A doctor explains the symptoms and causes of appendicitis, and how it is treated.
Appendicitis is the painful inflammation or swelling of the appendix. Anyone can get appendicitis but it is most common in teenagers and young adults.
It is still not known what causes appendicitis – however, it requires urgent medical attention. If left untreated, it can cause the appendix to burst, which can be serious or fatal.
Dr Juliet McGrattan looks at the symptoms and causes of appendicitis, plus, how it is diagnosed and treated.
What is appendicitis?
The appendix is a small pouch of tissue, shaped like a finger, which is attached to the colon (large bowel). It’s located in the lower right part of the abdomen. It’s unclear exactly what role the appendix has in the body; you can live normally without it. There are theories that it may help to support the immune system. When the appendix becomes inflamed, it’s called appendicitis.
We don’t know what causes this to happen, it might be if the appendix gets blocked by swollen glands or a piece of poo travelling through the colon.
Appendicitis is most common between age 10 and 20 but anyone can get it. Around 1 in 10 people will get appendicitis during their lifetime, often as a teenager or young adult. Because we don’t know what causes it, it’s hard to give advice about how to prevent it. Appendicitis is less common in parts of the world where diets are high in fibre so this may help to protect against it.
The main feature of appendicitis is abdominal pain and this usually progresses quite quickly over the course of a few hours from being mild and generalised to being severe and localised to the area of the appendix.
Here’s what you can expect with appendicitis:
• Abdominal pain
Typically begins around the belly button in the centre of the abdomen. As the condition progresses and the pain intensifies, it moves to the right lower abdomen. This is called the right iliac fossa (RIF). Pain comes and goes initially but becomes continuous and sharp in nature. It hurts to move around, cough or sneeze. Lying still eases the pain.
• Change in bowel habit
• High temperature
A mildly raised temperature is common.
Don’t delay seeing a doctor if you think you have appendicitis, urgent treatment is needed.
Abdominal pain is common and there are many different causes so the doctor will ask you lots of questions about your pain, including when it began, how it feels, and whether the pain is radiating anywhere else. They will also want to know what makes it worse and what eases it and whether you have any other symptoms alongside the pain.
The doctor will check your pulse, blood pressure and temperature. They will then need to examine your abdomen while you lie flat. They will press gently all over your tummy to locate the tender areas and check for any lumps or bumps. They may press a little more firmly in some areas and they may tap gently (percuss) on your abdomen too. Sometimes the doctor will need to examine your back passage (rectum).
If appendicitis is suspected, you will be referred to hospital immediately and assessed by the surgical team. The history (story of how you are feeling) and the examination, are usually enough to make a diagnosis of appendicitis.
Tests are not always necessary but include:
- Blood tests– to look for inflammation in the blood and to check your blood group if surgery is needed.
- Urine tests– to look for other causes of abdominal pain such as a urine infection or ectopic pregnancy.
- Ultrasound– this can be helpful to look for inflammation of the appendix but also to rule out other causes such as ovarian cysts in women.
- Other scansincluding abdominal X-rays and CT scans may be used if the diagnosis is unclear.
What else could it be?
Many other conditions can cause abdominal pain and present in a similar way to appendicitis.
- Ovarian cyst
- Urinary infection
- Irritable Bowel Syndrome (IBS)
- Kidney stone
- Inflammatory bowel disease e.g. Crohn’s disease
- Pelvic infections
- Ectopic pregnancy
Treatment for appendicitis
Surgery to remove an inflamed appendix is the standard treatment for appendicitis. If it is not treated or the treatment is delayed, then the appendix can burst and an abscess can form. When it bursts, the pus inside the appendix spills into the abdomen. This leads to a more severe and widespread condition called peritonitis where the lining of the abdomen becomes infected. It requires more extensive treatment and can be fatal.
An appendicectomy (appendectomy) is carried out under general anaesthetic and can be done laparoscopically which means through ‘key hole surgery’, or through a short cut in the skin overlying the appendix.
The appendix will be sent to the laboratory so the tissues can be examined under the microscope. This confirms the diagnosis but also rules out cancer of the appendix in adults.
If there is any peritonitis or signs of infection, then antibiotics will be given through a vein (intravenous) and a drain may be left in the abdomen for a short time to allow excess fluid to drain out of the body.
If the diagnosis is unclear then the doctors may observe you in hospital for a short time to avoid unnecessary surgery. Some studies have shown that giving antibiotics may be an alternative to surgery in uncomplicated appendicitis but this approach is not yet widespread as there is insufficient evidence to prove it.
How quickly you recover after appendicitis depends on many factors including the severity of your condition, how straightforward your surgery was, your age and whether you have any other medical conditions.
You will be encouraged to get up and about as soon after your surgery as you can. After an uncomplicated appendicectomy, done via a laparoscope, you may be able to leave hospital within 24 hours. Medical staff will check you can potter about, have eaten and have opened your bowels.
You will probably need pain killers for the first few days but these can be reduced and stopped when you feel comfortable. Make sure you drink plenty of fluid to avoid constipation which is common after bowel surgery.
You are advised to stay off work or school until you have fully recovered which usually takes about two weeks. You should avoid doing any strenuous activities for about four to six weeks. Check what is appropriate for you with your surgeon.
If you have been very unwell, your appendix burst or surgery was more complicated then recovery will take longer but most people make a full recovery.