Appendicitis - what's the point?

Up to one in 10 people get appendicitis. While it's most common between the ages of 10 and 20, much older people can be affected - as Elton John discovered in August 2013, when he was well past the first flush of youth.

The appendix used to be useful - now it's just a trouble maker. Tucked away at the very start of your large intestine, where it joins the small intestine just behind your right pelvic bone, it's not thought to do anything useful in modern man. It probably helped digest food when we lived on a tough fibrous plant diet. It may play a small part in fighting off disease through our immune system, acting as a reserve of 'good' bacteria which can emerge after a bout of gastroenteritis and help get the gut into shape again. But removing it does no long-term harm at all - which is fortunate, because the only time most of us give it any thought is when it gets inflamed and needs to be removed.

Up to one in 10 people get appendicitis. While it's most common between the ages of 10 and 20, much older people can be affected - as Elton John discovered in August 2013, when he was well past the first flush of youth.

Everyone knows that appendicitis causes tummy pain - more specifically, pain in the bottom right- hand side of the abdomen. But in fact, occasionally appendicitis can happen without pain in this part of the abdomen at all - particularly in pregnant women, where the appendix is pushed up by the growing womb. What's more, in early appendicitis pain is more commonly situated round the tummy button, moving down and right over the next few hours or sometimes days. It's usually made worse by coughing, moving or even deep breathing, and feeling or being sick, along with fever, become more marked as time progresses.

Because the appendix sits very close to the right ureter - the tube your urine passes down between your kidney and your bladder - inflammation of the appendix can irritate the ureter, causing a need to pass water often. In fact, a urine infection can sometimes be mistaken for appendicitis, as can kidney stones, ovarian cystsectopic pregnancy (a pregnancy outside the womb), or pelvic infection caused by sexually transmitted infection.

In children, it's not uncommon for inflamed lymph nodes in the tummy to cause symptoms that can be mistaken for appendicitis. Inflammation of the bowel from other causes, such as Crohn's disease or colitis can also mimic appendicitis.

Any pain in the right lower tummy which is bad enough to stop you sleeping or wakes you from sleep should be checked out, especially if you have any of the symptoms above. While I hasten to add that I don't recommend a 'diagnose-it-yourself' approach, hints that you shouldn't just hope for the best include pain accompanied by:

  • Feeling or being sick
  • Being off your food
  • Constipation (or diarrhoea)
  • Fever
  • Pain that starts around the belly button and moves south-east
  • Marked tenderness when you press just above the right hip bone
  • Pain in the lower right stomach when you press the lower left side.

You may be surprised to discover that even if you're admitted to hospital and your doctor thinks you might have appendicitis, you won't necessarily be rushed straight to surgery. There's no foolproof way of diagnosing appendicitis, and up to one in five people who have their appendix removed don't have appendicitis at all. So your doctor will do blood tests and urine tests to see how much inflammation is going on in your body and whether urine infection, kidney stone or pregnancy could be to blame. The may also recommend:

  • An ultrasound or CT scan
  • A urine test or a protein called LRG (not widely available on the NHS, and still going through trials, but LRG is often very raised in appendicitis and the test may be done routinely in the future)
  • Antibiotics, either to delay the need for surgery (which might make it safer) or to see if surgery can be avoided.

If you have all the classic symptoms of appendicitis, your doctor will probably want to operate sooner rather than later to avoid your appendix perforating. This lets the gut contents out into the abdominal cavity and can cause serious infection called peritonitis. At worst peritonitis can be life-threatening; at best it means you'll take longer to recover. But if your symptoms are less obvious, your doctor may recommend a 'wait and see' policy to avoid unnecessary surgery.

On the plus side, most people can have their appendix taken out using keyhole surgery, and are out of hospital in as little as 24 hours. Your appendix will always be examined under a microscope after it's removed to exclude the tiny chance that you have a tumour called carcinoid. You'll take a week or two to get back to normal, and you should avoid heavy lifting in the short term. As for the longer term? Doctors aren't going to remove your appendix for no reason, but you and your appendix can part company without you ever having to worry for your future health.

Dr Sarah is unable to provide medical advice or respond directly to questions concerning your health. If you have health concerns we recommend contacting your GP.