9 Appendicitis Symptoms You Should Know, According to Doctors

Diagnosing appendicitis can be tricky. You should see your doctor if you have the following symptoms.

Woman with cramps or pelvic pain holding stomach in bed
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Appendicitis occurs when your appendix, a worm-shaped pouch attached to the large intestine, becomes inflamed. It's fairly common, with about nine percent of males and seven percent of females getting appendicitis at some point during their lives, according to Alexander Greenstein, MD, an associate professor of surgery at the Mount Sinai Hospital in New York City.

If the appendix becomes too inflamed, it can rupture, turning appendicitis into something that could be fatal. After the onset of symptoms it usually takes at least 24 hours for the appendix to rupture, Dr. Greenstein says. However, it can take the appendix three days (from the onset of symptoms) to rupture in some individuals.

Luckily, doctors usually remove the inflamed appendix surgically before this happens. The removal of the appendix is the "most common surgical emergency," explains Dr. Greenstein. In fact, the removal of the appendix, aka an appendectomy, is currently the only proven treatment available for appendicitis. The appendix is usually removed via a minimally invasive laparoscopic procedure.

An actual diagnosis of appendicitis however can be tricky, says Michael Payne, MD, a gastroenterologist with Cambridge Health Alliance, a Harvard-affiliated public healthcare system, in Cambridge, MA. "It is a very common illness and many people don't have classic symptoms," he says. "We actually have to put our hands on a belly to see for sure."

Still, there are a few telltale signs of appendicitis that can spark your decision to go see a doctor in the first place. Here, nine signs that you may be dealing with appendicitis.

Belly-button pain

abdominal-migraine abdominal-pain woman health wellbeing stomach pain Even though it has the word “migraine” in its name, an abdominal migraine isn’t a headache. “Abdominal migraines are a cause of recurrent episodes of abdominal pain that can be severe in nature and generally are felt in the center of the abdomen,” Dr. Skeans says.They’re more common in children or young adults, but older adults can also experience them. In addition to stomach pain, abdominal migraines can often cause nausea and vomiting and can last for “hours to several days,” Dr. Skeans says.Doctors don’t totally know why abdominal migraines happen, but it’s thought to be due to something neurologic or hormonal. “The diagnosis is one made by excluding other more common causes of abdominal pain,” Dr. Skeans says. Abdominal migraines often similar triggers to “regular” migraines like chocolates, certain foods, stress, and anxiety.
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Appendicitis pain often occurs in the lower-right side of the abdomen. The first sign, however, is typically discomfort near the belly button, which then moves to the lower abdomen.

Some people, including children and pregnant women, may experience pain in different areas of their abdomen or on their side.

The pain also will get worse if you move your legs or abdomen; cough or sneeze; or are jarred—during a bumpy car ride, for instance.

Rapidly worsening pain

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Once the pain is in the lower part of the abdomen, it can be very intense. Dr. Payne says many of his patients describe it as, "like no other pain they have felt before."

Appendicitis is severe enough to wake someone who is sleeping. Once it hits, the severity of pain can increase quickly—within a matter of hours, Dr. Payne says.

Low-grade fever and chills

Ill woman looking at thermometer at home.

Appendicitis symptoms may mimic those of a stomach bug, including a low-grade fever, chills, and shaking.

Dr. Payne says that if you have stomach pain with a 100-degree fever, it's probably nothing to worry much about. But if you have a 103-degree fever and your stomach pain is severe enough that you can't stand up straight, it may be appendicitis.

Vomiting, nausea, or loss of appetite

You feel nauseous after meals often.
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"You won't have projectile vomiting," Dr. Payne says. "It's not like The Exorcist."

You may, however, have a couple days where your appetite is low with some mild nausea and vomiting, similar to what you might have with a stomach bug. If it improves after a day or so, you're probably fine.

But if it continues to get worse—particularly if you also have a fever and lower-right abdominal pain—Dr. Payne says to seek medical attention. If you have been vomiting for more than 12 hours, or have had diarrhea for more than a couple days, you should call your doctor.

Constipation or diarrhea

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Like many of the other symptoms, these may not be severe. They'll probably come on after you've already experienced abdominal pain.

But if you have mild diarrhea—especially if there is a lot of mucus in it—in addition to lower-right abdominal pain, see your doctor.

Gas and bloating

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Eating five pieces of pizza and washing them down with a few beers would cause bloating and indigestion in anyone.

But if you go to sleep after your indulgence and wake up still in pain—or the pain is worse—you should beware. Also beware if you have been bloated for more than a couple days, have a lot of gas accompanied by bowel pain, or have trouble passing gas.

These are general symptoms that may indicate appendicitis if they occur in conjunction with other telltale signs, such as fever and pain in the lower-right abdomen.

Rebound tenderness

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Rebound tenderness occurs when you push on the lower-right part of your abdomen and then experience pain when releasing the pressure. Dr. Payne says not to push on your abdomen again—"if it hurts, don't do it again" is a good rule with appendicitis-related abdominal pain—and see your doctor if you experience rebound tenderness, particularly if you have a fever, nausea, or other symptoms.

What else it could be

Doctor checking woman pregnancy during sonography examination - Gynecologist in sterile gloves using ultrasound scanner while examining female patient. Focus on doctor hand

The skin is loaded with sensors that pinpoint the pain if, for instance, you get stung by a bee. But it's a different story inside the body.

Conditions such as an ectopic pregnancy, Crohn's disease, pelvic inflammatory disease, and constipation can feel similar to appendicitis. But don't guess—see a doctor.

Even if the symptoms are not traditional, doctors can do an ultrasound or a white-blood-cell count (which would be high if you have an infection) to help diagnose appendicitis, Dr. Payne says.

No symptoms at all?

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Dr. Payne says he has heard stories about doctors opening up patients for unrelated surgery and discovering that their appendix has ruptured and healed without treatment.

But, he says, this is an urban legend. "If your appendix bursts, you're going to know it," he says.

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