Appendicitis Symptoms: What to Know and When to Act

Appendicitis​‍​‌‍​‍‌​‍​‌‍​‍‌ results in nearly 325,000 hospital admissions in the U.S. every year, as per the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). It's possible at any age, and symptoms may worsen very quickly. Recognizing the symptoms of appendicitis and acting promptly might make a huge difference and even save your life!

What Is Appendicitis?

The appendix is a tiny, finger-like sac attached to the large intestine on the lower right side of the abdomen. The role of the appendix is still a mystery to doctors. However, it is thought to have a minor involvement in the immune system.

Appendicitis is a condition in which your appendix is inflamed (swollen and irritated). It will become infected if blocked - usually by hard stool, mucus, or an infection. And bacteria will multiply quickly inside. That leads to pressure, swelling, and pain. If you do not treat it, your appendix may burst and spill harmful bacteria into your abdomen. Acute appendicitis, the sudden-onset type, is the most frequent cause of emergency abdominal surgery in the ​‍​‌‍​‍‌​‍​‌‍​‍‌US.

Appendicitis Symptoms

Appendicitis​‍​‌‍​‍‌​‍​‌‍​‍‌ is characterized by several symptoms such as abrupt pain in the lower right abdomen, nausea, vomiting, loss of appetite, slight elevation in temperature, and abdominal gas. Usually, the pain begins around the navel, and within a few hours, it moves to the lower right side.

Here is a brief list of the main symptoms of appendicitis:

What Does Appendicitis Feel Like?

Where does the pain of appendicitis occur?

The majority of individuals report that the initial pain is a mild, crampy discomfort around the navel. Within 12 to 24 hours, the pain intensifies and localizes to the lower right part of the abdomen - a little above and to the right of your hip bone. 

This area, known as McBurney's Point, is the usual first location of a doctor's finger during an examination. The test is to press on the area and then quickly release. A severe, sharp pain is the typical response, which is termed rebound tenderness.

How Appendicitis Pain Progresses

Appendicitis pain is different from gas or cramping. The pain:

• Gets progressively worse over time

• Becomes more intense when you move, cough, or breathe deeply

• Feels better when you lie down or curl up

If the pain suddenly becomes very strong and you feel it over the whole of your abdomen, then it is likely that your appendix has burst. This is a medical emergency. Call 911 or get to the nearest emergency room ​‍​‌‍​‍‌​‍​‌‍​‍‌immediately.

The 4 Stages of Appendicitis

As​‍​‌‍​‍‌​‍​‌‍​‍‌ appendicitis is a disease, of course, if the patient does not get treated, the disease will progress in a certain way. In fact, learning about the 4 phases of appendicitis can clarify the reasons why it is so critical to act quickly.

Research shows that between 16 and 40 percent of appendicitis cases get to the stage of perforation before the patients are operated on, and that this raises the risk of serious events such as sepsis (a very dangerous infection that moves to the bloodstream) quite a bit.

What Causes Appendicitis?

Doctors are of the opinion that a blockage within the appendix is responsible for the majority of cases. Typical causes include:

• Stool that has become hard (fecaliths) - Stool gets stuck in the opening of the appendix

• Increased lymph nodes - A stomach virus can make the lymph nodes immediately surrounding the appendix enlarge and press on it

• Mucus impaction - Thick mucus obstructs the passage

• Infected - Certain gut infections can cause inflammation of the appendix lining

Immediately after being blocked, bacteria multiply rapidly. Inflammation reduces the blood supply, and if therapy is not provided, the tissue starts to die.

Who Is at Risk?

According to NIH (National Library of Medicine), the lifetime risk of developing appendicitis in the U.S is 5 to 9 persons per 100 population. Some risk factors include:

• Age: Most commonly occurs in individuals 10-30 years old

• Sex: People assigned male at birth acquire it a little more often

• Family history: Having a first-degree family member with appendicitis increases your risk

• Diet: Some studies have found that low-fiber diets increase the risk, though evidence is still inconclusive

• Recent gut infections: Having stomach illness may increase short-term ​‍​‌‍​‍‌​‍​‌‍​‍‌risk

How Doctors Test for Appendicitis

There​‍​‌‍​‍‌​‍​‌‍​‍‌ are no appendicitis tests that are 100% conclusive on their own. Multiple methods will be combined by your medical team.

Physical examination: The doctor assesses for McBurney's Point tenderness, rebound tenderness, and other indications of appendicitis through palpation of the abdomen.

Blood tests: You will get a complete blood count (CBC) done, which includes white cell count. A white cell count that is high means infection, which is a feature of appendicitis, but can also be seen in other conditions.

Urinalysis: Testing urine will help to eliminate the possibility of kidney stones or urinary tract infection that can cause pain similar to that experienced in appendicitis.

Imaging: Based on a Cochrane systematic review published in PMC, the pooled sensitivity of CT scans for detecting acute appendicitis in adults is approximately 96%. For children and pregnant women, ultrasound is normally the first imaging modality used due to its lack of ionizing radiation. When necessary, MRI is another option, free of radiation.

Scoring tools: To figure out the probability of appendicitis by combining symptoms and test results, doctors may employ clinical scoring systems like the Alvarado Score.

Treatment Options

Once diagnosed, appendicitis is treated in one of two main ways: surgery or antibiotics.

Surgery (Appendectomy): Removal of the appendix is the usual approach and is called an appendectomy. Most of the time, laparoscopic surgery (three tiny incisions with very little recovery time) is done. Open surgery is reserved for cases where the appendix has ruptured or complications are present. NIDDK says that timely surgery lessens the risk of the appendix bursting.

Antibiotics as a substitute treatment: The pivotal APPAC randomized clinical trial, published in JAMA, revealed that many patients treated only with antibiotics for uncomplicated appendicitis were kept free of surgery during the 1-year follow-up. 

Nevertheless, the 5-year follow-up of the same study indicated that nearly 39% of the patients treated with antibiotics alone were operated on later. Surgery is the most perfect treatment. However, antibiotics could be an option for patients who are chosen very carefully. A matter that should be discussed with your doctor.

If the appendix bursts, immediate administration of intravenous antibiotics, possibly draining the abscess (a pocket of pus), and surgery will be ​‍​‌‍​‍‌​‍​‌‍​‍‌required.

When to Go to the ER

Seek​‍​‌‍​‍‌​‍​‌‍​‍‌ medical attention without delay if you experience:

• A sudden, sharp pain in the lower right side of the abdomen

• Pain that initially was in the belly button area, but now is in the lower right side

• Abdominal pain that intensifies continuously over several hours

• Fever associated with abdominal pain

• Persistent vomiting

• Board-hard or rigid abdomen

• Intense pain extending throughout the abdomen (possible rupture)

If you think you might have appendicitis, don’t put a heating pad on your stomach, take laxatives, or use antacids because these things could hide the symptoms or make your condition worse.

Not sure if your symptoms are serious enough for the ER? Try August, our AI health assistant that scored 100% on medical licensing exams. August can help you understand your symptoms and know exactly what to tell your doctor before you go in.

Key Takeaways

Appendicitis signs worsen rapidly. Pain that starts around the belly button and then moves down to the lower right side of the abdomen, accompanied by symptoms like fever, nausea, and loss of appetite, is a strong indicator of appendicitis. 

Don't hesitate to get to the hospital if you or others with whom you are concerned show these symptoms. Obtaining medical help early makes the difference between life and ​‍​‌‍​‍‌​‍​‌‍​‍‌death.