Is Your Abdominal Pain From Appendicitis?
Key takeaways:
Appendicitis is the most common reason someone needs emergency abdominal surgery. Understanding the signs to look for can help you know when to seek the care you need.
The classic symptoms of appendicitis in adults include abdominal pain, decreased appetite, nausea, and vomiting.
Diagnosing appendicitis in children is more challenging because their symptoms can often be subtle or vague. Even fussiness or refusal to walk can be signs of appendicitis.
Abdominal pain is a common symptom that can come from many different things. Most of the time, people know when it’s just a little stomach upset or cramping that will go away. Other times, what starts as a mild discomfort begins to get more painful or worrisome. And it may leave you wondering if it could be something more serious.
Appendicitis is one of the more common causes of abdominal pain that requires prompt treatment, which is most often surgery. It’s an inflammation of the appendix — a small, worm-like structure that’s attached to the large intestine. Curiously, the appendix doesn’t have any functional purpose. But it can become irritated or infected when it’s clogged, which is most commonly due to stool.
It can be hard to know when abdominal pain is nothing to worry about or when it could be a sign of appendicitis. So we will provide some more information to help you know when it’s time to get yourself to the ER.
Quiz: Do I have appendicitis?
What are the earliest symptoms of appendicitis?
The first signs of appendicitis can be easy to dismiss. But most people will start to clue into something going on when the following symptoms become more noticeable:
Abdominal pain is usually the first symptom. Many people describe a dull pain that starts around their belly button or to the right and below the belly button.
Nausea typically starts soon after the pain, and it may lead to episodes of vomiting.
Loss of appetite is also common in the early stages of the condition.
As appendicitis progresses, your symptoms will likely change as well. Usually within the first 24 hours you may start to experience:
Worsening pain: In classic cases, the pain moves from the belly button to the lower right side of your abdomen. The pain also tends to get more severe or sharp. And it often feels worse with walking or movement.
Fever: Although many people develop fever with appendicitis, not everyone experiences it.
Symptoms in women
Appendicitis is more common in men than in women. But for someone who has female reproductive organs, sometimes the diagnosis can be more challenging. This is because there are many conditions that can cause symptoms very similar to appendicitis. Pain from appendicitis may feel similar to:
Ovarian cysts
Menstrual cramping
Pregnancy-related pain or round ligament pain
Pregnancy can cause additional challenges, given the growing fetus can shift organs from their usual position in your body. So pain from appendicitis may start in an area not typically associated with appendicitis.
Symptoms in children
Not everyone with appendicitis will have all of the symptoms we described above. This is particularly true with very young children, who may not be able to communicate what they are feeling. Some signs of appendicitis that you may notice in your child include:
Increased fussiness
Poor feeding or lack of interest in any food or liquids
Refusal to walk or a new limp
As children get older, especially as they move into adolescence, they are more likely to have the classic symptoms described above.
What are the signs of a more serious appendicitis?
All cases of appendicitis are serious and require immediate medical attention. But some cases can be more severe than others. A “complicated” appendicitis is when the appendix gets so inflamed that it ruptures. And this is a medical emergency because the infection can then spread to other parts of the abdomen.
The risk of a ruptured appendix increases as time goes on, especially if you have had abdominal pain for more than a day. If the appendix bursts open, you may actually have a brief period when the pain seems much better. This is because of the temporary relief in pressure when the appendix ruptures. But typically it isn’t long before the pain returns and becomes worse.
With a burst appendix, if the infection starts to spread you can become very sick, very quickly. In addition to the symptoms we listed above, you may also notice:
Dizziness or a feeling like you may faint
Extreme weakness
Shortness of breath
Confusion or sleepiness, particularly in older adults
How is appendicitis diagnosed?
The approach to diagnosis can vary depending on factors such as your age, sex, or other medical conditions you may have. Some of the tools your medical team might use to determine if you have appendicitis include:
Physical exam: Even with today’s advanced technology, this likely remains the most important part of an appendicitis evaluation. In fact, surgeons used to take people to the operating room based on their exam alone if it suggested appendicitis. Still today, certain physical exam findings may make your diagnosis of appendicitis so likely that minimal testing will be needed to confirm the diagnosis.
Labs: It’s likely that you will have blood work done, especially to look at your white blood cell count. This level often rises when the body is fighting off an infection, so it can provide a helpful clue in diagnosis.
Imaging: There are multiple imaging studies that providers can use to diagnose appendicitis. For adults, this is usually a CT scan. For children, an ultrasound is more often the study of choice. (In the pediatric population, an ultrasound is often as good, if not better, than a CT scan. And it has the added bonus of no radiation exposure.) For people who are pregnant, the provider may order an MRI to limit any radiation exposure to the baby.
Observation and monitoring: Appendicitis can change over time. If you do some tests early in your illness, the results may be normal, which can make it hard to know if you have appendicitis. In these cases, your medical team may want to keep a close eye on you so they can continue to monitor your symptoms.
The bottom line
A lot of things can cause belly pain. That can make it hard to know when the pain is just a passing discomfort and when it’s something more serious like appendicitis. The most common symptom of appendicitis is increasing abdominal pain around the belly button and right lower part of the abdomen. But not everyone has the classic symptoms. Just remember that you know yourself best. If you’re experiencing abdominal pain and you’re worried it’s something more serious, get yourself checked out.
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References
Moris, D., et al. (2021). Diagnosis and management of acute appendicitis in adults: A review. JAMA.
Walter, K. (2021). Acute appendicitis. JAMA.
