Appendicitis: Causes, Symptoms, and Treatment

Jan 16, 2020 | General Medical


The most common cause of abdominal pain resulting in surgery in the United States is appendicitis. While appendicitis can be acute or chronic, in most cases, it is acute and requires immediate medical attention. However, in most cases, abdominal pain isn’t going to be appendicitis, and as a patient, it may be tough to tell what warrants an emergency visit and what doesn’t. Read on to learn more about your appendix, where it’s located, when to see a physician, and what the treatment and surgical options for appendicitis are. 

Where Is Your Appendix?

Your appendix is 3 ½ inches long and is a tube of tissue connected to your large intestine that is located on the lower right side of your body. Because of its location, when it becomes inflamed, it’s considered to be located in the abdominal area and is classified as abdominal pain. The pain may feel like it’s behind your belly button, or it may feel as if it’s in your lower right quadrant. It typically begins as mild cramping but quickly progresses to intense pain.

What Causes Appendicitis?

In most cases, doctors are unsure of what causes appendicitis. Typically, physicians think that the appendix becomes blocked, causing it to become inflamed. This obstruction can lead to serious complications if left untreated. Many different complications could potentially block the appendix. Some of these may include:

  • Tumors
  • Traumatic injury (such as a motor vehicle collision)
  • Buildup of stool
  • Intestinal worms
  • Enlarged follicles

This blockage can lead to the buildup of bacteria inside of the appendix. Remember that it is just a short, small tube, so bacteria can build up and multiply quickly if it is blocked. This can cause pain and pressure in the abdomen. In some cases, doctors are unsure of what causes appendicitis.

What Are the Symptoms of Appendicitis?

There are many reasons you could be suffering from abdominal pain. When it comes to appendicitis, location is essential. Although you may feel pain radiating from your belly button, you likely will feel a cramping pain on the lower right side of your abdomen. However, other causes could be gas, indigestion, kidney infection or kidney stones, or irritable bowel syndrome (IBS). Most of these conditions warrant a trip to the doctor, so it’s better to be safe than sorry. However, in most cases, appendicitis requires an urgent trip to the nearest emergency room. Besides the obvious symptom of abdominal pain, other symptoms of appendicitis to be mindful of include:

  • Loss of appetite
  • Nausea and vomiting
  • Diarrhea or constipation
  • Abdominal swelling
  • Low-grade fever
  • Inability to pass gas
  • Tenderness in the right side of the abdomen

The location of the abdominal cramping is paramount. If you suspect appendicitis may be a root cause and you are comorbidly suffering from constipation, do not take laxatives, as this may cause your appendix to rupture, which is very dangerous. This is known as peritonitis and can be life-threatening. Seek medical attention immediately. 

How Do You Know if You’re at Risk?

There is no way to prevent appendicitis, and there are no genetic or hereditary factors involved that would alert you to the fact that you’re at risk for appendicitis. In the entire U.S. population, the risk for developing appendicitis is fairly low. (In essence, that pain in your stomach is probably gas, but again, it’s always better to be safe than sorry). The entire population only has a 7 percent chance of developing appendicitis. The only risk factor for developing appendix inflammation is being young. Those who are ages 10 to 19 are at the highest risk of developing the condition. 

How Is Appendicitis Diagnosed?

Appendicitis is often an emergency visit, and the attending physician will run several tests. Usually, he or she will first rule out other conditions, then proceed with testing for an inflamed appendix itself. First, you’ll likely have a physical exam, where the healthcare provider will check for tenderness, rigidity, or swelling in the lower right part of the abdomen.

There’s no one test the doctor will order next. If you’re female, the doctor may take a urine sample to check for pregnancy. An ectopic pregnancy, while rare, can cause pain in the same area as the appendix. An ectopic pregnancy will still cause urine or blood draw to show a positive pregnancy result. Regardless of gender, the doctor will take a urine sample to rule out kidney infection or kidney stones, two conditions that also cause pain near the area of the appendix. The physician will also do a blood draw and take a complete blood count (CBC). This can alert the doctor to signs of infection. The “backup” of bacteria in the appendix will be visible on the CBC as a bacterial infection, letting the doctor know you may have appendicitis, which will allow them to run the next set of tests, likely imaging diagnostics. 

If the physician is still trying to rule out other conditions, if you are female, he or she may perform a pelvic exam to rule out pelvic inflammatory disease, or they may order a chest x-ray to look for pneumonia. Pain in the right lower area of the lungs is often mistaken for appendicitis but is actually a symptom of pneumonia. 

The doctor will be able to see the inflammation of the appendix using several different imaging tests. They likely won’t order all of them; it’s up to the physician which one they will choose. The most common types used to diagnose appendicitis include a CT scan, abdominal MRI, abdominal X-ray, or abdominal ultrasound. These are all first-line tests to give a conclusive diagnosis of appendicitis. 

What Are Differences Between Acute and Chronic Appendicitis?

It is important to note that there are two types of appendicitis: acute and chronic. Acute appendicitis develops quickly, over the course of 24 to 48 hours and requires immediate medical attention. If not, the appendix can burst, and peritonitis can develop, which is life-threatening. Chronic appendicitis is much less common and is difficult to diagnose. Symptoms may be mild and recurrent. Patients may not know they have chronic appendicitis until it suddenly becomes acute. They may just experience unexplained, yet mild, stomach cramping, over a period of months to years. If you find you experience this type of abdominal disturbance often, mention it to your doctor at your next visit.

What Is Appendicitis Treatment?

The most common treatment for appendicitis is an appendectomy, which is the complete removal of the appendix. In rare cases, your doctor may use needle drainage of an abscess, but an appendectomy is a first-line treatment for appendicitis. Your surgeon may use traditional surgery or laparoscopy to remove the appendix, depending on the individual case. As with any surgery, there are risks involved, but the risks of untreated appendicitis well outweigh surgery risks. 

Laparoscopic surgery requires much less recovery time, and you may even be discharged from the hospital the next day. Open surgery (which is more common for appendectomy) may require several weeks to recover fully. You will have incision sites to care for, as well as follow-up medications and appointments to adhere to. However, most patients fully recover from appendectomy after just a few weeks.

If you need more information about your appendix or abdominal pain or would like to be seen by a physician, request an appointment at Gastroenterology Associates of Savannah, P.C. We have five South Carolina offices and one Georgia offices for the convenience of our patients, as well as a great team that provides individualized and exceptional care.