If you have severe belly pain — especially in your lower right side — you may have appendicitis.
Providers diagnose an infected appendix through a combination of symptoms and imaging scans. If your appendix is swollen and infected, you may need surgery to remove it before it bursts.
A burst appendix can spread infection through the body. It is a medical emergency.
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What Is Appendicitis?
Doctors define appendicitis as an infection of the appendix.
The appendix is part of the digestive tract. It's a finger-sized tube in the lower-right abdomen. It's attached to the large intestine.
For years, the appendix has been a medical mystery. Researchers still haven't found a specific role for the organ. Some suggest it could play a role in the immune system. It may also bolster the gut's helpful bacteria.
An infected appendix can be a serious problem. Without treatment or surgery, it can burst. A ruptured appendix can spread infection elsewhere in the body, causing a life-threatening problem.
Appendicitis won’t go away on its own. If you have low belly pain that gets worse or doesn’t improve in 24 hours, it may be acute appendicitis. You should seek medical care immediately.
How common is appendicitis?
Appendicitis is a fairly common problem. Between 5% and 9% of people in the United States will have appendicitis at some point in their lifetime. It’s most common in people in their teens and 20s, but it can happen at any age.
What causes appendicitis?
Doctors don’t always know what causes appendicitis.
It may start with an infection. Germs from the large intestine can cause an infection. Bacteria are usually the culprit, but viruses, parasites, or fungi can also cause infections.
An infection can also develop when the opening to the appendix gets blocked.
Many substances can block the appendix, such as:
- Dried mucus.
- Hard stool.
- Swollen lymph nodes.
The infection triggers the body's immune system to respond. As immune-fighting cells flood the appendix, it swells. This swelling leads to pain in the lower right side of the belly.
Appendicitis risk factors
Appendicitis usually comes on quickly and without warning. But it’s good to be aware of the risk factors for the condition.
Appendicitis often occurs in otherwise healthy people. Most times, there doesn’t seem to be a primary reason or cause for it.
Risk factors may include:
- Age — Children and young adults ages 10 to 30 are most likely to get appendicitis. But it can occur at any age.
- Family history — Appendicitis isn’t inherited, but a family history of the condition seems to raise your risk of getting it.
- Low-fiber diet — People who eat a diet low in fiber are more likely to get appendicitis. A high-fiber diet may reduce your risk, but it doesn't fully remove the risk of appendicitis.
Complications of appendicitis
Once an infection starts in the appendix, the organ becomes inflamed by the immune system's reaction.
An inflamed appendix can burst. If that happens, the pain may suddenly get better, then worse again.
If doctors don't remove the infected parts of a burst appendix and clean the abdomen, the infection can spread.
The spreading infection and the immune system's response to it can damage other organs. If left untreated, a ruptured appendix can be fatal.
What Are the Signs and Symptoms of Appendicitis?
Appendicitis symptoms often begin with stomach pain. The pain may start on the right side of the abdomen or around the belly button. The pain then usually moves to the lower right side.
Appendix pain typically gets more severe over hours or days. It may get worse when you move, cough, or press on your belly. Sometimes, it feels better if you pull your knees up to your chest.
Other early warning signs of appendicitis include:
- Constipation or diarrhea.
- High fever.
- Loss of appetite.
- Nausea and vomiting.
- The urge to have a bowel movement.
- Urinating more than usual.
When should I see a doctor about my appendicitis symptoms?
You should call 911 or go to the nearest emergency department (ED) if you or a loved one has belly pain that:
- Doesn’t go away in 24 hours.
- Keeps getting worse.
- Moves to the lower right side of your belly.
You should not drive yourself. Have someone else drive you. Bring any medicines you usually take with you.
How Do You Diagnose Appendicitis?
Don’t try to diagnose appendicitis on your own. If you or a loved one is having severe belly pain, it’s better to get it checked out. If left untreated, a burst appendix can result in death.
Once you get to the hospital, you will see a doctor.
They will:
- Ask about your medical history and any other symptoms you're having.
- Perform a physical exam. They will press on different parts of the belly to see where it's tender or painful.
- Order tests if they suspect appendicitis.
Tests to diagnose appendicitis
Unfortunately, there’s not one definitive test for appendicitis. The symptoms can be like those of many other conditions. Your doctor may recommend waiting a few hours under observation to see if your symptoms get worse.
Your doctor will also order tests to help confirm a diagnosis of appendicitis, including:
- Blood tests — Look for an increase in white blood cells, which can be a sign of infection.
- CT scan — To see if the appendix is swollen. Doctors don’t use CT scans on children or pregnant women. The radiation from the scan may hurt an unborn child.
- Ultrasound — Uses sound waves to see inside your body. Ultrasound does not use radiation, so it’s safe for everyone.
- Urine tests — Can rule out kidney or bladder problems.
If it’s likely you have appendicitis, your doctor may recommend surgery right away. They won’t wait to give you more tests.
How Do You Treat Appendicitis?
Your treatment will depend on how advanced your condition is and whether your appendix has already burst. The goal of treatment is to stop the infection from spreading. In most cases, that means removing the appendix with surgery.
Medicine to treat appendicitis
If the infection hasn’t spread beyond your appendix or if surgery is high-risk for you, your doctor may treat you with antibiotics. Medication may be all that's needed for mild cases of appendicitis.
Surgery for appendicitis
Removing the appendix (appendectomy) is the usual treatment for appendicitis. Your body doesn’t need an appendix to live, so taking it out doesn’t cause long-term problems.
Doctors may suggest an appendectomy even when they can’t confirm appendicitis. It is usually the safest choice, because the risks of a ruptured appendix are high.
If the appendix has already burst, it’s a medical emergency. You will need surgery right away. The surgery to remove your appendix will take about an hour.
What happens during surgery
Your doctor will review your symptoms and medical history to decide the best type of appendectomy for you.
Your surgeon may remove your appendix using one of two methods:
- Minimally invasive laparoscopic surgery — Your surgeon will make small cuts in your abdomen. They will insert a tiny camera inside a tube through one of the cuts. They will use special tools to take out your appendix.
- Open surgery — Your surgeon will make one large cut in the lower right or middle of your abdomen to take out your appendix.
Minimally invasive surgery usually:
- Causes fewer complications.
- Has a shorter recovery time than open surgery.
- Often allows people to go home the same day as their surgery.
What happens if my appendix bursts before or during surgery?
If your appendix bursts, you may have problems that your surgeon will take care of during surgery.
You may get an infection called peritonitis on the inside lining of your belly. Your surgeon will clean the inside of your abdomen before taking out your appendix.
An abscess may also form. Your surgeon will drain the pus from the abscess so it can heal.
How effective is treatment?
Appendectomy is very effective. You will not get appendicitis again since you have no appendix.
If you have mild appendicitis or chronic (long-lasting) appendicitis, your doctor may recommend medicine instead of surgery.
Your doctor will talk to you about which form of treatment is best for you.
How long does it take to recover after treatment for appendicitis?
Whether you'll need to stay in the hospital depends on several factors, including:
- How severe your appendicitis was.
- The level of pain relief you need.
- Whether your appendix ruptured.
- Your other health problems.
With scheduled appendix surgery, you may go home the same day. With emergency surgery, you may need to stay in the hospital overnight.
Before you leave the hospital, your care team will give you written details on how to care for your incision and yourself.
They'll include when you can:
- Go back to work or resume your normal routine.
- Remove your bandages.
- Take a shower or a bath.
You'll also make a follow-up appointment with your surgeon, one to four weeks after the surgery.
Healing time after appendix surgery
In general, recovery time for minimally invasive surgery is between three and seven days. Recovery time for open surgery is 10 to 14 days.
You should limit strenuous physical activity, but walking every day will help with your recovery.
Your doctor will likely clear you to drive 24 hours after your appendectomy. Don't drive if you're in pain or if you're on prescribed pain medicine.
Some pain in your incision site or stomach is normal. You may also have shoulder pain from the gas used to expand the stomach cavity during surgery. This pain typically goes away within 48 hours.
For most pain, over-the-counter pain drugs like acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) will help you feel better. Your provider may also prescribe stronger pain medicine.
An appendectomy cures appendicitis. You should not need to make lifestyle changes after recovering from surgery.
Appendectomy risks
Problems from an appendectomy are rare but may include:
- An abnormal passage (fistula) that forms between your intestine or stomach and your skin.
- An abscess — a collection of pus or bacteria — inside your abdomen.
- A small bowel obstruction.
- Bands of scar-like tissue that form inside your abdomen.
- Blood clots.
- Bruising, bleeding, or infection at the incision site.
- Heart problems.
- Hernias.
- Ileus, a condition where your bowel doesn't work properly with no apparent cause.
When to call the doctor after an appendectomy
You should call your doctor if you don't start feeling better after a few days.
You should also call the doctor if you have:
- Blood or pus coming from your incision site.
- Breathing problems or a cough that doesn't go away.
- Fever over 101 F.
- Lack of appetite.
- Nausea or vomiting.
- Pain that doesn’t go away with medication.
- Redness in your surgery site that spreads or gets worse.
- Severe pain or swelling in your belly.
