What to Do If You Suspect Chronic Appendicitis

Appendicitis is a common cause of abdominal pain that starts near the belly button and moves to the lower right abdominal region. Appendicitis affects 5% to 9% of people over the course of their lifetime.

Appendicitis is most often an acute condition, which happens once and is treated with the removal of the appendix. However, when symptoms last for seven days or longer, or come and go for longer than that period, it is considered chronic. Researchers aren't sure how common chronic appendicitis is, but it may affect up to 23% of people who eventually have their appendixes removed.

Read on to learn more about chronic appendicitis, including symptoms, treatment, and why this condition is often misdiagnosed. 

Man touching his stomach in pain

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When Does Appendicitis Become Chronic?

In most cases, appendicitis is acute. The pain is severe and worsening, and the cure for the pain is to surgically remove the appendix, the small pouch extending off the large intestine. The pain is caused by inflammation of the appendix, which happens when the organ becomes blocked. If the appendix isn’t removed it can burst, which is a medical emergency.

Chronic appendicitis isn’t well understood, but it’s believed to be caused by inflammation. With this condition, appendicitis pain can come and go. The pain is often less severe than acute appendicitis, so people don’t necessarily seek medical care. Sometimes, the pain happens on and off for months before becoming bad enough that the condition is identified as appendicitis. 

Appendicitis Pain

Pain is the primary symptom of acute appendicitis. The pain often starts near the belly button and moves diagonally downward to the right lower section of the abdomen. The pain comes on quickly and is severe. It gets worse when you move or even take deep breaths. Some people say that the pain is different from anything else they’ve ever felt.

Can It Come and Go?

Healthcare providers are still trying to answer the question: Can appendicitis pain come and go, or can appendicitis come on slowly? However, case studies highlighting chronic appendicitis stories suggest this happens to some people. 

These chronic appendicitis stories include:

  • A 39-year-old man who experienced occasional sharp, shooting pains in the lower right abdomen for six months. The attacks would last for six to 12 hours and resolve on their own.
  • A 21-year-old woman who had upper abdominal pain one to two days a week for two months, accompanied by fever.
  • A 34-year-old man who experienced unexplained weight loss over the course of nine months. During that time, he had four one-week-long episodes of abdominal pain and fever. 

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 is inflamed from infection or inflammatory bowel disease (IBD) 

Factors That Contribute to Misdiagnosis

Most healthcare providers know appendicitis as an acute condition. If a someone doesn’t present with severe pain, they may not consider appendicitis. Since the symptoms of chronic appendicitis are milder, they can be confused with other gastrointestinal conditions. This is especially true since chronic appendicitis is poorly understood and has no diagnostic criteria.

Complications of Untreated Chronic Appendicitis 

If chronic appendicitis is left untreated, it can have an impact on quality of life. Oftentimes it progresses to an acute episode, where appendicitis is diagnosed. Like any form of appendicitis, chronic appendicitis carries the risk of the appendix bursting, which can lead to serious infection. Unfortunately, since the condition hasn’t been thoroughly studied it’s not clear how often chronic appendicitis leads to complications. 

Diagnosis

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

  • Discussion: Your healthcare provider will ask about your symptoms, including any patterns you’ve noticed and when they occur. 
  • 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: Your healthcare provider may order an ultrasound, MRI, or CT scan to get a picture of your appendix. This will show any inflammation and can help them detect a burst appendix. 

Treatment Options 

Since chronic appendicitis is poorly understood, healthcare professionals aren’t sure what the best course of treatment is. Talk with your healthcare provider about what is best for you. 

Your Healthcare Provider May Start With Antibiotics 

Many people with chronic appendicitis have been treated with antibiotics. These are designed to treat any underlying infection that could be leading to inflammation of the appendix. 

Watch and Wait Approach

Your healthcare provider may suggest that you monitor your symptoms before opting for an invasive treatment like surgery. Although this may help avoid unnecessary surgery, research indicates that many people ultimately need to have their appendix removed.

Eligibility for Surgery 

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. 

Since the pain of appendicitis is severe, most people feel better immediately after surgery. Follow your healthcare provider's tips for recovery. Most people will need to take it easy for about a week after surgery. 

Summary

Chronic appendicitis is a condition that isn’t very well understood. Healthcare professionals are recognizing that some people who present with acute appendicitis have experienced appendix pain that comes and goes over the preceding months. If you experience pain in your lower right abdomen that comes and goes, speak with your healthcare provider. 

A Word From Verywell

Advocating for yourself while you’re in pain can be difficult. Since chronic appendicitis isn’t a well-known condition, you may need to talk to your healthcare provider about your symptoms and outline why you believe this may be a chronic condition.

Frequently Asked Questions

  • How reliable is a CT scan for chronic appendicitis?

    A CT scan can show whether the appendix is inflamed or blocked, which can indicate chronic appendicitis.

  • What foods trigger appendicitis flare-ups?

    There aren’t certain foods that are tied to appendicitis flare-ups. Some people may experience appendicitis linked to eating nuts and seeds that are difficult to digest, while others may find symptoms get worse with greasy or fatty foods. 

  • Is there a link between stress and chronic appendicitis?

    Healthcare providers aren’t sure what causes chronic appendicitis. However, it is linked to inflammation, which can be caused by stress, so that some people may experience a connection between stress and appendicitis.

3 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. National Institute of Diabetes and Digestive and Kidney Diseases. Appendicitis.

  2. Holm N, Rømer MU, Markova E, Buskov LK, Hansen ABE, Rose MV. Chronic appendicitis: two case reports. Journal of Medical Case Reports. 2022;16(1):51. doi:10.1186/s13256-022-03273-2

  3. Kothadia JP, Katz S, Ginzburg L. Chronic appendicitis: uncommon cause of chronic abdominal pain. Therap Adv Gastroenterol. 2015;8(3):160-162. doi:10.1177/1756283X15576438

By Kelly Burch
Kelly Burch is has written about health topics for more than a decade. Her writing has appeared in The Washington Post, The Chicago Tribune, and more.