What does it feel like to have appendicitis

Not Just a Stomach Ache: Symptoms of Appendicitis

Jul 06, 2017 Cedars-Sinai Staff

Most of the time, an achy stomach isn’t anything serious. But when your pain persists, migrates, or is accompanied by other serious symptoms, a trip to the emergency room could be in order.

For more than 600,000 people each year, stomach pain is their first clue that their appendix has torn and they’re suffering appendicitis.

How do you sort out when it’s a stomach ache and when it’s appendicitis? Dr. Rodrigo F. Alban, associate director of the General Surgery Residency Program at Cedars-Sinai, offers this explanation of appendicitis and the symptoms to watch out for.

The appendix is part of the large intestine—a small, finger-shaped organ about 4 inches long, whose function is still largely a mystery, though it might offer a breeding ground for healthy gut bacteria after an infection. Or it may do nothing at all. Experts are still undecided. But when it tears, it has to be removed.

Appendicitis causes

Rodrigo F. Alban, MD

Sometimes stool can get stuck in the appendix, which is shaped like a tube with one closed end. Like a balloon that’s been tied off, there’s no way for what’s trapped inside to escape. The pressure builds as the appendix continues producing its normal secretions. The organ swells, and once this process starts, the appendix can tear or rupture.

In children, appendicitis can start when the certain tissues in the appendix that are rich in immune system cells get swollen. When kids get appendicitis, it’s usually this and not a fecal obstruction that causes it.

When to seek help

Your stomach pain is worth a trip to the emergency room when:

• Pain is severe and doesn’t let up
• Your stomach is tender to the touch
• The pain extends to you back
• Pain is accompanied by:
  • Fever
  • Vomiting
  • Difficulty breathing
  • Chest pain
  • Irregular heartbeat
  • Light-headedness
  • Dark or black stool
  • Vomiting blood

Symptoms commonly associated with appendicitis

Migrating pain: Your appendix troubles might start several days before the organ becomes torn or ruptures. During this time, you might have pain in the middle of your abdomen that feels like an upset stomach. If your appendix is the issue, this pain tends to move to the right or lower right side of the abdomen.

Nausea and vomiting: Nausea and vomiting are associated with appendicitis, but diarrhea is more consistent with a gastrointestinal infection.

Loss of appetite: Dr. Alban will ask a patient, “What is your favorite food?” And then, “Would you want to have something like that right now?” If a patient says they’re not interested in their favorite dish, it tips him off to pain so bad that it has caused loss of appetite.

Fever: A small tear might cause pain contained to the lower right side of the body. If untreated, the infection can spread through the abdomen causing fever and other symptoms.

Making a diagnosis

Doctors will often administer a blood test to check for a high white blood cell count, which would clue them in to an infection. You might also have an imaging test, like a CT scan.

Ruling out other conditions is also part of the process. Women can sometimes be more difficult to diagnose, because appendicitis has similar symptoms to ovarian cysts and other gynecologic conditions. Doctors will also try to rule out gastroenteritis and bowel diseases, as well as kidney stones in older people.

How it’s treated

Once you’ve been diagnosed with appendicitis, there are several options.

If the appendix is swollen and infected, but has not torn, it’s usually removed with a minimally invasive procedure requiring a few small incisions. These patients often go home on the same day.

If the appendix is already torn or ruptured, the surgery is more complex. Any abscess has to be drained and then the patient is treated with antibiotics. Once the swelling goes down, the appendix is removed.

More severe cases might require an open surgery, with a larger incision.

When there’s a pain in your abdomen, the chances are good that it’s something simple like gas or constipation. However, some small part of you may wonder: is it appendicitis?

Appendicitis is not that common of a condition — it occurs in about 5% of the population over a lifetime according to National Institutes of Health (NIH). However, appendicitis is the most common reason for urgent abdominal surgery in the United States.

Your appendix is about the size of your little finger and is located where your small and large intestine meet. The function of the appendix is still up for debate, but it is non-essential for adults. Removing the appendix doesn’t result in any long-term health consequences. 

Appendicitis occurs when the appendix becomes blocked, usually by a hard piece of stool, resulting in infection, inflammation and a buildup of bacteria and pus. Although other things like inflammatory bowel disease, parasites, ulcers or enlarged tissue in the abdomen can cause the blockage, it’s very uncommon. Once the appendix is blocked, it will continue to become larger and more swollen until it bursts.

A burst appendix is a surgical emergency that can be life threatening. When the appendix ruptures, it can spread the infected material throughout the abdominal cavity and lead to a more serious infection.

“Appendicitis is most common in people in their teens and twenties, but it can happen at any age,” said Andrew Sweeny, DO, from Samaritan Albany Surgical Associates. “Unfortunately, if you still have an appendix, there’s really nothing you can do to reduce your chances of getting appendicitis.”

Common Treatments

Fortunately, appendicitis is treatable. If caught early, treating an inflamed appendix may include antibiotics and likely involve surgery to remove the organ. Surgery is usually completed using laparoscopic techniques with smaller incisions. If the appendix is ruptured, the incisions may need to be larger so the surgeon can clean the abdominal cavity. “The risk of complications is much lower if we can remove the appendix before it bursts,” said Dr. Sweeny. “The whole goal of surgery is to take out the infection in the appendix and keep it from spreading to other areas of the body.”

Unique Symptoms

“At the beginning, appendicitis can seem like constipation or gas, sometimes even the flu,” said Dr. Sweeny. “The main factor that separates it from other conditions is a sharp pain that starts near the belly button and travels to the lower right side of the abdomen.”

Some people may experience pain in their lower back or pelvis rather than their abdomen, depending on where their appendix sits. Women who are pregnant and young children may not have pain in the typical location or be able to describe their pain.

Abdominal pain will likely be the first symptom. The pain will get progressively worse, often in a matter of hours. It may also be worse as you move, cough or take a deep breath. After that you may experience:

• Loss of appetite
• Nausea or vomiting
• Constipation or diarrhea
• Inability to pass gas
• Low-grade fever
• Swelling in your abdomen
• Feel like having a bowel movement will relieve discomfort

When to Head to the Hospital

Dr. Sweeny recommends that if the pain is still severe after 12 hours, you should be seen in the emergency department. The appendix is more likely to rupture after it has been inflamed for 24 to 36 hours.

“Diagnosing appendicitis can be complicated, so it’s not something you should try to diagnose yourself,” said Dr. Sweeny.

At the hospital, appendicitis is usually diagnosed using imaging like a CT scan or ultrasound to look for inflammation. The medical team may also order blood tests to look for evidence of an infection.

“Sharp pain in the abdomen can come from many other causes that don’t need surgery,” said Dr. Sweeny. “But in general, if you are having severe pain for more than 12 hours, it’s a good idea to see a doctor.”

Read patient Suzy Conway’s experience when she discovered she needed emergency apendicitis surgery. 

Not sure if you need to see a doctor? Start with an E-Visit first, available through MyChart. Don’t have an account, signup today at samhealth.org/MyChart.

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