Early Signs of Appendicitis

Abdominal pain, nausea, and fever are common

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Early appendicitis can seem like food poisoning or gas, but it typically starts with sudden, often sharp abdominal pain near the belly button. That pain will move to the lower-right side of your belly. Other early signs of appendicitis can include nausea, vomiting, and a low fever.

If you have severe abdominal pain or other symptoms you think are coming from your appendix, go to the emergency room. Don't second-guess or wait to see if you start to feel worse.

A person lying on a couch with their arms on their arms folded

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An inflamed appendix requires immediate treatment. It's better to be seen and be wrong about the cause of your symptoms than to ignore the early signs of appendicitis and risk a potentially life-threatening appendix rupture.

This article covers the early signs and symptoms of appendicitis, as well as how is diagnosed and treated.

Belly Pain: Most Common Early Sign of Appendicitis

A sharp, sudden pain in the abdomen near your navel is the most common early sign of appendicitis. Even though your appendix is lower down in your abdomen, pain starts near the center of your belly because the membrane that covers your intestines (peritoneum) is also inflamed.

The pain usually starts before other appendicitis symptoms, though you may have felt a little sick or “off” before you noticed it.

As the condition worsens, that pain moves closer to where your appendix is—toward the lower-right side of your abdomen, near your hip bone. This is known as McBurney's point.

Appendicitis pain will generally persist and quickly get worse, rather than slowly improve with things like having a bowel movement or taking an over-the-counter (OTC) medication.

While the pain may be confused for other issues early on, it usually takes on some unique traits that can help you differentiate it.

Appendicitis pain is:

  • In one area, rather than felt throughout the belly
  • Intense and hard to ignore (even potentially bad enough to wake you from sleep)
  • Constant, lasting for several hours to a few days (either until it is treated or the appendix bursts, which can make the pain suddenly get better only to get worse again)
  • Worse when you move, take deep breaths, cough, sneeze, or get jostled (e.g., when you go over a bump in the road while riding in a car)
  • Unlike other pain you've had

Can Appendicitis Pain Come on Slowly?

Acute appendicitis attacks usually always come on suddenly. Chronic appendicitis, on the other hand, can cause less intense pain that comes on more slowly and may come and go over days, weeks, months, or even years. Other signs of appendicitis may either not be present or wax and wane with pain.

Other Appendicitis Pain Locations

While most cases of appendicitis involve pain in that lower-right quadrant of the abdomen, there are exceptions to this:

  • If your pregnancy is advanced, you may have appendix pain in your upper-right quadrant.
  • If your appendix is located more toward the back (retroperitoneal), you might feel pain more in the lower-right back/flank.
  • Appendicitis pain can be on the left side if, for example, you have a larger-than-normal appendix or an extra-long intestine. This presentation is extremely rare.

Don't avoid medical care if you have symptoms that are not in the "right place."

Gastrointestinal Symptoms

Gastrointestinal (GI) symptoms can be among the early signs of appendicitis. These include:

  • Loss of appetite: When your body knows something is wrong, it may prompt you to avoid eating so there is less stress put on your GI tract.
  • Nausea and vomiting: As your body starts fighting inflammation and infection from appendicitis, you may get queasy and throw up. Unlike with a viral illness, you won't feel better after vomiting if you have appendicitis. In fact, you may start to feel worse. 
  • Trouble passing gas: You may feel or look bloated, but find that you cannot fart and get relief. 
  • Constipation and diarrhea: An infection or inflammation in your GI tract can make things speed up and cause loose stools or slow down and make stools hard to pass. In some cases, it can even lead to a complete digestive shutdown.

Appendicitis in Kids

Appendicitis symptoms in kids aren't always the same as in adults. Even when they are, children can have a hard time describing how they are feeling. If you notice your child holding their stomach, walking hunched over, or showing discomfort around their belly, seek medical care right away.


With early appendicitis, you may have a low fever (99 to 100.3 degrees F) as your body tries to fight inflammation and infection. A higher fever (over 100.4 degrees F) can be a sign that your appendix has burst.

Since a ruptured appendix is a medical emergency, don’t wait until your fever gets higher to seek medical care. 

Danger of Ignoring Early Appendicitis Signs

You can’t diagnose yourself with appendicitis, but you can compare your symptoms to some of the key features of an inflamed appendix and see if they align.

If they do, or if you even think they might, go to the emergency room. It is extremely unlikely that appendicitis will get better on its own without treatment.

Research has shown that waiting more than 48 hours to get a diagnosis and start treatment leads to complication rates greater than 60%.

Your provider will move quickly to either confirm that you have appendicitis or rule it out. They will ask about your symptoms and medical history, do a physical exam, and run some tests to reach a diagnosis.

If your appendix has not ruptured yet, the clock is ticking in terms of the window of opportunity for preventing complications.

Appendix Rupture

How long it takes for appendicitis to lead to a burst appendix varies, but it can happen within hours to a day or two.

In general, data suggest that the risk of your appendix bursting if you get treatment within the first 24 to 36 hours is low. The risk goes up about 5% for every hour past 36 hours that you wait.

An inflamed appendix can burst or leak and lead to serious infection that can keep moving throughout your body and potentially be fatal. This is why it is usually treated with an appendectomy—surgery to remove the appendix.

You may need to have antibiotics (in an IV or taken as a pill by mouth) for a while after you have your appendix out as well.


The most common early sign of appendicitis is abdominal pain that begins at the belly button, then moves to the lower-right side of your belly. You may also have nausea, vomiting, constipation, diarrhea, bloating, fever, loss of appetite, and trouble passing gas.

Recognizing the early signs of appendicitis and getting medical care as soon as possible is key. If the appendix bursts, it can lead to life-threatening complications and even death.

Frequently Asked Questions

  • How do you rule out appendicitis?

    To diagnose appendicitis, a healthcare provider will do a physical exam and run some tests like blood work, urinalysis, and abdominal ultrasound, MRI, or CT scan.

  • How long does appendix pain last?

    Appendicitis pain can last anywhere from 24 to 72 hours before the appendix bursts. When this happens, the pain might briefly get better only to get worse again.

13 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. Definition and facts for appendicitis.

  2. Snyder MJ, Guthrie M, Cagle S. Acute appendicitis: efficient diagnosis and managementAm Fam Physician. 2018;98(1):25-33.

  3. National Institute of Diabetes and Digestive and Kidney Diseases. Symptoms and causes of appendicitis.

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

  5. Blachford A, Blachford A. A pregnant woman with upper right quadrant pain. Journal of Urgent Care Medicine. Published June 2020.

  6. Nahhas A, Abderahman A, Kharaba A. A snake in the grass: retroperitoneal abscess due to perforated appendicitis-management, approach and recommendationsJ Surg Case Rep. 2019;2019(5):rjz163. Published 2019 May 28. doi:10.1093/jscr/rjz163

  7. Hu Q, Shi J, Sun Y. Left-sided appendicitis due to anatomical variation: A case reportFrontiers in Surgery. 2022;9. doi:10.3389/fsurg.2022.896116

  8. Johns Hopkins. Appendicitis.

  9. Nemours Children's Health. Appendicitis.

  10. National Institute of Diabetes and Digestive and Kidney Diseases. Diagnosis of appendicitis.

  11. Alyhari Q, Ahmed F Sr, Nasreldin M, et al. Prehospital delay and its associated factors in Sudanese patients presenting with acute appendicitis at a teaching hospitalCureus. 2022;14(3):e23036. Published 2022 Mar 10. doi:10.7759/cureus.23036

  12. van Rossem CC, Schreinemacher MHF, van Geloven AAW, Bemelman WA. Antibiotic duration after laparoscopic appendectomy for acute complicated appendicitisJAMA Surgery. 2016;151(4):323. doi:10.1001/jamasurg.2015.4236

  13. MedlinePlus. Appendicitis tests.

By Kathi Valeii
As a freelance writer, Kathi has experience writing both reported features and essays for national publications on the topics of healthcare, advocacy, and education. The bulk of her work centers on parenting, education, health, and social justice.