Causes of Appendix Pain and Treatment Options

Everything you need to know about pain in the appendix

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Pain in your appendix area—i.e., your lower-right belly—can be caused by a few different conditions. The most common cause is appendicitis, in which the space inside the appendix (the lumen) gets infected, inflamed, and blocked. This will cause your appendix to feel very sore.

A collection of pus, or an abscess, can form on your appendix and also cause pain. Although rare, a tumor can form there too. Appendicitis may develop as a result of these conditions or other causes.

This article takes a closer look at these three causes of true appendix pain. It touches on how the pain may feel depending on the cause, what other conditions can cause pain in this general area, and when you should see your healthcare provider.

appendix pain causes

Verywell / Alexandra Gordon

Causes

The appendix is a small, tube-like organ that is about two to four inches in length. It sits in the lower-right part of the abdomen and is connected to the large intestine (colon).

It's not quite clear what purpose the appendix serves, if any at all. You don't need it to live, and it's often removed if it gets inflamed or infected.

The following conditions could explain why your appendix hurts.

Common

Appendicitis is the most common cause of appendix pain, though the potential for an abscess should also be considered.

Appendicitis

Appendicitis is often acute. This means that when the lumen gets blocked, symptoms can begin suddenly and progress rapidly.

Three common causes of a blocked lumen include:

  • Stool blocking the tube that joins your appendix and large intestine
  • A lymph node swelling due to infection and pressing on the appendix
  • Hardened fecal "stones," known as a fecalith or appendicolith, getting lodged in the lumen

If the lumen gets blocked, pressure will build inside it. Less blood will flow to the area, leading to infection and inflammation. Without blood flow, inflamed tissues will start to die (become gangrenous).

From there, the appendix may burst or form holes and tears in its walls. If this happens, stool, mucus, and infection can leak into the abdomen. A serious infection called peritonitis can then develop. This can be life-threatening.

At first, appendicitis can feel like dull pain in the middle or on the right side of the abdomen. The pain often becomes sharp and moves to the lower-right abdomen.

There can be other signs too, such as:

The pain often feels worse when sneezing, coughing, moving, and breathing. Some people may pull their knees up to their chest to lessen the pain.

Left untreated, the appendix can burst within 48 to 72 hours after symptoms start. If you suspect you could have appendicitis, it's important to get to a hospital right away.

Abscess

A collection of pus in your abdomen or on your appendix will cause pain. This type of abscess is called an intra-abdominal abscess.

It can form on the appendix due to appendicitis. Or, the abscess can form on another abdominal organ and then lead to appendicitis.

When the abscess comes first, appendicitis can be prevented if treatment is given quickly enough.

Symptoms of an intra-abdominal abscess can mimic appendicitis. However, the pain can come from anywhere in the belly, not just the appendix.

In addition to pain, symptoms include:

  • Fever
  • Chest pain or shoulder pain
  • Lack of appetite
  • Nausea and/or vomiting
  • Change in bowel movements
  • Tender rectum or the feeling that your rectum is full
  • A mass in your belly

Rare

Rarely, a tumor is at the root of appendix pain. Appendix cancer usually doesn’t cause symptoms until it is advanced.

About 50% of appendix tumors are carcinoid tumors. These can grow so slowly that a person can have one for several years before it is found.

If a tumor does cause symptoms, one may experience:

  • Pain in their stomach or pelvis area
  • Bloating
  • Ascites (fluid in the abdomen)

When symptoms do start, it is because appendicitis has developed. In many cases, the tumor is found during appendicitis surgery.

When to See a Doctor

Abdominal pain can be a symptom of anything from a mild stomach virus to something serious like appendicitis.

Because there is the possibility of a life-threatening cause, it's important to get new abdominal pain checked out by a healthcare provider.

Severe pain in the lower-right abdomen is a hallmark sign of appendicitis. It could start further up in your belly then migrate downward. You need to go the emergency room without delay if you experience this type of pain.

Diagnosis

Symptoms such as abdominal pain and fever may cause a physician to suspect that the appendix is inflamed. Several tests might then be used to determine whether or not you have appendicitis and to explore other possible reasons for your pain.

Physical Exam

The physical exam is important in diagnosing appendicitis. Healthcare providers may use it to determine if your appendix needs to be removed.

During the exam, the provider will palpate (press) on your lower right abdomen to check for pain and tenderness. The pain may worsen when they release pressure. If the appendix has ruptured, the abdomen might be rigid and swollen.

If your healthcare provider suspects that your symptoms could be related to your reproductive organs (for women), rather than your appendix, they may perform a pelvic exam. During the exam, your provider will look at your uterus, vagina, cervix, fallopian tubes, ovaries, bladder, and rectum to check for signs of disease.

Lab Tests

There isn’t a blood test that indicates appendicitis. However, your white blood cell count is higher when you have an infection.

A high white blood cell count, along with the results of a physical exam, may be enough to diagnose an inflamed appendix.

If your healthcare provider suspects another condition could be causing your symptoms, they may order a urinalysis to test your urine. You may also be asked to take a pregnancy test if there is a chance your could be pregnant.

Imaging

A computed tomography (CT) scan produces images that show the structures inside your abdomen.

You will lie on a table that slides into a large X-ray machine. You may be given contrast dye through an IV, which makes your abdominal organs more clear in an image. The CT scan will show if the appendix is inflamed, dilated, or narrowed.

An ultrasound may also be done. This uses sound waves to visualize the structures inside the body. A tool called a transducer is moved over the abdomen to take images. If the appendix is dilated, it may show on the ultrasound images.

If your healthcare provider suspects an appendix tumor, they may order magnetic resonance imaging (MRI) or positron emission tomography (PET).

An MRI is a type of full-body scanner that uses magnetic fields and radio waves to produce images of your organs.

Similar to a CT scan, an MRI requires you to lie on a table that slides into a large donut-shaped machine. You may be given contrast dye through an IV to create a more clear image of your abdominal organs. The MRI will show if there are any abnormal growths on your appendix or other nearby tissues and organs.

Although a PET scan machine looks similar to an MRI or CT scan machine, PET scans can be much more detailed, allowing healthcare providers to view your organs at a cellular level. For this reason, PET scans can take much longer to complete.

While a CT scan may only take about 10 to 30 minutes, an MRI can take up to an hour. A PET scan can take several hours, depending on your condition and how many images your healthcare provider orders.

Differential Diagnoses

If your healthcare provider finds that appendicitis is not the cause of your symptoms, they may consider the possibility of another condition or disease as the cause.

These other possible conditions are called differential diagnoses, and they tend to cause similar symptoms to an inflamed appendix.

Possibilities include:

  • Biliary colic: Gallstones cause a blockage in the bile duct
  • Cholecystitis: Inflammation of the gallbladder
  • Colonic carcinoma: A cancerous tumor in the large intestine (colon)
  • Crohn's disease: A chronic inflammatory bowel disease (IBD) that causes inflammation and open sores (ulcers) in the digestive tract
  • Degenerating uterine leiomyoma: Noncancerous (benign) growths shrink and grow on the uterus due to lack of blood supply
  • Diverticulitis: Bulging pouches (diverticula) form in the lining of the digestive tract and get inflamed
  • Enterocolitis: Inflammation in the digestive tract due to a bacterial or viral infection
  • Gastroenteritis: A viral infection of the intestinal tract (also known as the stomach flu)
  • Mesenteric adenitis: Swollen lymph nodes in the lower part of the abdomen often due to infection
  • Mesenteric ischemia: Low blood flow to your small intestine due to a narrowed or blocked artery
  • Omental torsion: Fatty tissue that keeps your abdominal organs secure (called omentum) gets twisted, resulting in low blood supply to the area
  • Pancreatitis: Inflammation of the pancreas
  • Perforated peptic ulcer: An ulcer in the stomach lining or upper part of the small intestine (the duodenum)
  • Rectus sheath hematoma: A pool of blood called a hematoma forms in the tissues that cover your abdominal muscles
  • Ureterolithiasis (kidney stones): Hard deposits of minerals and acid salts move into the ureters, tubes that carries urine from the kidneys to the bladder
  • Urinary tract infection (UTI): A bacterial infection in your urinary system, including your kidneys, bladder, ureters, and urethra

Treatment

If your pain is due to one of the appendix-related causes first described in this article, you will need medication and/or a procedure to treat it. What type and how quickly depends on what is affecting you.

Removal of the Appendix

Surgery to remove the appendix, called an appendectomy, is almost always recommended for the treatment of appendicitis.

It is also the treatment for an appendix tumor. If the cancer has not spread to nearby organs, an appendectomy may be enough to remove the cancer entirely. If the cancer has spread, treatment will depend on the stage of the disease (e.g. chemotherapy for advanced cancer).

Prior to surgery, antibiotics are given to prevent further infection and peritonitis. If there is already an abscess, a physician may put a tube under the skin to drain it.

An appendectomy might be done as:

  • Open surgery: A small incision is made on the lower-right abdomen so the surgeon can directly visualize the organ and operate to remove it.
  • Laparoscopic surgery: This is done through the use of three or four small incisions. Surgical tools with a scope are inserted so that the surgeon can see the inside of the body on a monitor and operate.

Most people stay in the hospital for one or two days after an appendectomy.


It's very important that you take care to prevent complications after the surgery. You may be prescribed antibiotics to treat the infection that caused your appendicitis, or to prevent infection after your appendectomy.

Any time you are prescribed antibiotics, it is vital that you finish the full course prescribed to you.

Be on the lookout for signs of infection after an appendectomy. This includes redness or oozing at the incision site(s), fever, vomiting, and/or abdominal tenderness. If they occur, bring them to your healthcare provider's attention right away so you can be treated. This can help prevent such complications as peritonitis and sepsis, an extreme response to infection that can cause organ failure.

Antibiotics

In some cases, antibiotics may be the only treatment given for appendicitis.

Some studies have shown that appendicitis may improve after a course of antibiotics in some patients who have acute appendicitis.

However, 40% of those patients will need their appendix removed in the next year due to another bout with appendicitis.

Drainage of an Abscess

Intra-abdominal abscesses often need to be drained. The procedure may be done through surgery or with a needle and a small tube (a catheter).

A physician will guide the catheter to the abscess using ultrasound or CT imaging. To stop the infection from spreading, antibiotics are typically given before and after the procedure.

Prevention

Appendicitis is believed to be caused by multiple factors that are beyond your control, such as air pollution. Ultimately, you may not be able to prevent appendicitis.

However, some studies suggest that eating more fiber-rich foods, such as fruits and vegetables, whole grains, and beans, may reduce your risk of appendicitis. If you smoke cigarettes, quitting may reduce your risk as well.

Summary

Lower abdominal pain is a sign of appendicitis. This is very serious and can be life-threatening.

An appendix can burst within three days, so it's critical that you do not delay getting medical attention. Once an appendicitis diagnosis is made, treatment usually begins right away. An appendectomy is typically done to remove the appendix.

This surgery may also be done if you have an appendix tumor (which is rare). An abscess on your appendix is another relatively common source of abdominal pain. If it is an abscess, it will need to be drained and you will be given antibiotics.

A Word From Verywell

After limiting activity for a short time after an appendectomy, most people go back to their regular activities and don’t need to change anything about their diet or lifestyle.

People live a normal life without an appendix. Once the appendix is removed, there’s no chance of the problem recurring.

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10 Sources
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