Appendicitis: Symptoms, Causes & Which Doctor to See

What is appendicitis and what causes it?

The appendix is a narrow, finger-shaped tube attached to the start of the large bowel in the lower right abdomen. Appendicitis happens when the opening becomes blocked, often by a small hard piece of stool (a faecolith) or by swollen lymph tissue after an infection. Bacteria multiply, the appendix swells and its blood supply suffers.

If it is not treated, an inflamed appendix can burst (perforate) and spread infection through the abdomen (peritonitis) or form an abscess. Appendicitis can occur at any age but is most common between 10 and 30 years. There is no reliable way to prevent it, and it is nobody’s fault.

• Blockage by hardened stool
• Swollen lymph tissue after a viral or bowel infection
• More common in teenagers and young adults
• Can occur in children, older people and pregnancy
• Not caused by eating seeds or spicy food

What are the symptoms of appendicitis?

The typical pattern starts with a dull pain around the belly button that, over several hours, moves to the lower right side and becomes sharper and constant. It hurts more on walking, coughing, going over speed bumps or pressing the area. Loss of appetite is very common, along with nausea, vomiting and a mild fever.

Symptoms can be less typical. Young children may be irritable and unwilling to walk. In pregnancy, pain can be higher up on the right. In older adults, pain may be milder and fever absent. If the appendix lies behind the bowel, pain may be felt in the side or back, or with urinary symptoms.

• Pain starting near the navel and moving to the lower right
• Pain worse with movement, coughing or bumps on the road
• Loss of appetite
• Nausea or vomiting
• Low-grade fever
• Constipation, diarrhoea or frequent urination in some people
• Appendicitis in pregnancy needs especially prompt assessment

When should I go to emergency for abdominal pain?

Suspected appendicitis always needs same-day emergency assessment. Go to the nearest emergency department or call 112 or 108 if you or your child has any of the following. Do not drive yourself.

Pain that suddenly eases and then becomes widespread can mean the appendix has burst. Do not take laxatives or enemas, and avoid eating until you have been assessed in case you need surgery. Pain relief given in hospital will not hide the diagnosis, so do not delay treatment out of worry about painkillers.

• Abdominal pain that keeps getting worse over hours
• Pain moving to or settling in the lower right abdomen
• Pain with vomiting and fever
• Severe pain across the whole abdomen or a rigid, board-like tummy
• Fast heartbeat, confusion, pale or clammy skin
• Any severe abdominal pain in pregnancy, a child or an older adult

Which doctor should I see for appendicitis?

Appendicitis is diagnosed and treated by a general and laparoscopic surgeon, usually after an emergency department assessment. For acute pain, go directly to the nearest emergency department rather than booking a clinic appointment.

At Lotus, the general and laparoscopic surgery team provides surgical opinions for people with recurring right-sided abdominal pain, those who have been treated with antibiotics alone and want to discuss next steps, people advised to have a planned (interval) appendicectomy after an abscess, and follow-up after surgery.

• Acute pain: nearest emergency department
• Recurring right lower abdominal pain: general surgery review
• Advice after antibiotic-only treatment
• Planned appendicectomy after an appendix abscess
• Wound or recovery concerns after surgery

What happens when appendicitis is suspected?

The doctor asks how the pain began and moved, about appetite, vomiting, bowel and urinary symptoms and, for women, periods and the possibility of pregnancy. They examine the abdomen for tenderness in the lower right area and for signs of peritonitis.

Many hospitals use scoring systems combining symptoms, examination and blood tests to judge how likely appendicitis is. Some people are observed for a few hours with repeat examinations before a decision is made, because early appendicitis can be subtle.

If the diagnosis is uncertain, you may be admitted for observation, with repeated examination, blood tests and imaging over several hours. This is a safe and common approach that avoids unnecessary operations while making sure appendicitis is not missed.

• Describe exactly where the pain started and where it is now
• Mention the last time you ate or drank
• Women should mention their last period
• Bring a list of medicines and allergies
• Ask whether surgery or observation is planned

Which tests diagnose appendicitis?

Blood tests look for a raised white cell count and inflammation markers such as CRP. A urine test helps exclude urinary infection and stones. Women of childbearing age have a pregnancy test, because ectopic pregnancy can cause similar pain.

Ultrasound is often the first scan in children, pregnant women and slim adults. CT scan of the abdomen is more accurate in adults and helps show complications such as perforation or abscess. MRI may be used in pregnancy.

• Complete blood count and CRP
• Urine test
• Pregnancy test for women of childbearing age
• Ultrasound abdomen
• CT abdomen in adults
• MRI in pregnancy when ultrasound is unclear

How is appendicitis treated?

The standard treatment is removal of the appendix (appendicectomy), most often by laparoscopic surgery through small incisions under general anaesthesia. Keyhole surgery usually allows a quicker return to normal activity and smaller scars. Open surgery is used when needed. Antibiotics are given around the time of the operation.

For selected adults with uncomplicated appendicitis confirmed on CT, antibiotics alone may be offered. Many recover, but in trials roughly a quarter to around two in five people had appendicitis again within a few years. If the appendix has formed an abscess, it may be drained and treated with antibiotics first, with surgery considered later. Your surgeon will explain which option is suitable for you.

Before surgery, you will be asked not to eat or drink, given intravenous fluids and pain relief, and reviewed by the anaesthetist. The surgeon explains the operation, risks such as wound infection, abscess and bleeding, and the possibility of converting from keyhole to open surgery if needed.

• Laparoscopic appendicectomy
• Open appendicectomy when required
• Antibiotics alone for selected uncomplicated cases
• Drainage and antibiotics for an appendix abscess
• Interval appendicectomy in selected patients
• Intravenous fluids and pain relief

Can appendicitis be prevented?

There is no proven way to prevent appendicitis. A diet with plenty of fibre from vegetables, fruit, whole grains and pulses supports bowel health in general, but it has not been shown to prevent appendicitis.

What you can control is how quickly you act. In Bengaluru, traffic can lengthen journeys considerably, so if abdominal pain is worsening, set out for the nearest emergency department early rather than waiting until late at night. Avoid self-treating persistent abdominal pain with home remedies, antacids or antibiotics bought without a prescription, which can delay diagnosis.

• Do not ignore worsening abdominal pain
• Avoid laxatives for unexplained pain
• Do not self-medicate with antibiotics
• Know the route to your nearest emergency department
• Seek care early for children and older relatives

What is recovery like and when should I follow up?

After uncomplicated laparoscopic surgery, many people go home within one to two days and return to desk work within one to two weeks. Avoid heavy lifting and strenuous exercise for a few weeks, as advised by your surgeon. Recovery is longer if the appendix had burst.

The removed appendix is sent for laboratory examination, and the result is discussed at follow-up. Seek prompt review for fever, increasing abdominal pain, wound redness or discharge, or vomiting, which can indicate infection or an abscess.

Start with light meals and build up as your appetite returns. Constipation is common after surgery and pain medicines; fluids, fibre and walking help.

• Walk from the first day
• Wound check at the follow-up visit
• Discuss the pathology report
• Prompt review for fever or increasing pain