Appendicitis Symptoms

Abdominal pain is the most common symptom of appendicitis. The pain usually starts around the belly button before traveling to the lower right side of the abdomen. Associated symptoms include nausea, vomiting, bowel habit changes, loss of appetite, and fever.

This article highlights the symptoms of appendicitis, including a general timeline for symptom progression. Insight into conditions that may mimic appendicitis and steps you should take if you suspect appendicitis will also be reviewed.

What Are the Most Common Appendicitis Symptoms?

Abdominal pain is a universal symptom of appendicitis. It's classically felt around or near the belly button before traveling or migrating to the lower right side of the belly. This migration (movement) of pain typically occurs over 12 to 24 hours.

The symptoms of appendicitis, especially early on, tend to be subtle. The pain typically starts as crampy, mild, and intermittent before becoming sharp and constant over several hours. For some people, though, the pain may begin suddenly, becoming severe within minutes.

Besides abdominal pain, other symptoms of appendicitis include:

• Loss of appetite
• Nausea and vomiting (occur after the pain begins)
• Constipation
• Diarrhea
• Malaise (feeling generally unwell)
• Low-grade fever

Keep in mind appendicitis symptoms may differ based on the precise place of the appendix within the abdomen. While the appendix's base is always attached to the large intestines, its tip varies in location.  

For example, if the tip of the appendix is next to the rectum, appendicitis may be associated with tenesmus (frequent urge to pass stool when the bowels are empty). Likewise, if the appendix tip is in the pelvis, a person may complain of dysuria (burning with urination) and urinary frequency from appendicitis.

Appendicitis Symptoms in Children

Appendicitis rarely occurs in babies or preschool-aged children. It becomes more common in children over age 5.

The symptoms of appendicitis in children may be vague or nonspecific (can be symptoms of a number of different conditions). While fever, nausea or vomiting, and diarrhea may be present, the abdominal pain may not migrate and can be felt on both sides of the abdomen.

In addition, children sometimes complain of atypical appendicitis symptoms, like right hip pain or trouble walking. Their symptoms also progress faster than adults, and they can have difficulty communicating them.

What Is the Most Common Cause of Appendicitis?

An obstruction within the appendix is believed to be the primary cause of appendicitis.

This obstruction may be caused by a fecalith (hard, firm stool), swollen lymph nodes, infection, tumor, or appendicolith (calcified collection of tightly packed stool).

As a result of the obstruction, the appendix becomes filled with mucus and bacteria and begins swelling from the increased pressure.

Eventually, the tension within the inflamed appendix can impact its blood supply, resulting in necrosis (tissue death).

An inflamed and necrotic appendix is at risk for rupture and subsequent complications, such as:

• An abscess (collection of pus/bacteria) around the appendix
• Peritonitis (potentially life-threatening infection within the abdominal cavity)
  

What Can Be Mistaken for Appendix Pain

Several health conditions may cause pain in the lower right side of the belly, resembling appendicitis.

Examples of such conditions include:

• Gastrointestinal diseases: Gastroenteritis (stomach flu) and Crohn's disease (chronic inflammation of the digestive tract)
• Kidney/bladder diseases: Kidney stones, kidney infection, and urinary tract infection (UTI)
• Vascular (blood vessel) diseases: Abdominal aortic aneurysm (bulging of the major blood vessel in the belly) and mesenteric ischemia (when blood flow to the intestines is restricted)
  

Various tests, like white blood cell count, urinalysis, and an imaging test of the abdomen, can help rule out alternative diagnoses to appendicitis.

Imaging tests used include:

• Computed tomography (CT) scan: Uses X-ray images and computer technology to visualize structures within the body.
• Ultrasound: Uses sound waves and is the preferred imaging study for children or pregnant people.

All said, even with these tests and after a physical exam and considering a person's symptoms, a diagnosis of appendicitis can still be missed or delayed. The imaging tests may not be conclusive, or a person's symptoms may be mistaken for more common conditions like stomach flu or constipation.

Appendicitis-Like Symptoms in Females

Diagnosing appendicitis in females can be particularly challenging because symptoms may be atypical or overlap with those of various gynecologic conditions.

One study found that a missed diagnosis of appendicitis was more likely to occur in females, regardless of age (child or adult).

In females, appendicitis pain may be felt on both sides of the belly and the upper abdomen during pregnancy.

Symptoms of the following gynecologic conditions may mimic those of appendicitis:

• Pelvic inflammatory disease (infection that affects the uterus, ovaries, or fallopian tubes)
• Ectopic pregnancy (a nonviable pregnancy implanted outside the uterus)
• Ovarian torsion (the ovary twists around the tissue that supports it)
• A ruptured ovarian cyst (a fluid-filled sac on the ovary bursts open)
• Endometriosis (tissue similar to the uterine lining grows outside the uterus)

To help distinguish between appendicitis and the above gynecologic diseases, females with possible appendicitis are usually given a pelvic examination. A pregnancy test is also performed in females of childbearing age.

How Long Can You Have Symptoms Before an Appendix Bursts?

The precise timing for when an appendix may rupture is impossible to predict.

One older study found that appendix rupture risk was 2% or less in people with less than 36 hours of untreated appendix symptoms. After 36 hours, the risk of appendix rupture increased by 5% every 12 hours.

Other studies have shown that delaying appendectomy by up to 24 hours in children or adults with appendicitis does not increase the risk of appendix rupture. While not always the case, in individuals whose appendix ruptured, most had symptoms for 48 to 72 hours or more.

As such, experts tend to recommend performing an appendectomy within 12 to 18 hours of a person going to the emergency room with appendicitis symptoms.

How Do You Check Yourself for Appendicitis?

Appendicitis cannot be diagnosed at home, but you can check for symptoms and seek medical attention if one or more are present. 

For example, abdominal pain that is worsening, severe, or felt in the lower right side of your belly warrants immediate medical evaluation.

Besides symptoms, you (along with the help of someone else) can perform some maneuvers at home. Although, again, these maneuvers should never replace an evaluation by a healthcare provider.

A "positive" sign means the maneuver reproduces lower right-side abdominal pain. Its presence may further support possible appendicitis.

• Positive psoas sign: Lie on your left side and extend your right thigh backward.
• Positive obturator sign: Lie on your back with your right knee and hip bent at 90 degrees. Rotate your right leg internally at the hip.
• Positive Rovsing's sign: Press on the lower left side of your belly to increase the pain felt in the lower right side of your abdomen.
  

When to Go to the Hospital

Appendicitis is a medical emergency. If not promptly treated, an inflamed and infected appendix can rupture and cause a potentially life-threatening infection in the abdomen or throughout the body.

It's essential to seek immediate medical attention if you are experiencing any symptoms of appendicitis. Treatment of appendicitis most commonly involves surgical removal of the appendix (appendectomy). In some cases, antibiotics alone may be sufficient.

Summary

Abdominal pain is present in nearly all cases of appendicitis. The pain's location, intensity, and onset may vary among individuals. However, the pain classically starts around the belly button before traveling to the lower right side, becoming constant, severe, and sharp. Other appendicitis symptoms may include nausea, vomiting, fever, and loss of appetite.

Appendicitis is a medical emergency, as an inflamed appendix can burst open, causing life-threatening complications. Seek medical attention right away if you are experiencing symptoms of appendicitis.