Overview
The appendix is a small, finger-shaped tube attached to the large intestine, low on the right of the tummy. Life is normal without it.
Appendicitis happens when the appendix becomes blocked, then infected and swollen. Pressure builds inside, and if nothing is done it can burst, spilling infection into the abdomen. This is why it is an emergency.
Symptoms
The pain is the main clue. It usually starts as a dull ache around the navel, then moves over a few hours to the lower right and becomes sharper and constant.
- Pain that is worse on walking, coughing or being pressed, and eased by lying still with the knees drawn up
- Loss of appetite, feeling sick and vomiting
- A mild fever, with constipation or loose stools
- In older people, confusion and simply seeming unwell
When to see a doctor
Get seen the same day if tummy pain is building slowly and not settling, especially in pregnancy, young children and older people, where appendicitis can be less obvious.
Causes
Appendicitis begins with a blockage at the opening of the appendix. Hard stool or a piece of undigested food can plug it, and swelling of the lining can do the same. Germs then multiply inside, and the appendix swells and becomes infected.
Risk factors
- Age: it is most common in children over 10 and in young adults, and rare in babies under a year
- Anything that blocks the opening of the appendix, such as hard stool
Appendicitis can happen to anyone, so the pattern of the pain matters more than risk factors.
Complications
If the appendix bursts, infection spreads to the lining of the abdomen, a serious condition called peritonitis, and can pass into the bloodstream as sepsis. Sometimes the body walls it off into a pocket of pus, called an abscess, which has to be drained. A burst appendix can also block the bowel, and in pregnancy it can affect the baby. These need urgent surgery and .
Prevention
There is no reliable way to prevent appendicitis, and no food or habit is known to stop it. What changes the outcome is getting help early, before the appendix bursts: pain that keeps getting worse, especially in the lower right with fever or vomiting, means going to hospital the same day.
Diagnosis
There is no single test that proves appendicitis. A doctor examines the tummy, asks how the pain began and moved, and arranges blood and urine tests, with a pregnancy test where relevant.
An or a can show a swollen appendix and rule out other causes such as a kidney stone or an ovarian problem. Sometimes the picture is unclear and the person is kept in hospital for a few hours so symptoms can be watched.
Treatment
The usual treatment is an operation under general anaesthetic to remove the appendix. Keyhole surgery, through a few small cuts, is common and allows a quicker recovery. Open surgery, through one larger cut, is used when the appendix has burst or keyhole surgery is not suitable.
are given around the operation, and for longer if infection has spread. A mild, uncomplicated case is occasionally treated with antibiotics alone. An abscess may be drained first and the appendix removed later.
Most people go home a day or two after keyhole surgery and are back to normal in one to two weeks, longer after open surgery or a burst appendix.
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“Appendicitis comes from eating seeds, chillies or too much outside food.”What is true?
Fact
The appendix becomes inflamed when its opening is blocked and infection follows, sometimes by hard stool or a piece of undigested food. In most people it is not possible to say what blocked it, and avoiding a particular food is not known to prevent it.
Myth“Tummy pain can be given a day or two with home remedies before seeing anyone.”What is true?
Fact
Appendicitis is a medical emergency. It does not settle on its own, and an appendix left untreated can burst and spread infection through the abdomen. Pain that keeps getting worse and moves to the lower right needs to be seen the same day.
Myth“If the pain is not in the lower right, it cannot be the appendix.”What is true?
Fact
The pain usually starts around the navel and only moves to the lower right after some hours. In pregnant women, young children and older people it can be milder, slower to develop or felt elsewhere, and an older person may simply become confused and unwell.
Myth“Antibiotics can always cure appendicitis, so surgery is never needed.”What is true?
Fact
Removing the appendix is the usual treatment. Antibiotics alone are sometimes used for a mild, uncomplicated case, or when surgery would be too risky, but symptoms can return and an operation may still be needed later. Which path suits you is a decision for the surgical team.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
Can appendicitis get better without an operation?
It is not safe to assume so. Antibiotics settle some mild cases, but symptoms can return and surgery may still be needed. Once appendicitis has started, the safe path is to be assessed in hospital rather than to wait and see at home.
Is keyhole surgery better than open surgery?
Keyhole surgery usually means smaller cuts, less pain afterwards and a faster return to normal life. Open surgery is chosen when the appendix has burst, when there is a lot of infection, or when previous operations make keyhole surgery difficult. The surgeon decides based on what is found.
Does the body miss the appendix after it is removed?
No. The appendix has no essential role in digestion, and people live completely normally without it. Digestion, diet and long-term health are not affected by its removal.
How is appendicitis different from ordinary gas or indigestion?
Gas and indigestion tend to move around, come and go, and ease after passing wind or a motion. Appendicitis pain is steady, keeps getting worse over hours, settles in one place low on the right, and hurts more on moving or coughing, usually with loss of appetite and often a fever.
