk of complications.

Inflammation can cause the appendix to rupture, sometimes as soon as 48 to 72 hours after the symptoms begin.

A rupture can cause bacteria, stool, and air to leak into the abdomen, causing infection and further complications, which can be fatal.

Infections that can result from a burst appendix include peritonitis, an inflammation of the lining of the abdomen, or an abscess.

Taking pain medications can potentially mask symptoms and delay treatment.

With prompt treatment, appendicitis is treatable, and recovery is normally fast and complete. With early surgery, the mortality rate is under 1 percent.

Without surgery or antibiotics, for example, in remote areas, the mortality rate can be 50 percent or higher.

If the appendix bursts, this can lead to complications, such as an abscess or peritonitis. Recovery may be lengthy in these cases. Older people make also take longer to recover.

The appendix is often considered a nonfunctioning organ, unnecessary for survival, but some scientists suggest that it may play a role in maintaining a healthy immune system.

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