Appendicitis

Symptoms of appendicitis

Symptoms of appendicitis usually start with pain in the middle of your abdomen (tummy), around your belly button. After a few hours the pain usually moves to the lower right side of your abdomen, and gets worse.

The pain may feel worse when you move, cough or press on the area. It may feel slightly better when you pull your knees up to your chest.

Some people with appendicitis do not have the usual pain symptoms. For example, you might have pain that's less severe, develops more slowly, or in a different place. This can be more likely if you're pregnant and in young children and older people.

Other symptoms of appendicitis can include:

• feeling or being sick, or loss of appetite
• a high temperature
• constipation or diarrhoea
• peeing more than usual
• sudden confusion (in older people)

If appendicitis is not treated quickly, your appendix can burst. If this happens your pain may suddenly get better for a short time. You'll then usually have severe pain that spreads to the whole of your abdomen. It may be very painful to move.

If you're not sure it's appendicitis

Many other conditions can cause pain in your abdomen, including:

• urinary tract infections
• kidney stones or gallstones
• bowel problems such as irritable bowel syndrome or Crohn's disease
• conditions affecting your womb or ovaries, such as pelvic inflammatory disease or a ruptured ovarian cyst
• an ectopic pregnancy

But do not try to diagnose the problem yourself. Get medical help if you're worried.

How appendicitis is diagnosed

If you have symptoms of appendicitis, a GP or hospital doctor will feel your abdomen (tummy) to check for pain and swelling.

You'll need to go to hospital for tests and treatment. Tests you may have include:

• blood tests
• testing a sample of your pee
• scans such as an ultrasound scan or CT scan to check for swelling in your appendix
• a pregnancy test if there's a chance you could be pregnant

There's no test that can always show if you have appendicitis. It can be hard to diagnose because the symptoms can be similar to other conditions. Sometimes doctors will try waiting a few hours to see how your symptoms develop in hospital.

If your symptoms mean it's very likely you have appendicitis, or if your appendix may have burst, doctors may recommend surgery instead of waiting for more tests.

Treatment for appendicitis

Appendicitis is usually treated with surgery to remove your appendix (an appendectomy). You do not need your appendix, so it's not harmful to remove it.

If you need surgery, it will be done as soon as possible, but you may need to wait a few hours. The operation usually takes about an hour.

The main steps of an appendectomy are:

1. You'll be given a general anaesthetic, so you'll be asleep and will not feel any pain.
2. The surgeon makes some small cuts in your abdomen (tummy), and uses a thin tube with a camera to see your appendix (keyhole surgery). Sometimes they'll need to make a larger cut in the lower right side of your abdomen (open surgery).
3. The surgeon removes your appendix by cutting where it's joined to your bowel. If your appendix has burst, the area will be cleaned.
4. Your abdomen is closed with stitches, clips or glue.

Sometimes it's possible to treat appendicitis with antibiotics rather than surgery. This may be recommended if the infection has not spread and surgery is high risk for you.

Sometimes appendicitis causes a lump where part of your abdomen and bowel stick to your appendix, called an appendix mass. If this happens you'll usually need antibiotics first, and then surgery a few weeks later if you still have symptoms.

Recovering from appendicitis

Most people recover fully from appendicitis in 1 to 2 weeks. It may take longer if you had complications such as a burst appendix.

After surgery for appendicitis:

• you'll have some small wounds in your abdomen (tummy)
• you'll usually have stitches that dissolve so they do not need to be removed
• you may have some pain in your abdomen and around your wounds
• you may have constipation or diarrhoea for several days

Recovering in hospital

After surgery for appendicitis, you'll spend some time in the recovery room, before moving to a ward. You'll be given medicine to help with pain.

How long you'll stay in hospital can vary. If you had keyhole surgery you may be able to go home the day after the operation. If you had open surgery, or any complications, you may need to stay in hospital for a few days.

You can go home when doctors think you're well enough. They'll usually want to check that you're eating and drinking, and you're able to poo.

You might be offered a follow-up appointment at the hospital or with a GP, but this is not always needed.

Recovering at home

There are things you can do to help your recovery.

Possible complications of surgery for appendicitis

There's a chance of complications during or after surgery to remove your appendix (an appendectomy), but these are rare. Your doctor will explain the risks to you before the operation.

Complications can include:

• the wound becoming infected
• bleeding
• scar tissue forming (adhesions), which can cause a blockage in your bowel in rare cases
• an abscess forming where your appendix was removed
• appendicitis coming back in the small part of your appendix that was not removed (stump appendicitis)

Risks of a burst appendix

A burst appendix (also called a perforated or ruptured appendix) is a serious condition that can lead to complications such as:

• an infection of the inner lining of your abdomen (peritonitis)
• a life-threatening reaction to infection (sepsis)
• a painful build-up of pus (abscess)
• a blockage in your bowel
• problems in pregnancy

These complications will need to be treated urgently with surgery and antibiotics.

Causes of appendicitis

The appendix is a small pouch that's joined to your bowel in the lower right side of your abdomen (tummy).

Appendicitis happens when your appendix becomes infected and swollen. This is often caused by something getting stuck in your appendix, such as a small piece of undigested food or hard poo.

Appendicitis is common. It can happen at any age, but it's most common in children over 10 years old and young adults. It's rare in babies under 12 months old.