Your large intestine is the body’s roadway for waste. After the small intestine takes nutrients from your food, the rest enters the large intestine, turns into stool and travels toward the rectum.
But there’s a little side street—your appendix.
“The appendix is like dead-end alley,” says UNC Health emergency medicine physician Smeet Bhimani, DO. “The entry can be blocked off, either by hard stool or by inflammation. If bacteria gets stuck in there, the appendix can get infected.”
That infection is called appendicitis. It’s not clear what function this tiny little pouch serves in the body, but when it’s infected, it requires immediate attention.
Symptoms of Appendicitis
A sudden loss of appetite is usually the first symptom of appendicitis.
“Most people think of pain in the right lower abdomen as the first symptom, but that tends to be a little later in the course of the infection,” Dr. Bhimani says. “You may lack the desire to eat for about six to 12 hours before the pain starts.”
Abdominal pain might start around your belly button or on your left side before settling on your right side.
“It’s a dull, vague ache that doesn’t go away, and then as the infection worsens, it becomes sharp and more severe,” Dr. Bhimani says.
It’s common to experience nausea or vomiting, which causes some people to think it’s food poisoning. But “food poisoning typically involves diarrhea and appendicitis generally doesn’t,” Dr. Bhimani says.
You might develop a fever, but not everyone does.
Appendicitis can happen to anyone at any age, but between the ages of 10 and 35 is the most common time. It affects 8.6 percent of men and 6.7 percent of women during their lifetime, and if your parent or sibling had appendicitis, your risk goes up threefold.
Treatment for Appendicitis
If you think you may have appendicitis, head for the nearest emergency department. Urgent cares do not typically have the kinds of imaging machines needed, and if you do have appendicitis, you’ll need surgery.
At the emergency department, your provider will perform a physical exam and press on parts of your belly. One sign they’re looking for is rebound tenderness; if someone applies pressure to your abdomen and then lets go, the pain often feels worse when the pressure is removed. You’ll also have blood work (an increase in white blood cells might indicate that your body is fighting an infection) and imaging. Doctors typically use ultrasounds for children, MRI for pregnant women and CT scans for otherwise healthy adults.
“If these exams indicate appendicitis, you’ll be started on antibiotics, and we’ll get a friendly surgeon involved to take out the appendix,” Dr. Bhimani says. “This is a common, easy surgery, and most people are home in less than 24 hours.”
This surgery, called an appendectomy, can often be performed laparoscopically, meaning that only small incisions are necessary. Removing the appendix does not cause any long-term issues for your body.
In 2020, a study suggested that high-dose antibiotics could be used instead of surgery, leading to many headlines about a nonsurgical option.
“That’s not the current standard of care,” Dr. Bhimani says. “In the study, about 30 percent of people got appendicitis again within a few months. You risk another infection, complications and you still have to get your appendix taken out.”
What Happens When Your Appendix Bursts
While it may be tempting to delay the emergency department to see if abdominal pain will resolve, you don’t have the luxury of time if your pain is caused by appendicitis.
“Within a day or two, you’re at risk for your appendix to rupture,” Dr. Bhimani says. “It’s like a balloon full of bacteria, and when it bursts, you’ll become more ill.”
If your appendix bursts, you might feel a little bit better at first, because some pressure has been released. But as the bacteria and fecal matter (poop) enter your abdomen, you’ll feel sick again.
“There will be sudden relief, then progressively worse abdominal pain,” Dr. Bhimani says. “That sudden change is a red flag. When you have a foodborne illness or a virus, recovery tends to be over several hours or a day, not this quick shift.”
The pain won’t stay in your lower right abdomen; you may feel it in your bladder or on both sides of your body. The pain will be worse when you try to move. You may have a fever, shaking and nausea.
Again, head for the emergency department. A ruptured appendix can lead to peritonitis, or an infection in your abdomen, and abscesses, pockets of pus. Left untreated, you’re at risk for sepsis, when the immune system starts to attack your organs, which can cause death.
You’ll need a longer course of antibiotics if your appendix bursts. Then, depending on the damage, you may still have an appendectomy to remove tissue, or you may need a drain inserted into your abdomen to remove abscesses.
When in doubt about abdominal pain, have it checked out, Dr. Bhimani says. “If you’ve had abdominal pain for longer than six hours, it’s different from other abdominal pain you’ve had or it’s getting progressively worse, those are some red flags.”
Questions about abdominal pain? Talk to your doctor or find one near you.