What Is Chronic Appendicitis?

Chronic appendicitis is long-term inflammation of the appendix, the small pouch extending off the large intestine. This causes pain in the lower-right part of the abdomen that may persist or come and go over time. How long you can have chronic appendicitis varies: For some, it lasts months. For others, years.

Researchers aren't sure how common this condition is. Chronic appendicitis does not always require surgery, but it may affect up to 23% of people who eventually have their appendixes removed.

Read on to learn more about chronic appendicitis, including how it differs from acute cases, what causes it, how it is diagnosed (and why it's often misdiagnosed), and how it is treated.

What Chronic Appendicitis Feels Like

Chronic appendicitis is typically on the milder side. It can either last for seven days or more, or come and go for longer.

Because of this, people don’t necessarily seek medical care. You can have chronic appendicitis pain on and off for months before it becomes bad enough that the condition is identified.

Chronic vs. Acute Appendicitis Pain

This is in stark contrast to acute appendicitis, the more common type. With this, pain comes on quickly and is severe, and it gets worse when you move or take deep breaths. It often starts near the belly button and moves diagonally downward to the lower-right section of the abdomen.

Some people say the pain of acute appendicitis is different from anything else they’ve ever felt.

Chronic appendicitis pain is far less specific.

Causes

The causes of chronic appendicitis mirror the causes of acute appendicitis, which can include:

• The opening to the appendix being blocked by food or stool
• The appendix becoming inflamed due to infection or inflammatory bowel disease (IBD)

Complications of Chronic Appendicitis

Left untreated, chronic appendicitis can have an impact on quality of life. Oftentimes, it progresses to an acute episode.

Like any form of appendicitis, chronic appendicitis carries the risk of the appendix bursting, which can lead to serious infection. This is not an immediate concern like it is for acute cases, however.

Unfortunately, since the condition hasn’t been thoroughly studied, it’s not clear how often chronic appendicitis leads to complications. 

Diagnosing Chronic Appendicitis

Chronic appendicitis can be diagnosed through discussion with your healthcare provider, a physical exam, and imaging.

• Patient history: Your healthcare provider will ask about your symptoms, including any patterns you’ve noticed and when they occur. They will also ask about your overall health.
• Exam: The healthcare provider will feel your abdomen and possibly your right leg. 
• Testing: A blood test will look for signs of infection, while a urine analysis will help rule out other conditions like bladder or kidney infections.
• Imaging: Chronic appendicitis may show up on a computed tomography (CT) scan, magnetic resonance imaging (MRI), or ultrasound. These can detect inflammation and help detect a burst appendix. 

Misdiagnosis

Most healthcare providers know appendicitis as an acute condition. If a someone doesn’t present with severe pain, they may not consider appendicitis as a possible diagnosis.

Since the symptoms of chronic appendicitis are milder, they can be confused with other gastrointestinal conditions like irritable bowel syndrome. This is especially true since chronic appendicitis is poorly understood and has no formal diagnostic criteria.

Does Chronic Appendicitis Require Surgery?

Unlike acute appendicitis, chronic appendicitis doesn't require emergency surgery. However, appendix removal is sometimes the best way to treat the condition.

In some cases, a healthcare provider may choose to first give you antibiotics to treat an underlying infection that could be leading to inflammation of the appendix. Medication or not, they may also suggest that you monitor your symptoms before opting for surgery.

Although these options may help you avoid an unnecessary procedure, research indicates that many people ultimately need to have their appendix removed.

Appendectomy

If you are experiencing severe or reoccurring pain, your healthcare provider may recommend an appendectomy, a surgery to remove the appendix.

This can be done via a traditional incision or laparoscopically, which uses three smaller incisions. The surgery usually lasts less than an hour and is often an outpatient procedure, meaning you will be sent home the same day.

Most people feel better immediately after surgery, but follow your healthcare provider's tips for recovery. Most people need to take it easy for about a week after the procedure.

Summary

People with chronic appendicitis typically feel milder pain than those with acute appendicitis. The pain may last for days at a time or it may come and go.

Like acute appendicitis, chronic appendicitis may progress to a ruptured appendix. This is why it is important to seek medical care if you have symptoms of chronic appendicitis.

Antibiotics are sometimes used to treat this condition, but many people with chronic appendicitis will ultimately need to undergo surgery to remove the appendix.