Let Us Call You
Appendicitis is swelling and infection of the appendix, a small pouch attached to the large bowel, and it needs urgent treatment in hospital. The most typical first sign is pain that starts around the belly button and moves to the lower right side of the abdomen within a few hours. It is most common in children over 10 and young adults, although it can happen at any age. Most people are treated with surgery to remove the appendix and recover within 1-2 weeks.
Key Takeaways
- Appendicitis pain usually begins near the belly button, then settles in the lower right abdomen and gets worse.
- Severe abdominal pain with confusion, pale or blotchy skin or difficulty breathing needs emergency care.
- No single test always confirms appendicitis, so diagnosis combines examination, blood and urine tests and often a scan.
- After keyhole surgery, some people go home the next day and most recover within 1-2 weeks.
Where is Your Appendix?
Your appendix sits in the lower right part of your abdomen, where the small bowel joins the large bowel. This is why appendicitis pain usually ends up on the right side. In pregnancy the appendix is pushed higher, so the pain may seem to come from the upper abdomen.
What Are the Symptoms of Appendicitis?
The main symptom of appendicitis is abdominal pain that gets steadily worse over a few hours. The pain often becomes sharper when you move, cough or press on the area, and it may ease slightly if you pull your knees up to your chest.
Other symptoms can include:
- Feeling sick or vomiting
- Loss of appetite
- A high temperature, which may start low and rise
- Constipation or diarrhoea
- Needing to urinate more often
- Sudden confusion, in older people
Symptoms are not always typical. In young children, older adults and pregnant women, the pain may be milder, develop more slowly or appear in a different place.
What Causes Appendicitis?
Appendicitis usually starts when the inside of the appendix becomes blocked. Mucus and fluid then build up behind the blockage, bacteria multiply and the appendix becomes swollen and infected. It is most common between the ages of 10 and 30, and men have a slightly higher risk than women. In many people, no single cause is found.
Hardened stool (faecolith)
A small, hard piece of stool called a faecolith, or appendicolith, can block the opening of the appendix. It is one of the most common causes and is found more often in children and young adults.
Swollen lymph tissue
The wall of the appendix contains lymph tissue that can swell during a viral or bacterial infection, or in people with inflammatory bowel disease. The swelling narrows the opening of the appendix until it closes.
Undigested food or swallowed objects
Undigested food or a small swallowed object can occasionally get stuck inside the appendix and block it.
Intestinal worms
Parasites such as intestinal worms are a less common cause of blockage.
Growths in the appendix
Rarely, a growth (tumour) inside or near the appendix blocks it and leads to appendicitis.
How Is Appendicitis Diagnosed?
Appendicitis is diagnosed with a physical examination of the abdomen, supported by tests. No single test always confirms it, so doctors sometimes watch how the symptoms change over a few hours before deciding on treatment.
- Blood tests to look for signs of infection
- A urine test to rule out a urinary infection
- An ultrasound or CT scan of the abdomen
- A pregnancy test, where relevant
If appendicitis is very likely, or the appendix may have burst, surgery may be recommended without waiting for further tests.
How Is Appendicitis Treated?
Most people with appendicitis have an operation to remove the appendix, done as soon as possible. Antibiotics alone are an option for some people, depending on how severe the infection is and their overall health.
Appendix surgery (appendicectomy)
Appendicectomy, also called appendectomy, is the removal of the appendix and usually takes about an hour. It can be done as keyhole (laparoscopic) surgery through small cuts or as open surgery through one larger cut.
Antibiotics
For some adults with uncomplicated appendicitis, antibiotics can be tried first instead of an operation, and around 7 in 10 people treated this way do not need surgery over the following three months. Antibiotics are less likely to work when the appendix contains an appendicolith (a hard, calcified deposit), so doctors take scan results into account before suggesting this option.
What Happens if Your Appendix Bursts?
A burst appendix spreads infection into the abdomen and needs urgent surgery and antibiotics. The pain may ease briefly when the appendix bursts and then become severe across the whole abdomen.
- Peritonitis, an infection of the lining of the abdomen
- Sepsis, a life-threatening reaction to infection
- An abscess (a collection of pus), which is usually drained before the appendix is removed
How Long Is Recovery After Appendix Surgery?
Most people recover from appendicitis surgery within 1-2 weeks. After keyhole surgery you may be able to go home the next day, while open surgery or a burst appendix usually means a few days in hospital and a longer recovery.
- Return to normal activities gradually and avoid strenuous exercise until you feel fully recovered.
- Do not drive until you can do so safely, including making an emergency stop.
- Finish any antibiotics you have been given.
- Eat fibre and drink plenty of fluids to avoid constipation.
Seek urgent advice if the wound becomes red, swollen or starts to leak pus, or if you develop a high temperature after surgery.
If you have abdominal pain that keeps getting worse or moves to the lower right side, an urgent assessment by a general surgery specialist or emergency doctor is advisable.
