About Appendicitis - Everything You Need To Know

What is Appendicitis?

Appendicitis is a condition in which the appendix becomes inflamed and swollen, often due to a blockage or infection. The appendix is a small, finger-like pouch attached to the lower right side of the large intestine. When inflamed, it causes sharp pain in the lower abdomen, specifically the lower right side, known as the typical appendicitis pain location.

This condition can develop suddenly, known as acute appendicitis, or progress more gradually, referred to as subacute appendicitis. The inflammation can worsen quickly, and if not treated in time, it may lead to a ruptured appendix, which can cause severe complications.

Symptoms of Appendicitis

Appendicitis begins with a sudden, sharp pain in the lower abdomen on the right side. This is the most common appendix pain location. In many cases, the discomfort starts near the navel and later shifts to the appendicitis area of pain, which is the lower right side. This pain usually worsens with movement, deep breathing, coughing, or sneezing.

Common signs and symptoms of appendix problems include:

• Pain that begins near the belly button and moves to the lower right abdomen
• Increased pain during movement or pressure
• Loss of appetite
• Nausea and vomiting
• Mild fever that may increase as the inflammation worsens
• Bloating or swelling in the abdomen
• Constipation or diarrhoea
• Inability to pass gas

In females, appendix location may shift slightly due to reproductive anatomy, which sometimes makes appendicitis symptoms harder to pinpoint. During pregnancy, the growing uterus may push the appendix upward, causing discomfort in the upper abdomen.

Some people may also experience:

• A feeling of general illness or malaise
• Frequent or urgent urination, if nearby nerves or the bladder are irritated
• A swollen abdomen, which may suggest the appendix has ruptured
• Diarrhoea or unusually frequent bowel movements
• Constipation caused by decreased bowel movement (bowel paralysis)

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Causes of Appendicitis

Appendicitis usually occurs due to a blockage in the appendix, often caused by hardened stool, foreign material, or swelling of the lymphatic tissue. This blockage leads to bacterial growth, resulting in infection and appendix inflammation symptoms. As the bacteria multiply, the appendix becomes inflamed, swollen, and filled with pus.

If not addressed in time, the appendix may rupture, leading to severe infection, abscess, or peritonitis (inflammation of the abdominal lining). This is why identifying the signs of appendix pain early is important.

Types of Appendicitis

Appendicitis can present in different forms depending on how severe it is, how quickly it develops, and the symptoms a patient experiences. Understanding the various appendicitis types is important for timely diagnosis and treatment.

Here are the 2 types of appendicitis:

1. Acute Appendicitis

Acute appendicitis is the most common and urgent form. It develops quickly, usually within a few hours to a couple of days. It typically causes sudden and intense lower abdominal pain on the right side, along with nausea, vomiting, fever, and a loss of appetite. The appendix pain location often starts near the belly button and shifts to the appendicitis area of pain on the lower right.

This condition requires prompt medical attention, as the inflamed appendix may rupture if left untreated.

2. Chronic Appendicitis

Chronic appendicitis is rare and harder to diagnose. The symptoms are milder and may come and go over several weeks or months. People may experience vague appendix inflammation symptoms, including abdominal discomfort, bloating, and intermittent signs of appendix issues.

How is Appendicitis Diagnosed?

Diagnosing appendicitis can be challenging, especially in the early stages when the symptoms of appendix problems are not always clear. However, a combination of physical examination, blood and urine tests, and imaging scans help doctors confirm the diagnosis and rule out other causes of lower right abdominal pain.

Medical Tests to Diagnose Appendicitis

1. Physical Examination – Your doctor will begin by reviewing your medical history and asking about your symptoms. You may be asked to:

• Describe the appendix pain location.
• Point to the most painful area.
• Undergo a gentle examination to check for tenderness, especially in the appendicitis area of pain.
• Undergo a rebound tenderness test, where pain increases when pressure is suddenly released.

In women, a pelvic examination may be performed to rule out gynaecological causes, considering the appendix location in females may mimic ovarian or fallopian tube issues.

2. Blood Test – A blood test helps detect elevated white blood cell count, which could indicate an infection or inflammation, a common sign of acute appendicitis.

3. Urine Test – To rule out urinary tract infections or kidney stones that may cause similar symptoms, your doctor may recommend a urinalysis.

4. Imaging Tests – Imaging plays an important role in confirming the diagnosis and detecting complications such as a busted appendix, appendix rupture, or thickened appendix.

• Ultrasound – Often the first imaging test is performed, especially in children and pregnant women. It helps identify an inflamed or enlarged appendix, signs of an abscess, or fluid collection.

• CT Scan (Computed Tomography) – A CT scan provides detailed cross-sectional images of your abdomen and is considered highly accurate for detecting appendix inflammation symptoms, perforation, or a ruptured appendix. It is commonly used to diagnose both acute and subacute appendicitis.

• MRI (Magnetic Resonance Imaging) – RI is often used for pregnant patients, as it avoids radiation exposure. It produces clear images of abdominal organs and can detect appendix issues such as inflammation or rupture.

• Abdominal X-ray – While not usually the primary method, an X-ray may help rule out other causes of lower abdominal pain, such as bowel blockages.

Stages of Appendicitis Severity

Appendicitis can progress through various stages if not treated promptly. Understanding the severity levels can help in recognising the warning signs early and seeking timely medical intervention.

Stage 1 – Early Appendicitis

In the earliest phase, the appendix becomes inflamed, often due to a blockage. This causes vague discomfort or cramping near the belly button – also known as the appendix pain location in early stages. At this point, it may be hard to localise the pain. You might also experience:

• Loss of appetite
• Nausea or vomiting
• Mild abdominal tenderness

These are common symptoms of appendix problems and are usually the first signs that you have appendicitis. At this stage, the inflammation is limited to the inner lining of the appendix and can often be managed successfully with prompt surgical treatment.

Stage 2 – Suppurative Appendicitis

As the condition worsens, bacteria multiply and pus begins to collect inside the appendix. This stage is marked by:

• Sharp pain that shifts from the navel to the lower abdomen on the right side – a classic appendicitis area of pain
• Increased sensitivity and tenderness in the affected area
• Fever and worsening nausea

At this point, the appendix wall thickens due to infection. This type of appendicitis is more serious and requires urgent medical attention. Without treatment, it may progress to more dangerous stages.

Stage 3 – Gangrenous Appendicitis

If the inflamed appendix continues to swell, the blood supply to the appendix may get cut off. This results in gangrene – a condition where the tissue begins to die. This stage is considered a medical emergency and may present with:

• Severe and continuous abdominal pain
• High fever
• Rapid heart rate
• General weakness

This stage significantly increases the risk of an appendix rupture, especially if left untreated. The appendix becomes fragile and can tear under pressure, spreading infection in the abdomen.

Stage 4 – Perforated or Ruptured Appendicitis

A ruptured appendix is a life-threatening condition. When the appendix bursts, stool and infectious materials leak into the abdominal cavity. This may lead to:

• Sudden relief of pain (a deceptive sign) followed by worsening symptoms
• Severe abdominal tenderness and rigidity
• High fever and chills
• Signs of sepsis or infection spread

Ruptured appendix symptoms include widespread pain, abscess formation, and inflammation throughout the abdomen (peritonitis). A busted appendix can be especially dangerous in children, the elderly, or pregnant individuals due to delayed diagnosis or atypical symptoms.

Stage 5 – Appendicular Abscess or Phlegmon

In some cases, the infection from a perforated appendix becomes walled off by surrounding tissues, such as the greater omentum, creating an abscess or phlegmon. This results in:

• A thickened appendix
• A localised collection of pus (abscess)
• A swollen, hardened, and inflamed area (phlegmon)

Symptoms may include:

• Persistent fever
• Swelling in the abdomen
• Painful mass on examination
• Prolonged illness and slow recovery

In these cases, immediate surgery may not always be possible. Treatment may involve draining the abscess first and scheduling surgery later to remove the damaged appendix.

What Are the Possible Risks and Complications of Appendicitis?

Appendicitis is considered a medical emergency because it can quickly lead to serious health complications if not treated on time. Whether it is acute appendicitis or a milder subacute appendicitis, the condition can worsen rapidly. That is why early diagnosis and treatment — such as laparoscopic appendicectomy, which is available at Pristyn Care, are important.

Below are the possible complications of untreated or advanced appendicitis:

1. Ischaemia and Tissue Death (Necrosis)

When the appendix becomes severely inflamed, swelling can cut off its blood supply — a condition called ischaemia. Without enough oxygen and nutrients, the appendix tissues begin to die, leading to necrosis. This stage may not cause additional symptoms at first, but it sets the stage for further complications.

Common symptoms of appendix problems at this point include:

• Increasing pain in the lower abdomen on the right side
• Fever
• Generalised discomfort

2. Gangrene and Appendix Rupture

If the blood supply remains blocked, the dead tissue becomes vulnerable to bacterial invasion. This results in gangrene, and eventually the appendix may burst or perforate.

Signs of an appendix rupture include:

• Sudden relief of pain (a deceptive warning sign)
• Followed by sharp worsening of symptoms
• High fever
• Chills and signs of infection

A busted appendix can release pus and faecal matter into the abdominal cavity, making the infection spread rapidly. If the appendix bursts, it is considered life-threatening and requires immediate medical attention.

3. Abscess or Phlegmon Formation

In some cases, the body tries to contain the infection by forming an abscess (a pocket of pus) or a phlegmon (a mass of inflamed tissue) around the appendix. These are common in cases of ruptured appendix symptoms.

You may experience:

• Localised swelling in the abdomen
• Fever
• Prolonged discomfort
• Delayed recovery

Though the infection is somewhat localised, these formations can still burst and cause further infection. Treatment often involves draining the abscess and later removing the appendix surgically.

4. Peritonitis and Widespread Infection

If the appendix bursts and the infection spreads into the peritoneal cavity (the lining of the abdominal area), it causes peritonitis, a serious and painful condition.

Symptoms may include:

• Severe abdominal pain
• Swollen or rigid abdomen
• Vomiting
• High fever
• Rapid heart rate

The infection can also reach the bloodstream, leading to sepsis or septic shock, which can be fatal without urgent treatment. These are the most dangerous complications of advanced appendicitis.

Treatment for Appendicitis

Appendicitis usually requires prompt medical treatment. Depending on the severity and type (such as acute or subacute appendicitis), your doctor may recommend either medication or surgery.

Antibiotic Medication

In mild or early cases, antibiotics may be used to control infection and inflammation. However, this is often a temporary solution, as appendicitis may return if the appendix is not removed. Antibiotics are also given before surgery to prevent infection.

Laparoscopic Appendicectomy

This is a minimally invasive surgery where the appendix is removed through small incisions using a camera-guided tool. It involves less pain, smaller scars, and a quicker recovery time. It is the preferred method at Pristyn Care.

Open Appendicectomy

In more severe cases, such as when the appendix has ruptured, a larger incision is made to remove the inflamed appendix and clean the abdominal cavity. This method may be needed for complicated or advanced cases.

Please Note: If left untreated, appendicitis can lead to serious complications like an appendix burst, abscess, or widespread infection. Seek medical help immediately if you notice appendix pain or other signs of appendix issues, especially lower right abdominal pain, fever, or nausea.

Can Appendicitis Be Prevented?

Currently, there is no guaranteed way to prevent appendicitis. The condition often develops suddenly and without warning, especially in cases of acute appendicitis or subacute appendicitis.

However, some studies suggest that following a high-fibre diet may help reduce the risk. A diet rich in fibre can prevent constipation and promote better digestion, which may help reduce the chances of blockages that lead to appendix inflammation.

Tips to Potentially Lower the Risk of Appendicitis:

• Eat more fibre-rich foods such as fresh fruits, vegetables, oats, lentils, brown rice, and whole wheat products.
• Stay hydrated by drinking enough water daily.
• Avoid frequent constipation, which can lead to hardened stool and blockages in the appendix.
• Maintain regular bowel movements by including probiotics and natural sources of fibre in your daily meals.

When to consult a doctor for Appendicitis?

These are common symptoms of appendix problems, and in many cases, they indicate acute appendicitis, which requires urgent medical care. Ignoring the signs could lead to complications such as a ruptured appendix, which can cause a severe infection and may be life-threatening.

Seek Immediate Medical Help If You Notice:

• Intense and worsening abdominal pain
• High fever or chills
• Vomiting that doesn’t stop
• Signs of dehydration or confusion
• Appendix burst signs, such as sudden relief from pain followed by worsening symptoms