Appendicitis is inflammation of the appendix, a small pouch attached to the large bowel. It is one of the most common reasons for emergency abdominal surgery worldwide, most often in people aged 10 to 30. If it bursts, it can cause a life-threatening infection called peritonitis.
Pain that starts near the belly button and moves to the lower right is a pattern worth remembering. It could send someone you love to hospital before their appendix bursts.
The classic pain pattern
- Pain starts as a vague ache around the belly button.
- Over several hours, it moves to the lower right side of the abdomen and becomes sharp and constant.
- It gets worse when you move, cough, walk or go over bumps in a car.
Other symptoms
- Loss of appetite (very common)
- Nausea and vomiting
- A mild fever
- Constipation or diarrhoea
- Feeling generally unwell
Not everyone has the classic pattern. Young children, pregnant women and older adults may have pain in a different place or less obvious symptoms.
Go to an emergency department if abdominal pain is getting worse, especially in the lower right, or if pain suddenly spreads across the whole abdomen, which can mean the appendix has burst.
What to do (and not do)
- Do not eat or drink until you have been assessed, in case you need surgery
- Do not take laxatives or use a hot water bottle on the abdomen
- Do not ignore pain that does not settle
Diagnosis and treatment
Health professionals examine the abdomen, take blood and urine tests, and may use an ultrasound or CT scan. Treatment is usually surgery to remove the appendix, often by keyhole (laparoscopic) surgery. In some uncomplicated cases, antibiotics alone may be offered, though some people later need surgery.
Recovery
Most people go home within a day or two after keyhole surgery and return to normal activities in two to three weeks. Avoid heavy lifting for a few weeks and watch the wounds for signs of infection.
“But it is probably just a stomach bug.”
Many stomach bugs cause pain and vomiting. What sets appendicitis apart is pain that moves to the lower right and gets worse with movement. If you are not sure, get checked.
Your next step: if abdominal pain is getting worse rather than better after a few hours, go to an emergency department.
Sources: NHS appendicitis guidance; World Society of Emergency Surgery (WSES) Jerusalem guidelines on acute appendicitis (2020).
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