Appendix pain: Could it be appendicitis?

We all experience abdominal pain in our lives. But what type of abdominal pain signals appendix pain or appendicitis? Since appendicitis requires urgent medical attention, knowing the symptoms and when to seek help can be lifesaving.

What is appendicitis?

Appendicitis is an inflammation of the appendix, a small pouch attached to the large intestine. While the role of the appendix is unclear, inflammation of the appendix can lead to swelling, pain, and, if left untreated, rupture. Because of these risks, appendicitis is a medical emergency that requires immediate attention.

According to Dr. Robert H. Shmerling, senior faculty editor at Harvard Medical School's Harvard Health Publishing, "If it's appendicitis, the pain is unlikely to go away on its own. No one with symptoms strongly suggestive of appendicitis should try to tough it out at home."

Symptoms of appendicitis

Typically, appendicitis starts with abdominal pain near the belly button. Within a few hours, the pain shifts to the lower right side of the abdomen, where the appendix is usually located.

This pain intensifies over time. It tends to worsen when you press on it (and is often even worse if you quickly stop pressing), when walking, taking deep breaths, coughing, or sneezing. Although many people refer to it as "appendix pain," the discomfort is more accurately described as "abdominal pain" because conditions other than appendicitis can cause similar symptoms.

Additional symptoms of appendicitis may develop in some people. These include:

• loss of appetite
• nausea and vomiting
• fever
• abdominal swelling
• inability to pass gas
• diarrhea or constipation.

Symptoms can vary among individuals. While appendicitis typically causes pain in the right side of the abdomen, in some people, the appendix is not in the usual location, affecting how their symptoms present.

What other conditions could mimic symptoms of appendicitis?

Appendicitis could be mistaken for other conditions that can cause similar discomfort, particularly in the lower right side of the abdomen. Some conditions that might be confused with appendicitis include:

• severe irritable bowel syndrome (IBS)
• gastroenteritis
• constipation
• bladder, urine, or pelvic infections
• ovarian cyst rupture
• ectopic pregnancy.

Potential causes of appendicitis

In many cases, the cause of appendicitis is not apparent. Possible causes of appendicitis include:

• Blockage. The appendix may be obstructed by hardened stool, a foreign object, or a tumor.
• Infection. Bacteria, or occasionally other infectious agents, may cause inflammation and swelling of the appendix wall.
• Inflammatory bowel condition.Crohn's disease or other forms of inflammatory bowel disease (IBD) may lead to inflammation of the appendix.

When to see a doctor for appendix pain

Appendicitis is a medical emergency. "Most abdominal pain is not due to appendicitis," says Dr. Shmerling. "But if a person experiences the typical symptoms — especially persistent, worsening pain that moves over to the right lower abdomen — they should seek immediate medical attention and have a prompt in-person evaluation."

Delaying treatment can lead to complications such as rupture of the appendix, inflammation of the lining of the abdominal cavity (peritonitis), abscess, sepsis, and even death.

To diagnose appendicitis, your doctor will review your medical history, ask you questions about your bowel movements, and assess your current symptoms. Your doctor will also perform a physical exam, checking for pain in the lower right abdominal area.

Certain tests can help your doctor make an accurate diagnosis of appendicitis. These tests may include:

• a blood test to look for signs of infection
• a urine test to check for urinary tract infection or kidney stones.

If your symptoms, physical exam, and initial tests point to appendicitis, imaging tests such as CT scan, ultrasound, or MRI can help your doctor confirm the diagnosis.

Treatment for appendicitis

The standard treatment for appendicitis is surgical removal of the appendix, known as an appendectomy. Appendicitis is the most common surgical emergency worldwide.

In some cases, particularly mild ones, antibiotics may be used as an initial treatment and the infection may respond well to antibiotics alone, making surgery unnecessary. "It used to be the case that if appendicitis was the question, emergency surgery was the answer," explains Dr. Shmerling. "But research has demonstrated that some people with appendicitis can forego surgery and do well with just antibiotics and supportive care such as intravenous fluids and pain medicines."

Because of the availability of imaging to confirm the diagnosis before surgery and the recognition that nonsurgical treatment can be safe and effective once the diagnosis is established, fewer people have unnecessary surgery for suspected appendicitis.

Ongoing research is exploring which patients can safely avoid surgery based on factors like symptom severity, CT scan results, overall health, and age. Despite these advancements, surgery remains the primary treatment for most cases.

Surgery to remove the appendix is often done laparoscopically. This type of surgery, which is performed using small surgical incisions and a camera, can lead to a quicker recovery.

Appendicitis is a serious condition that should never be ignored. If you experience persistent or worsening abdominal pain, seek immediate medical attention. Early diagnosis and treatment can prevent complications and maximize chances of a smooth recovery.