Appendicitis occurs when your appendix, a worm-shaped pouch attached to the large intestine, becomes inflamed.
It can be life threatening if the appendix bursts, but doctors usually remove it surgically before this happens.
A diagnosis can be tricky, however, says Michael Payne, MD, a gastroenterologist with Cambridge Health Alliance, a Harvard-affiliated public healthcare system, in Cambridge, Mass. "It is a very common illness and many people don't have classic symptoms," he says. "We actually have to put our hands on a belly to see for sure."
Symptoms of Appendicitis
Appendicitis pain often occurs in the lower-right side of the abdomen. The first sign, however, is typically discomfort near the belly button, which then moves to the lower abdomen.
Some people, including children and pregnant women, may experience pain in different areas of their abdomen or on their side.
The pain also will get worse if you move your legs or abdomen; cough or sneeze; or are jarred—during a bumpy car ride, for instance.
Rapidly worsening pain
Once the pain is in the lower part of the abdomen, it can be very intense. Dr. Payne says many of his patients describe it as, "like no other pain they have felt before."
Appendicitis is severe enough to wake someone who is sleeping. Once it hits, the severity of pain can increase quickly—within a matter of hours, Dr. Payne says.
Low-grade fever and chills
Appendicitis symptoms may mimic those of a stomach bug, including a low-grade fever, chills, and shaking.
Dr. Payne says that if you have stomach pain with a 100-degree fever, it's probably nothing to worry much about. But if you have a 103-degree fever and your stomach pain is severe enough that you can't stand up straight, it may be appendicitis.
Vomiting, nausea, or loss of appetite
"You won't have projectile vomiting," Dr. Payne says. "It's not like The Exorcist."
You may, however, have a couple days where your appetite is low with some mild nausea and vomiting, similar to what you might have with a stomach bug. If it improves after a day or so, you're probably fine.
But if it continues to get worse—particularly if you also have a fever and lower-right abdominal pain—Dr. Payne says to seek medical attention. If you have been vomiting for more than 12 hours, or have had diarrhea for more than a couple days, you should call your doctor.
Constipation or diarrhea
Like many of the other symptoms, these may not be severe and probably will come on after you’ve already experienced abdominal pain.
But if you have mild diarrhea—especially if there is a lot of mucus in it—in addition to lower-right abdominal pain, see your doctor.
Gas and bloating
Eating five pieces of pizza and washing them down with a few beers would cause bloating and indigestion in anyone.
But if you go to sleep after your indulgence and wake up still in pain—or the pain is worse—you should beware. Also beware if you have been bloated for more than a couple days, have a lot of gas accompanied by bowel pain, or have trouble passing gas.
These are general symptoms that may indicate appendicitis if they occur in conjunction with other telltale signs, such as fever and pain in the lower-right abdomen.
Rebound tenderness occurs when you push on the lower-right part of your abdomen and then experience pain when releasing the pressure. Dr. Payne says not to push on your abdomen again—"if it hurts, don't do it again" is a good rule with appendicitis-related abdominal pain—and see your doctor if you experience rebound tenderness, particularly if you have a fever, nausea, or other symptoms.
What else it could be
The skin is loaded with sensors that pinpoint the pain if, for instance, you get stung by a bee. But it's a different story inside the body.
Conditions such as an ectopic pregnancy, Crohn's disease, pelvic inflammatory disease, and constipation can feel similar to appendicitis. But don't guess—see a doctor.
Even if the symptoms are not traditional, doctors can do an ultrasound or a white-blood-cell count (which would be high if you have an infection) to help diagnose appendicitis, Dr. Payne says.
No symptoms at all?
Dr. Payne says he has heard stories about doctors opening up patients for unrelated surgery and discovering that their appendix has ruptured and healed without treatment.
But, he says, this is an urban legend. "If your appendix bursts, you're going to know it," he says.
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