Appendix Friend or Foe: Causes, Warning Signs, and Treatments for Appendicitis

The appendix is a small pouch on your large intestines that is often considered a useless organ. But it might play a role in your immunity. And when it gets inflamed, it might need to be removed. Here are the facts about this seemingly unnecessary organ, why it might not be so useless after all, and why it sometimes causes so much trouble.

The appendix is often considered a useless organ that can cause problems. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), 5% to 9% of the population will develop appendicitis—an inflammation of the appendix—at some point.

What Is the Appendix and What Does It Do?

The appendix is a thin, worm-shaped pouch attached to the large intestine. For years, doctors weren't sure if the appendix had any real purpose. They thought perhaps it was a piece of the intestine that was left over from earlier stages in the course of our evolution. But researchers are now finding that it might be beneficial after all.

In a 2018 review of the literature published in the journal Seminars in Immunology, researchers stated that the appendix might have value when it comes to immunity and contributing to helpful intestinal bacteria. The study authors noted that the appendix "contains dense lymphoid tissue," which, along with the rest of the gut's immune system, helps fight infections. And that the "appendix contains a microbiota as diverse as that found in the colon and could replenish the large intestine with healthy flora after a diarrhea episode."

Other researchers have come up with similar findings, as published in a 2022 review of the literature in the journal The Anatomical Record.

In other words, the appendix appears to increase the "good" bacteria in your gut, which also helps strengthen your immune system. The authors of the same 2018 literature review in Seminars in Immunology also theorized that having your appendix removed might increase your chances of inflammatory diseases.

According to the National Institute of Environmental Health Sciences (NIEHS), inflammatory diseases include many chronic diseases, such as cardiovascular diseases, autoimmune diseases, cancers, gastrointestinal disorders, lung diseases, diabetes, and even mental illnesses (like depression).

Having an appendix could even help us as a species generally live longer than mammalian species without an appendix, according to a 2021 study published in the Journal of Anatomy.

Appendicitis: Your Appendix Acting Up

Appendicitis is simply an inflammation of the appendix. Telltale appendicitis symptoms include belly button pain and right-side abdominal pain. Though sometimes symptoms can be excruciating and obvious, it's often the opposite. Many people don't feel pain in the typical places, depending on how their appendix sits inside their body.

For example, some people have an appendix that points backward instead of forward, so the symptoms present in a different location in the body, which makes the diagnosis harder, Eugene Shapiro, MD, deputy director of the Investigative Medicine Program at Yale University, explained to Health.

Other symptoms include fever, nausea, vomiting, and bloating. If you have any of these symptoms, see your healthcare provider ASAP.

When Appendicitis Pain Going Away Isn't a Good Thing

Sometimes people have telltale signs of appendicitis, but then the pain disappears, and they think they're fine. In this case, added Dr. Shapiro, the appendix may have ruptured.

According to the NIDDK, fluids can seep into the abdomen when the appendix ruptures and cause a potentially severe infection called peritonitis. A ruptured appendix requires immediate surgery to remove the tissue and clean the abdominal cavity to prevent it from becoming life-threatening.

Johns Hopkins Medicine states that many of the signs of peritonitis are similar to appendicitis. So while the pain may initially go away when the appendix bursts, it will return as the infection sets in.

This is why it is essential to seek medical care if you experience any symptoms that point toward appendicitis—even if you start to feel better.

Is Surgery the Only Option for Appendicitis?

While surgery has long been the primary treatment for appendicitis, studies show that there may be another alternative. For example, a 2020 study published in the New England Journal of Medicine suggested that antibiotics might be able to save many people with appendicitis from going under the knife. Researchers compared treatments in 1,552 patients and found that antibiotics for some people are as effective as surgery for appendicitis.

Not all medical practitioners agree with this method of treating appendicitis. According to Johns Hopkins Medicine, while some studies have suggested that intravenous antibiotics alone might cure appendicitis, "these results remain controversial, and appendectomy remains the standard of care."

If you have symptoms of appendicitis, see your healthcare provider, discuss your options, and choose the one you feel is best for you. Regardless of which route you choose, the important thing is to prevent appendicitis from becoming life-threatening.