Appendicitis: Why Fast Action Matters

Appendicitis can sneak up on anyone. What starts as mild stomach discomfort can quickly turn into a medical emergency caused by an inflamed appendix. Recognizing the warning signs quickly and acting fast can make all the difference between a simple recovery and serious complications.

Every year in the United States, approximately 300,000 people visit the hospital due to appendicitis, and more than 6% of people will get acute appendicitis in their lifetime.  

What Causes Appendicitis?

The appendix is a small 2- to 4-inch pouch attached to your large intestine in the abdominal cavity. Appendicitis begins when something blocks the narrow tube of the appendix. This blockage can be due to:

• Hardened stool (poop)
• Swollen lymph tissue (especially after an infection)
• Colitis (inflammation in your colon)

“In children especially, appendicitis often develops after they have a cold,” says Dr. Goldman.  

When the appendix becomes blocked, trapped bacteria can quickly multiply, causing inflammation, swelling and infection.

A blocked appendix can then:

• Fill with pus
• Swell
• Lose blood flow
• Become infected

“There is only one way in and out of the appendix,” says Dr. Goldman. “The appendix communicates with the rest of the colon. If something blocks it for too long, bacteria can grow out of control, which leads to an inflamed appendix.”

If left untreated, the appendix can rupture within 48 to 72 hours, letting bacteria leak into the abdomen. This can cause peritonitis — inflammation of the peritoneum (the thin layer of tissue inside the abdomen) — which can lead to a serious infection.

Symptoms to Watch For

Early warning signs are easy to miss because they’re often mild. Symptoms include:

• Generalized or dull pain near the belly button that shifts to the lower right side
• Mild fever
• Loss of appetite
• Nausea and vomiting
• Gas, constipation or diarrhea

Pay close attention to persistent discomfort that feels different than a typical stomachache.

“The pain usually comes before the nausea and vomiting, and these symptoms will persist,” says Dr. Goldman.

Stomach Pain vs. Appendicitis

The pain from appendicitis usually worsens over time and can move locations. You might also feel like you need to hunch over or guard your stomach (place your hands on your stomach to protect it).

While indigestion and acid reflux often come and go, appendicitis pain:

• Shifts from a dull ache to sharp pain
• Worsens with movement, coughing, getting up to stand and walking
• Doesn’t improve with rest

Symptoms in Children, Older Adults and People Who Are Pregnant

Appendicitis symptoms can be different for certain people.

• Children often can’t clearly describe their pain. They may seem irritable or tired, have a reduced appetite, vomit or cry more than usual.
• Older adults may feel less intense pain, which can increase their risk of delayed care.
• People who are pregnant might feel pain in the upper abdomen since the appendix shifts as the uterus grows. This is sometimes mistaken for gallbladder pain.

When to Seek Help

Any persistent abdominal pain, especially around the belly button or lower right abdomen, should get evaluated immediately. Appendicitis can worsen quickly, especially within 24 hours of the onset of pain, so don’t wait.  

If you suspect appendicitis, go to your nearest emergency department or call 911.

Diagnostic Tests

Several tests can help diagnose appendicitis.

• During a physical exam, your physician will check for tenderness, abdominal stiffness and whether pain returns when pressure is released. For example, if your doctor pushes on the lower right side of your abdomen and there is more pain when the pressure on the area is released, that is considered rebound tenderness and a sign of appendicitis.
• Blood tests often show a high white blood cell count, which can indicate an infection.
• A urine test can help rule out a urinary tract infection or kidney stones.
• Imaging tests:
• A CT scan is one of the most accurate ways to diagnose appendicitis, but it’s more commonly used for adults. It can rule out other medical conditions that have similar symptoms, such as an ovarian cyst or ectopic pregnancy. An ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, usually in one of your fallopian tubes.
• Ultrasound is more commonly used for children and people who are pregnant.

Treatment Options: Robotic, Laparoscopic and Open Surgery

An appendectomy is the gold standard of treatment for appendicitis. This surgery is performed to remove an inflamed appendix. Most appendectomies take place within 24 hours of being diagnosed with appendicitis.

There are two minimally invasive surgery methods:

• Laparoscopic surgery uses small incisions, tools and a camera.
• Robotic surgery uses a robotic arm that holds small surgical tools. Your surgeon will use a viewing screen and move the arm with a controller during the surgery.

These surgical options are common if appendicitis is caught early. Benefits include:

• Less post-operative pain
• Faster recovery
• Shorter hospital stay
• Less scarring

Open surgery is another option. This involves a larger incision and is typically used if the appendix ruptures or there’s widespread infection. This type of surgery has a longer recovery time.

“No matter what surgery you have, an appendectomy is a common and routine surgery,” says Dr. Goldman.

What to Expect After Surgery

After the appendix is removed, many patients stay in the hospital for one or two days. But if your surgery is in the morning, it’s possible to be discharged the same day.

Recovery depends on the type of surgery you have and whether there are any complications:

• Laparoscopic and robotic: You can typically return to normal within a few weeks.
• Open appendectomy: It can take six weeks for a full recovery.

Your physician may prescribe an antibiotic to take after the surgery and have you schedule a follow-up appointment within a couple of weeks of your surgery.

Can Appendicitis Get Better Without Surgery?

In rare cases, mild appendicitis symptoms can improve with antibiotics alone, but symptoms often return. For most patients, surgery to remove the appendix is the preferred choice to prevent serious complications.

“Surgery is still the safest option for appendicitis,” says Dr. Goldman. “Don’t be afraid to ask your physician questions about all of your options.”

What Happens if Your Appendix Bursts?

If your appendix bursts, bacteria can leak into the abdominal cavity and cause peritonitis. This can be life-threatening and can lead to sepsis (a blood infection). Emergency open surgery is often required to clean the area and remove the appendix.

“The overall risk of rupture is very low. But if your appendix does rupture, it creates a longer hospital stay if you don’t get it treated right away,” says Dr. Goldman.

For some people, a burst appendix can lead to the following:

• Chronic abdominal pain
• Internal scar tissue that may block intestines
• Ongoing infection or an abscess (collection of pus)
• Higher risk during future surgeries

Prompt treatment can help prevent these complications.

Risk Factors and Prevention

There’s no specific way to prevent appendicitis, but these factors may increase your risk:

• Family history of appendicitis
• Blockage from stool or infection

Eating more fiber and staying hydrated by drinking water can support your digestive health, but they don’t prevent appendicitis.

Is the Appendix a Useful Organ?

The appendix is not a useless organ, but you can live without it. It may house beneficial gut bacteria, protect some immune function and help recover gut balance after an illness.

Although the appendix does have some immune function, Dr. Goldman says the amount of immune activity is minimal and removing the appendix does not typically cause health problems.

Don’t Wait: Get Help for Your Symptoms

“Appendicitis is usually not life-threatening, especially if caught early enough,” says Dr. Goldman.

But fast action matters. If you feel persistent abdominal pain that doesn’t go away, get medical help right away. With an accurate diagnosis and surgery to remove the appendix, most people recover fully. Quick attention can help prevent complications like a ruptured appendix.