Expert reviewer, Mrs Sara Badvie, Consultant Laparoscopic, Colorectal and General Surgeon
Next review due, August 2021

Appendicitis is inflammation of your appendix – a small tube that forms part of your large bowel. It can cause severe pain in the right-hand side of your abdomen. If you have appendicitis, you’ll need to have surgery to have your appendix removed.

Around one in 10 people will develop appendicitis during their lifetime – it’s one of the most common reasons for having emergency surgery in the UK.

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About appendicitis

Your appendix is a small, narrow tube attached to the first part of your large bowel. It’s usually located in the lower right-hand side of your abdomen. Your appendix isn’t thought to have any useful function.

Appendicitis is usually thought to happen if your appendix becomes blocked. This is normally thought to be due to a hard mass of faeces (poo) in your intestines. Sometimes other things can cause the blockage too – like fragments of food that can’t be digested. If your appendix becomes blocked, this can cause an infection, which can lead to appendicitis.

Appendicitis isn't always caused by a blockage in your appendix – there may be no clear reason why you’ve developed it. There are some people who are more likely than others to get appendicitis. It’s most common in children and young adults aged between 10 and 20, although you can get it at any age. Men and boys are slightly more likely to get appendicitis than women and girls. People who smoke, and children who have been exposed to passive smoking, are also more likely to get appendicitis.

If you have appendicitis, you’ll need surgery to remove your appendix. This operation is called an appendicectomy.

Symptoms of appendicitis

The most common symptoms of appendicitis include:

  • pain in your abdomen – this usually starts in the centre and then moves to the lower right-hand side of your abdomen
  • losing your appetite
  • feeling sick or vomiting
  • constipation or diarrhoea

The pain with appendicitis usually gets worse during the first 24 hours, becoming constant and sharp. It can feel worse with certain movements, such as coughing or laughing. It’s possible to feel the pain elsewhere in your abdomen, as sometimes your appendix can be in a different position. For instance, if you’re pregnant, the pain in your abdomen may be higher up than it usually is for appendicitis. Older people may have fewer symptoms, whereas young children may only have vague pain and lose their appetite. See FAQ for more information on appendicitis in children.

These symptoms aren't always due to appendicitis, and if you do have appendicitis, you may not have all of the symptoms listed here. If you have any symptoms that are worrying you or don’t seem to be getting better, you should always seek medical attention.

Complications of appendicitis

You may develop complications from appendicitis if you don’t seek treatment quickly. If your appendix becomes inflamed and isn't removed quickly, it can burst (perforate). This only usually happens if you’ve been having symptoms for 12 hours or more. It’s more likely to burst in elderly people and young children.

If your appendix bursts, it can cause a severe abdominal infection, called peritonitis. Peritonitis can cause severe abdominal pain, a high temperature and vomiting. It can be potentially life-threatening if it’s not treated quickly.

Sometimes, membranes in your abdomen can stick to your inflamed appendix, leading to what’s called an ‘appendix mass’. You’ll usually have treatment with painkillers and antibiotics for this. It’s also possible to develop an abscess – a collection of pus in your abdomen. If you have an abscess, you’ll usually need to have it drained. This is often done using ultrasound or a computer tomography (CT) scan to guide the drain. Sometimes, your surgeon may recommend you have surgery to remove your appendix straightaway.

Diagnosis of appendicitis

Your GP will ask you about your symptoms and examine you. They’ll want to feel around your abdomen for any pain and tenderness. Your GP may ask you to do a urine test, to check whether your symptoms are caused by a urinary tract infection. If you’re a woman, they may ask you to do a pregnancy test too if there’s any chance you might be pregnant. They may also ask you to have a blood test, to rule out other infections.

Doctors can usually get a good idea of whether your symptoms might be due to appendicitis just from examining you. Appendicitis is a medical emergency, so your doctor will send you straight to hospital if they think your symptoms could be due to appendicitis.

You may have further tests at the hospital, such as a blood test and an ultrasound or a computer tomography (CT) scan, to confirm your diagnosis. This may be more likely if you haven’t got the typical symptoms of appendicitis. If you’re pregnant, you may be asked to have an ultrasound or a magnetic resonance imaging (MRI) scan to check your appendix. It’s important that appendicitis is treated quickly, so most people will have surgery to have their appendix out straightaway, without having these tests.

Treatment of appendicitis

If the doctors at the hospital think your symptoms are due to appendicitis, you’ll need to have an operation called an appendicectomy to remove your appendix. You’ll normally have surgery straightaway. But if there’s uncertainty about whether your symptoms are due to appendicitis, your doctor may delay surgery and monitor you in hospital for a short time.

An appendicectomy is done under general anaesthesia, which means you’ll be asleep during the operation. It’s usually carried out using keyhole surgery (laparoscopy), which means your surgeon will carry out the surgery through small cuts in your abdomen. It can also be done as open surgery – where your surgeon will make a larger cut in your abdomen to remove your appendix.

It’s possible that during surgery, your surgeon will find that your symptoms aren’t due to appendicitis after all, but some other reason. Your surgeon will then aim to treat whatever’s causing the problem during your operation if possible. They may still remove your appendix anyway, especially if you are having open surgery. This is because if you need any medical treatment in the future, doctors may assume from your scar that you’ve already had your appendix out. This could potentially cause confusion.

It can take more time to recover with open surgery than it does with laparoscopy, and there may be more chance of complications, like infection. However, open surgery can be safer for some people. Which type you have depends on your own personal circumstances as well as your surgeon’s experience. Sometimes, your surgeon may need to switch from keyhole surgery to open surgery during the procedure, if there are any difficulties.

Once your appendix has been removed, your surgeon will close your wounds with stitches and sometimes special sticky strips (called steristrips) too.

After your surgery

You’ll usually be able to go home the day after your surgery. It may be longer if you have had any complications. The hospital staff will give you advice and instructions before you go. These will include how to manage any pain, possible complications and what to do if you have any problems.

The recovery from appendicectomy is usually quite straightforward. But it can take a week or two, or sometimes even more, to get back to your normal activities.

Frequently asked questions

  • You won’t be able to tell for sure if your child has appendicitis – there can be lots of things that cause abdominal (tummy) pain in children. If your child is complaining of severe tummy pains that don’t seem to be getting any better, you should take them to see your GP as soon as possible. Your GP can often tell just from examining your child whether their symptoms are likely to be due to appendicitis.

    More information

    The first symptom of appendicitis is usually abdominal pain. It normally starts in the centre of your abdomen and then moves to the lower right-hand side. The other symptoms of appendicitis can include losing your appetite, vomiting and diarrhoea.

    Not everyone who gets appendicitis will have these typical symptoms though. Young children may only complain of vague tummy pains at first and go off their food. If it’s appendicitis, their pain will continue to get worse and they may start being sick.

    If your child’s appendix bursts, their pain may actually reduce for a while, but then it can come back, and they may also have a high temperature and vomiting. These can be symptoms of abdominal infection (peritonitis), which can be life-threatening if you don’t get treatment. You should seek immediate medical attention if your child develops these symptoms.

  • No, pain on the lower right side of your abdomen isn't always due to appendicitis.

    Appendicitis is one of the most common causes of severe abdominal pain. However, there are many reasons why you may have abdominal pain on your right-hand side. Pain in this area can be caused by something as simple as a virus, or by another problem such as kidney stones or a strangulated hernia. In women, pain on the right-hand side may also be caused by ovarian torsion (twisting of one of your ovaries), an ovarian cyst, an ectopic pregnancy or pelvic inflammatory disease. If you’re a woman and you see your doctor with this type of pain, you’ll usually be asked to have a pregnancy test to rule out an ectopic pregnancy.

    Other common causes of severe abdominal pain can include bowel obstruction, caused by scar adhesions or gallstones, and inflammation due to diseases such as Crohn’s disease, ulcerative colitis and diverticulitis.

    You should seek medical advice for any severe abdominal pain. Your GP can often have a good idea just from examining you whether your symptoms are likely to be due to appendicitis. If there’s any doubt as to what may be causing your pain, they’ll be able to refer you for the appropriate tests.

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Related information

    • Acute appendicitis. BMJ BestPractice., last reviewed May 2018
    • Appendicitis. NICE Clinical Knowledge Summaries., February 2016
    • Appendicitis. PatientPlus., last checked 23 July 2014
    • Gastrointestinal medicine. Oxford handbook of general practice. Oxford Medicine Online., published April 2014
    • Colorectal surgery. Oxford handbook of operative surgery. Oxford Medicine Online., published May 2017
    • Personal communication, Mrs Sara Badvie, Consultant Laparoscopic, Colorectal and General Surgeon, 20 July 2018
    • Sauerland S, Jaschinski T, Neugebauer EAM. Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database of Systematic Reviews 2010, Issue 10. Art. No.: CD001546. DOI: 10.1002/14651858.CD001546.pub3
    • Laparoscopic appendectomy. Medscape., updated 27 August 2017
    • Open appendectomy. Medscape., updated 18 August 2017
    • Pediatric appendicitis. Medscape., updated 23 August 2017
    • Assessment of acute abdomen. BMJ Best Practice., last reviewed June 2018
  • Reviewed by Pippa Coulter, Freelance Health Editor, August 2018.
    Expert reviewer Mrs Sara Badvie, Consultant Laparoscopic, Colorectal and General Surgeon.
    Next review due August 2021