Appendicitis

Overview

The appendix is a small, finger-shaped pouch attached to the large intestine in the lower right belly. When it gets blocked, it can swell and become infected. This is appendicitis.

Appendicitis is the most common cause of sudden belly pain that needs surgery. If it isn't treated, the appendix can burst and spread infection through the belly. Quick treatment prevents most problems.

Symptoms

Pain usually comes first, then other symptoms.

• Stomach pain that starts near the belly button
• Pain that moves to the lower right belly
• Pain that gets worse over hours, or when you move, cough, or sneeze
• Loss of appetite
• Nausea

Less common

• Vomiting
• Low fever
• Constipation or diarrhea
• Swollen belly
• Not able to pass gas

How it usually goes

• First hours: Dull pain near the belly button, loss of appetite.
• 12 to 24 hours: Pain moves to the lower right and gets sharper.
• 24 to 72 hours: Risk of the appendix bursting goes up.

When to get medical care

Causes

Appendicitis happens when the inside of the appendix gets blocked. The blockage raises pressure, cuts blood flow, and lets bacteria grow.

Blockages can come from hard stool, swollen tissue from an infection, or, rarely, a growth.

Does it spread or run in families?

• It isn't contagious. You can't catch it from someone else.
• It can run in families. Tell your doctor if a parent, brother, or sister has it.

Who is more likely to get it

• Age 10 to 30, though anyone can get it
• Family history of appendicitis

Possible complications

• Peritonitis: Infection of the belly lining from a burst appendix
• Sepsis: Infection spreading in the blood
• Dehydration: From vomiting and not eating

Diagnosis

There's no single test for appendicitis. Doctors use your symptoms, an exam, and tests together.

Questions you may be asked

• Where the pain started and where it is now
• Whether it's worse when you move, cough, or walk
• Loss of appetite, nausea, vomiting, or fever
• Bowel changes
• For women: periods and chance of pregnancy

The exam

They'll press on your belly. Pain that gets worse when the lower right side is pressed is a sign of appendicitis.

Tests

Tests often include:

• Blood tests: To look for signs of infection.
• Urine test: To rule out a bladder or kidney problem.
• Pregnancy test: To rule out ectopic pregnancy in women.
• Ultrasound, CT, or MRI: To see the appendix and check for other causes.

Treatment

Appendicitis is treated in the hospital. Most people have surgery to remove the appendix (appendectomy).

Self-care

• Go to the emergency room if you think you have appendicitis
• Don't eat or drink until a doctor checks you, in case you need surgery
• Don't use heating pads, laxatives, or enemas to treat the pain
• After surgery, follow your care team's plan for activity and wound care

Medicines

Medicines are given by your care team.

Most surgery is done through small cuts with a camera (laparoscopic). Recovery is usually faster this way. If there's an abscess, you may get antibiotics first and surgery later. Some mild cases are treated with antibiotics alone, but surgery is still the standard.

How it compares

Prevention

There's no proven way to prevent appendicitis.

• Know the signs and get care quickly
• Quick treatment prevents most complications

Which doctor treats this

• Start with your primary care provider (family doctor or internist).
• They may send you to a surgeon.

Children, pregnancy, and older adults

• Children: May not describe pain well. Watch for belly pain with vomiting, fever, refusing to eat, or not wanting to walk.
• Pregnancy: The pain may be higher up on the right. Get checked for any new belly pain.
• Older adults: Symptoms may be milder, so the appendix is more likely to burst before diagnosis.

Pregnancy and breastfeeding

• If you're pregnant or planning to be, tell your prenatal provider about this condition.
• Don't start or stop any medicine on your own. Some are safe in pregnancy and some need to be changed.
• Ask before taking any pain reliever. The FDA advises avoiding ibuprofen and naproxen after 20 weeks unless your doctor says to.
• Breastfeeding: Most medicines are fine, but ask. The NIH LactMed database lists what's known about each one.

Outlook

Most people recover fully after surgery, often going home within a day or two. Recovery is longer if the appendix burst. You don't need your appendix to be healthy.

Getting ready for your visit

This is usually an emergency visit.

What to bring

• When the pain started and where
• A list of medicines and allergies
• When you last ate or drank

Questions to ask

• Do I need surgery now?
• Will it be laparoscopic?
• How long is recovery?
• When can I go back to work, school, or sports?

Research studies

Research studies test new ways to find and treat health problems. Some are looking for volunteers. Talk with your doctor before joining one.

Search ClinicalTrials.gov for studies on Appendicitis