Symptoms of appendicitis

What are the symptoms of appendicitis?

The symptoms vary but the classic symptom is a dull pain around your belly button that then moves to become a pain that suddenly becomes much sharper in the right side of your lower tummy. Other symptoms may include nausea, vomiting, loss of appetite, diarrhoea and fever.

Over the next few hours the abdominal pain typically gets worse spreading across your abdomen to the lower right-hand side. This is the area covering the normal position of the appendix.

Typically the pain becomes worse and spreads over 6-24 hours. It may become severe. The pain tends to be sharper if you cough or make any jarring movements. The pain may ease a bit if you pull your knees up towards your chest, and may be worse if you push on your tummy or try to move around. The lower abdomen is usually tender, particularly in the lower right-hand side. You may find that pushing in on this area of your tummy gently with two fingers is very painful. Letting go - releasing the two fingers quickly after you push in - is often even more painful (this is called 'rebound tenderness').

Other symptoms that may occur include the following:

• Feeling sick (nausea) and being off food are typical. You may be sick (vomit).

• High temperature (fever) and generally feeling unwell.

• Constipation may occur, and sometimes diarrhoea.

• Frequent passing of urine may develop. This is thought to be due to the inflammation irritating the nearby ureter. The ureter is the tube between the kidney and bladder.

If your appendix bursts (perforates) then severe pain can spread to the entire abdominal cavity. Any movement is painful and you will want to keep very still. This is a medical emergency and you should call for an ambulance immediately (by calling 999 if in the UK). Infected material from the appendix, together with contents of the bowel, can leak into your abdomen and track between the other organs. You become very ill as you develop serious infection of the membrane called the peritoneum, which lines the whole abdomen. This condition is called peritonitis.

If you develop peritonitis, coughing and moving the legs at the hips is painful. Your tummy will feel hard and tense and you won't be able to push into it at all. You may be unable to pass wind or go to the toilet, and probably won't want to.

Sometimes, once the appendix has burst, the infection is 'walled off' quickly by the membrane lining the stomach, which sticks to the appendix and traps the leaking fluid and pus. If this occurs you will still be in severe pain but the pain may remain quite focused in the lower right area of your abdomen, where a health professional may be able to feel the whole inflamed section of tissue as a firm, painful lump called an 'appendix mass'.

See the separate article called Appendicitis in children: what are the signs.

How long do early symptoms of appendicitis last?

Appendicitis often starts with a pain in the middle of your tummy (abdomen). This pain may come and go. These early symptoms vary in duration but often last a few hours before the pain moves to your right lower tummy, which is where the appendix usually lies. The pain then becomes constant and severe.

What is non-typical appendicitis like?

Not all cases of appendicitis have typical symptoms.

• Sometimes the symptoms of appendicitis are not typical and may be similar to other possible diagnoses, such as a urinary tract infection.

• In some cases the pain may develop more slowly and run a more gradually smouldering course. This is particularly true when an appendix mass develops.

• The pain can also start in the lower right-hand side of the tummy (abdomen), rather than around the belly button.

• In some cases the pain may be relatively mild and may not actually become severe until the appendix perforates.

• The site of the pain may also not be typical if the side where the appendix lies is in an unusual place. Sometimes it is felt around the back passage, for example, or lower down in the groin.

• Appendicitis in pregnancy can begin quite vaguely further up the tummy or even under the ribs, as the appendix is pushed away from its usual location by the growing baby.

• Appendicitis is rare in small babies, but if it does occur it can often look more like an attack of gastroenteritis, with being sick (vomiting), irritability and diarrhoea.

• In some cases the appendix is not in the usual place. The pain of appendicitis can develop more slowly and in a different area such as in the hip joint or around the back passage. However, other symptoms, such as feeling sick (nausea) and high temperature (fever) are also seen.

Removal of the appendix

In order to treat appendicitis your appendix will usually need to be removed as soon as possible. This is called an appendicectomy and is performed by keyhole surgery (laparoscopy) or open surgery. Open surgery requires a larger incision in your right lower abdomen to remove your appendix. Open surgery may be needed instead of keyhole surgery if your appendix has burst, or if you have needed open abdominal surgery before for any other reason.