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.
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.
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.
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.
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.
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.
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.(Video) Appendix pain symptoms | Appendicitis: Abdominal pain on the right side that comes and goes
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.
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.
National Institute of Diabetes and Digestive and Kidney Diseases. Appendicitis.
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
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.
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Can you have appendicitis pain that comes and goes? ›
Appendicitis typically starts with a pain in the middle of your tummy (abdomen) that may come and go. Within hours, the pain travels to your lower right-hand side, where the appendix is usually located, and becomes constant and severe. Pressing on this area, coughing or walking may make the pain worse.Can chronic appendicitis cause pain? ›
In some cases, abdominal pain is the only symptom with chronic appendicitis. The pain is usually in the lower right side of the abdomen. It may also appear near the belly button and move to the lower right side of the stomach in some cases. The pain can vary from sharp to dull, but it's more common for it to be dull.Why does my appendix hurt and then go away? ›
If you start having abdominal pain, especially in your lower right side, be on the lookout for fever, nausea, and loss of appetite. These symptoms, along with abdominal pain, could signal appendicitis. Similar pain that goes away on its own without other symptoms is likely a buildup of gas.How long can chronic appendicitis last? ›
Chronic appendicitis is a less common form of appendicitis that lasts longer than acute appendicitis. A 2015 article says that chronic appendicitis is a less severe, continuous pain that lasts for longer than the usual 1- or 2-day period. The pain can last for weeks, months, or years.Can stress cause 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.Does chronic appendicitis need surgery? ›
Chronic appendicitis is not considered a surgical emergency ; however, it can go undiagnosed or be misdiagnosed and develop complications including perforation, abscess formation, peritonitis, and infertility, most of which require surgical intervention [1,2,8,11].Does chronic appendicitis show up on ultrasound? ›
Imaging that can aid in the diagnosis of CA or recurrent appendicitis includes barium enema, ultrasonography, and CT scan of the abdomen.Can appendicitis be cured without surgery? ›
Can doctors treat appendicitis without surgery? Anyone who might have appendicitis is treated with antibiotics before surgery. Some people may improve with the antibiotics and not need surgery. Some mild cases of appendicitis may be treated with antibiotics alone.Can appendicitis go away with medication? ›
A new study points out that antibiotics can be effective in treating appendicitis. The researchers said that in some cases the antibiotics can eliminate the need for surgery.What antibiotics treat appendicitis? ›
Antibiotics Used for Treating Appendicitis
The antibiotics used for appendicitis, particularly Cefotan (cefotetan) and cefotaxime (Claforan, Mefotoxin), help prevent wound infections after surgery. Other antibiotics used for appendicitis include: Zosyn (piperacillin and tazobactam) Unasyn (ampicillin and sulbactam)
Can chronic appendicitis be treated with antibiotics? ›
Antibiotics are now an accepted first-line treatment for most people with appendicitis, according to final results of the Comparing Outcomes of antibiotic Drugs and Appendectomy (CODA) trial and an updated treatment guideline for appendicitis from the American College of Surgeons.Does poor diet cause appendicitis? ›
There is no evidence that diet and nutrition play a role in causing or preventing appendicitis. Although anyone can get appendicitis, it's most common between ages 5 and 20, says Jeremy Moore, MD, who specializes in emergency medicine. Appendicitis is also the most common form of abdominal pain requiring surgery.Does eating make appendicitis worse? ›
Since the appendix is part of the digestive system, experiencing appendicitis symptoms can make you feel sick to your stomach. "People with appendicitis generally have no appetite — the thought of eating makes them feel worse," said Dr. Anders.Can acid reflux cause appendicitis? ›
This data suggests a strong link between GERD and appendicitis. GERD may trigger appendicitis episodes and these two diseases might share similar pathways to making people sick. The patient's diet, nervous system imbalance, or bacterial infections may trigger appendicitis in those with prior GERD.Does appendicitis make you tired? ›
As well as abdominal pain, people with chronic appendicitis may also experience the following symptoms: fever. swelling and tenderness of the abdomen. feeling tired and having no energy.How long is appendix surgery? ›
A normal appendectomy will typically take about one hour.Can chronic appendicitis cause low blood pressure? ›
The following are symptoms of a ruptured appendix: Low blood pressure. Severe abdominal pain. High fever.Can chronic appendicitis cause gastritis? ›
Clinical experience has shown that chronic appendicitis is frequently masked by what appears to be a chronic gastritis, a cholecystitis, or even a gastric or duodenal ulcer, and intensive study is required to rule out an organic lesion where it is not present.Can your appendix hurt for months? ›
(3) One or more episodes of acute appendicitis, lasting one to two days, is considered recurrent appendicitis. Chronic appendicitis, on the other hand, usually occurs as a less severe, nearly continuous abdominal pain lasting longer than a 48-hour period, sometimes extending to weeks, months, or even years.Can chronic appendicitis be missed on a CT scan? ›
Park et al.9 reports the overall sensitivity of CT for diagnosis of acute appendicitis is 96.4%, meaning nearly 4% of acute appendicitis will be missed with CT alone.
What is the best medicine for appendix? ›
|Best medications for appendicitis|
Your recovery time depends on the type of surgery you had. If you had laparoscopic surgery, you will probably be able to return to work or a normal routine 1 to 3 weeks after surgery. If you had an open surgery, it may take 2 to 4 weeks. If your appendix ruptured, you may have a drain in your incision.What changes after appendix removal? ›
Your belly may be swollen and may be painful. If you had laparoscopic surgery, you may have pain in your shoulder for about 24 hours. You may also feel sick to your stomach and have diarrhea, constipation, gas, or a headache. This usually goes away in a few days.Is appendix surgery painful? ›
An appendectomy is the surgical removal of the appendix. It is a common procedure that surgeons usually carry out in an emergency. A person is under general anesthesia when doctors remove the appendix, meaning they should not feel any pain during the procedure. However, the surgical area may become tender as it heals.Can you delay appendix surgery? ›
In conclusion, delayed appendectomy is safe for patients with acute nonperforated appendicitis. It can improve quality of provided care from surgeons, enhance quality of care for patients, and increase effective utilization of medical resources and operating rooms for life-threatening emergencies.What can be mistaken for appendix pain? ›
Often, it can be mistaken for gallbladder issues, urinary tract infections, or a variety of intestinal problems. To get an accurate diagnosis, an abdominal exam, blood test, or CT ultrasound are just some of the methods used to spot inflammation.What can mimic appendicitis? ›
Inflammatory bowel disease, infectious terminal ileitis, Henoch-Schönlein purpura, Meckel's diverticulum, and intussusception are the gastrointestinal causes of acute abdominal pain that can clinically mimic appendicitis.How do you rule out appendicitis? ›
- Physical exam to assess your pain. Your doctor may apply gentle pressure on the painful area. ...
- Blood test. This allows your doctor to check for a high white blood cell count, which may indicate an infection.
- Urine test. ...
- Imaging tests.
- Sudden pain that begins on the right side of the lower abdomen.
- Sudden pain that begins around your navel and often shifts to your lower right abdomen.
- Pain that worsens if you cough, walk or make other jarring movements.
- Nausea and vomiting.
- Loss of appetite.