When to Suspect Early Appendicitis (2022)

The appendix is a small tubelike pouch attached to the large intestine in your lower-right abdomen. Appendicitis occurs when the appendix becomes inflamed. Without medical care, the appendix can burst, leading to complications like sepsis (body-wide infection) and even death, so it's vital to catch the early signs.

Symptoms of early appendicitis vary and are often confused with other conditions. Most commonly, people experience pain low in their abdomen. This pain typically starts near the belly button, then moves to the lower-right area. In addition, it is common to experience nausea and other gastrointestinal symptoms.

This article explains early appendicitis symptoms, how healthcare providers diagnose it, and how it's treated.

When to Suspect Early Appendicitis (1)

Early Signs of Appendicitis

Since the appendix can rupture without prompt treatment, it's crucial to recognize appendicitis symptoms early. These early signs often include appendix pain, gastrointestinal symptoms, and fever.

It's not always clear what causes appendicitis. Healthcare providers think it may be caused by a blockage in the appendix from hardened stool, growths, infection, or inflammatory bowel disease (IBD).

When to Seek Medical Attention

Not everyone experiences every early appendicitis symptom, so don't wait to see if you develop more serious symptoms. If you have severe abdominal pain or suspect another symptom could be appendicitis, seek medical attention.

Severe and Sudden Pain

The most common early appendicitis symptom is severe and sudden pain in the abdomen. Abdominal pain caused by appendicitis is sometimes mistaken for other abdominal problems, like gas. However, appendicitis pain has several unique traits, including:

  • Pain starts at the belly button and then moves to the lower right (migratory pain).
  • Pain comes on suddenly.
  • It may be intense enough to wake you from sleep.
  • It worsens when you move, take deep breaths, cough, or sneeze.
  • It feels unlike other pain you've experienced.
  • It usually happens before other symptoms.
  • It worsens quickly.

Lower right abdominal pain is a classic symptom of appendicitis during pregnancy. However, if your pregnancy is advanced, you may experience pain as high as the upper-right quadrant.

Nausea and Vomiting

Nausea and vomiting are also early appendicitis signs. If your stomach upset is accompanied by severe abdominal pain, you could have appendicitis.

Stomach Bloating

Bloating is another early appendicitis symptom. Bloating is when the abdomen distends or expands, making your stomach look larger. A feeling of fullness or discomfort often accompanies it.

Bloating is common during menstruation or episodes of gas, so people often dismiss this symptom. However, if bloating is accompanied by other symptoms, especially severe abdominal pain, you may have appendicitis.

Constipation or Diarrhea

Constipation and diarrhea are both appendicitis symptoms. Unfortunately, they also accompany many other illnesses and infections, making it difficult to know if these symptoms arise from appendicitis or something else.

If constipation or diarrhea are accompanied by other symptoms, especially abdominal pain, you should contact a healthcare provider.

Low Fever

An early appendicitis symptom is a low fever, but a higher fever may indicate your appendix has burst.

(Video) US for Suspected Appendicitis in Children

Low vs. High Fever

The difference between a low fever and a high fever is:

  • A low fever is between 99 and 100.3 degrees Fahrenheit.
  • A high fever is over 100.4.

Since a ruptured appendix is a medical emergency, don't wait until your fever is high to seek medical care.

Loss of Appetite

Losing your appetite is another symptom of early appendicitis. Sometimes appetite loss comes before other abdominal symptoms like nausea and vomiting.

Difficulty Passing Gas

If you have appendicitis, you may have trouble passing gas or feel like having a bowel movement would relieve your pain. However, using the bathroom does not ease appendicitis pain.

Appendicitis in Children

It can be challenging to determine appendicitis in children. While they can experience the same symptoms as adults, oftentimes children do not experience typical symptoms, or they may have difficulty describing their pain. Therefore, seek medical advice if you notice your child holding their stomach, walking hunched over, or otherwise exhibiting discomfort.

How Is Appendicitis Diagnosed?

A healthcare provider will take your medical history, including your symptoms, do a physical exam, and run some tests to diagnose appendicitis. Standard tests and exams for appendicitis diagnosis include:

  • Abdominal palpation (pressing on the abdomen)
  • Movement tests to determine the location of the pain
  • Rectal exam
  • Pelvic exam
  • Complete blood count (CBC) test
  • C-reactive protein (CRP) blood test
  • Urinalysis
  • Pregnancy test
  • Abdominal ultrasound
  • Magnetic resonance imaging (MRI)
  • Computed tomography (CT scan)

Tests may confirm appendicitis or determine that something else is causing your pain, like intestinal obstruction or kidney stones.

How Is Appendicitis Treated?

Surgeons treat appendicitis by surgically removing the appendix in a procedure called an appendectomy. During an appendectomy, a surgeon removes your appendix while you are under general anesthesia, which means you are asleep during the procedure.

An appendectomy may be open, in which a surgeon makes an incision in the lower-right abdomen in order to remove the appendix, or laparoscopic, a procedure in which a surgeon cuts smaller incisions and works with the help of cameras. Laparoscopic surgery is less invasive and usually results in fewer complications.

Some mild cases of appendicitis may resolve with antibiotics instead of an appendectomy. A study comparing antibiotics and appendectomies found that antibiotic use helped prevent the need for surgery and offered better recovery outcomes.

In the trial, half of the participants received antibiotics, and half underwent appendectomies. The study found that while 29% of people in the antibiotic group required an appendectomy, most avoided surgery, were treated on an outpatient basis, and missed less work than those in the appendectomy group.

However, it’s important to remember that antibiotics would likely only be used in mild cases of appendicitis.

Can You Prevent Appendicitis?

There is no known way to prevent appendicitis. However, noticing and seeking care for early appendicitis symptoms can reduce the likelihood that your appendix will rupture.

Summary

The most prominent early sign of appendicitis is abdominal pain that begins at the belly button, then migrates to the lower-right side. In addition, you may experience nausea, vomiting, constipation, diarrhea, bloating, fever, loss of appetite, and trouble passing gas. Seeking care early may help you catch the problem before your appendix bursts.

(Video) Appendicitis Signs & Symptoms | & Why They Occur

A Word From Verywell

Appendicitis symptoms mimic lots of other illnesses and infections. Fortunately, an appendectomy is a common procedure that saves lives. If you're feeling this kind of pain in your lower-right abdomen, it's important to reach out to your healthcare provider.

Frequently Asked Questions

10 Sources

(Video) Can Appendicitis Be Treated With Antibiotics Rather Than Surgery?

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. Symptoms and causes of appendicitis.

  2. Aptilon Duque G, Mohney S.Appendicitis in pregnancy. In:StatPearls[Internet]. StatPearls Publishing.

  3. Nemours Children's Health. Appendicitis.

  4. Cedars Sinai.Fever.

  5. National Institute of Diabetes and Digestive and Kidney Diseases. Definition and facts for appendicitis.

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

  7. National Institute of Diabetes and Digestive and Kidney Diseases. Treatment for appendicitis.

  8. Flum, D, et al.A randomized trial comparing antibiotics with appendectomy for appendicitis.NEJM. Oct. 5, 2020. doi:10.1056/NEJMoa2014320

  9. Johns Hopkins Medicine. Appendicitis.

  10. National Health Service. Appendicitis symptoms.

When to Suspect Early Appendicitis (2)

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.

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FAQs

How do you detect early appendicitis? ›

Tests and procedures used to diagnose appendicitis include:
  1. Physical exam to assess your pain. Your doctor may apply gentle pressure on the painful area. ...
  2. Blood test. This allows your doctor to check for a high white blood cell count, which may indicate an infection.
  3. Urine test. ...
  4. Imaging tests.
7 Aug 2021

When should you suspect appendicitis? ›

Signs can appear anywhere from four to 48 hours after a problem occurs. It's especially important to see a doctor if you also experience: Fever. Loss of appetite with nausea or vomiting.

What is the gold standard for diagnosing appendicitis? ›

Multi-detector computed tomography (MDCT) is considered the gold standard technique to evaluate patients with suspected AA, because of its high sensitivity and specificity [2, 3].

What is early diagnosis of acute appendicitis? ›

Abdominal pain is the primary presenting complaint of patients with acute appendicitis. The diagnostic sequence of colicky central abdominal pain followed by vomiting with migration of the pain to the right iliac fossa was first described by Murphy but may only be present in 50% of patients.

What are the 4 stages of appendicitis? ›

The stages of appendicitis can be divided into early, suppurative, gangrenous, perforated, phlegmonous, spontaneous resolving, recurrent, and chronic.

How do you check your appendix at home? ›

Belly Examination & Palpation for Appendicitis Video: Michael Fink

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.

Can you have appendicitis for months? ›

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.

What is the rebound test for appendicitis? ›

To check for rebound tenderness, a doctor applies pressure to an area of your abdomen using their hands. They quickly remove their hands and ask if you feel any pain when the skin and tissue that was pushed down moves back into place. If you do feel pain or discomfort, you have rebound tenderness.

Is appendix pain constant? ›

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.

Can you have appendicitis without fever? ›

Conclusions: The diagnosis of acute appendicitis cannot be excluded when an adult patient presents with isolated rebound tenderness in the right lower quadrant even without fever and biological inflammatory signs.

Can appendix be treated without surgery? ›

Some people may improve with the antibiotics and not need surgery. Some mild cases of appendicitis may be treated with antibiotics alone. Researchers are studying who might safely avoid surgery based on their symptoms, test results, health, and age, but surgery remains the standard of care.

What are the three stages of appendicitis? ›

The natural history of appendicitis has been described in three stages: (1) a normal appendix, (2) uncomplicated acute appendicitis, and (3) complicated appendicitis, according to their macroscopic and microscopic appearance and clinical relevance.

What are the most predictive signs of acute appendicitis? ›

Common Symptoms of Appendicitis

Anorexia, nausea and vomiting are symptoms that are commonly associated with acute appendicitis. The classic history of pain beginning in the periumbilical region and migrating to the right lower quadrant occurs in only 50 percent of patients.

How quickly does appendicitis progress? ›

The appendix can get infected. If not treated it can burst (rupture). This can happen as soon as 48 to 72 hours after you have symptoms. Because of this, appendicitis is a medical emergency.

Can you test yourself for appendicitis? ›

How do you check for appendicitis at home? Aside from paying attention to your symptoms, you can check to see if you experience sharp abdominal pain when you: Lie on your left side and extend your right hip. Flex your right hip and knee and rotate your right hip.

Can appendix pain come and go for days? ›

The pain may come and go at first, but if it's caused by appendicitis, it will progressively get worse over a few hours. Signs your abdominal pain is caused by appendicitis: Your pain begins suddenly, possibly waking you from sleep. Your pain gets worse when you move, cough or breathe deeply.

How long can you have appendicitis without knowing? ›

It can go undiagnosed for several weeks, months, or years. Acute appendicitis has more severe symptoms that appear suddenly within 24 to 48 hours . Acute appendicitis requires immediate treatment.

Does appendicitis pain come in waves? ›

Unlike other conditions that cause uncomfortable sensations in the abdomen, like gastroenteritis, the pain doesn't usually come and go in waves. According to Dr. Anders, appendicitis pain starts as a constant, achy feeling in the abdomen, rather than an intermittent cramping sensation. And it doesn't go away.

What is the leg test for appendicitis? ›

A health care provider tests for the obturator sign by asking the patient to lie down with the right leg bent at the knee. Moving the bent knee left and right requires ffexing the obturator muscle and will cause abdominal pain if the appendix is inffamed.

What causes false appendicitis? ›

When appendicitis is misdiagnosed, the true culprit for the pain varies. In men, the cause may be an inflamed lymph node or a viral infection of the intestinal tract. In women, the problem may be infection of the ovary or uterus, or ectopic pregnancy (when a fertilized ovum implants outside the uterus).

How hard is it to diagnose appendicitis? ›

Appendicitis can be tricky to diagnose unless you have the typical symptoms, which are only present in about half of all cases. Also, some people's appendixes may be located in a slightly different part of their body, such as: the pelvis. behind the large intestine.

Does appendicitis make you gassy? ›

“At the beginning, appendicitis can seem like constipation or gas, sometimes even the flu,” said Dr. Sweeny. “The main factor that separates it from other conditions is a sharp pain that starts near the belly button and travels to the lower right side of the abdomen.”

Can emotional stress cause appendicitis? ›

Acute appendicitis (AA) is a common surgical disease. Although its dominant cause is thought to be luminal obstruction,[1] less common causes include emotional stress[2] and blunt abdominal trau- ma.

Can stress cause appendicitis symptoms? ›

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.

Will an ultrasound show appendicitis? ›

Imaging tests

Doctors use an ultrasound as the first imaging test when checking for possible appendicitis in infants, children, young adults, and pregnant women.

Can an inflamed appendix heal itself? ›

Since the late 1800s, doctors have turned to surgery to treat appendicitis, even though an inflamed appendix sometimes gets better on its own. A new report suggests that trying intravenous antibiotics first works as well as surgery for some people.

Is appendicitis tender to the touch? ›

As the pain intensifies, the lower right-hand side of the abdomen, where the appendix is typically located, will generally become particularly tender, and may be painful to the touch. If the appendix has burst, the pain will typically spread across the whole abdominal region and will be correspondingly severe.

What is pinch an inch test? ›

Our pinch-an-inch test is essentially a form of rebound tenderness, only in reverse. To perform the test, a fold of abdominal skin over McBurney's point is grasped and elevated away from the peritoneum (see Fig. 1). The skin is then allowed to recoil back briskly against the peritoneum.

Would appendicitis wake you up? ›

Appendicitis usually strikes suddenly—it may even wake you from your sleep. It gets worse in a matter of hours and also when you move, cough, or sneeze.

Can you have appendicitis without vomiting? ›

This pain may start out as mild and dull, but is likely to intensify. Other symptoms of acute appendicitis include: nausea with or without vomiting.

When should I go to the hospital for abdominal pain? ›

If the pain is sudden, severe or does not ease within 30 minutes, seek emergency medical care. Sudden abdominal pain is often an indicator of serious intra-abdominal disease, such as a perforated ulcer or a ruptured abdominal aneurysm, although it could also result from a benign disease, such as gallstones.

Does appendicitis pain feel like period cramps? ›

Appendicitis occurs when the appendix — a part of the large intestine — becomes inflamed. And for the most part, it can feel very similar to abdominal and menstrual cramps. But, unlike cramps that come and go, inflammation of the appendix is a medical emergency and requires prompt care.

Can blood test detect appendicitis? ›

Appendicitis tests usually include a physical exam of your abdomen and one or more of the following: Blood test to check for signs of infection. A high white blood cell count is a sign of an infection, including, but not limited to, appendicitis. Urine test to rule out a urinary tract infection.

What is the main cause of appendicitis? ›

Appendicitis may be caused by various infections such as virus, bacteria, or parasites, in your digestive tract. Or it may happen when the tube that joins your appendix with your large intestine gets blocked or trapped by stool. Sometimes tumors can cause appendicitis. The appendix then becomes sore and swollen.

Can antibiotics stop appendicitis? ›

The finding -- appearing Dec. 14 and led by Theodore Pappas, M.D., professor in the Department of Surgery at Duke University School of Medicine -- cites the consensus of evidence that antibiotics successfully treat up to 70% of appendicitis cases.

What can be mistaken for appendix pain? ›

Appendicitis can easily be confused with something else, such as:
  • gastroenteritis.
  • severe irritable bowel syndrome (IBS)
  • constipation.
  • bladder or urine infections.
  • Crohn's disease.
  • a pelvic infection.

How long can you have appendicitis without knowing? ›

It can go undiagnosed for several weeks, months, or years. Acute appendicitis has more severe symptoms that appear suddenly within 24 to 48 hours . Acute appendicitis requires immediate treatment.

What triggers appendicitis? ›

It's not clear what causes appendicitis. In many cases it may be that something blocks the entrance of the appendix. For example, it could become blocked by a small piece of poo, or an upper respiratory tract infection could cause the lymph node within the wall of the bowel to become swollen.

Do appendicitis pains come and go? ›

The most common symptom of appendicitis is lower right abdominal pain, starting near the navel. The pain may come and go at first, but if it's caused by appendicitis, it will progressively get worse over a few hours.

Does appendicitis pain get worse after eating? ›

You don't feel like eating anything

"People with appendicitis generally have no appetite — the thought of eating makes them feel worse," said Dr.

How quickly does appendicitis progress? ›

The appendix can get infected. If not treated it can burst (rupture). This can happen as soon as 48 to 72 hours after you have symptoms. Because of this, appendicitis is a medical emergency.

Can you have appendicitis without fever? ›

Conclusions: The diagnosis of acute appendicitis cannot be excluded when an adult patient presents with isolated rebound tenderness in the right lower quadrant even without fever and biological inflammatory signs.

Does appendicitis hurt to the touch? ›

As the pain intensifies, the lower right-hand side of the abdomen, where the appendix is typically located, will generally become particularly tender, and may be painful to the touch. If the appendix has burst, the pain will typically spread across the whole abdominal region and will be correspondingly severe.

Can you have appendicitis for months? ›

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 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.

What are the 5 most common causes of appendicitis? ›

What causes appendicitis?
  • Abdominal injury or trauma.
  • Blockage at the opening where the appendix connects to the intestines.
  • Digestive tract infection.
  • Inflammatory bowel disease.
  • Growths inside the appendix.
6 Jul 2020

Can stress cause appendicitis symptoms? ›

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.

Can an inflamed appendix heal itself? ›

Since the late 1800s, doctors have turned to surgery to treat appendicitis, even though an inflamed appendix sometimes gets better on its own. A new report suggests that trying intravenous antibiotics first works as well as surgery for some people.

What does appendicitis feel like in the beginning? ›

Signs and symptoms of appendicitis may include: 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.

What is the leg test for appendicitis? ›

A health care provider tests for the obturator sign by asking the patient to lie down with the right leg bent at the knee. Moving the bent knee left and right requires ffexing the obturator muscle and will cause abdominal pain if the appendix is inffamed.

Can you have appendix pain for weeks? ›

(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.

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