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The Telltale Signs of Appendicitis

8 min read

By Emily Lockhart

If your appendix burst were to rupture (burst), you would certainly know it! Appendicitis is a condition that can lead to the rupture of this pouch-shaped organ. The appendix protrudes from the first section of the large intestine (cecum) and is credited for producing beneficial germs for the digestive system, even though the organ is thought to have lost its function through human evolution.

A ruptured appendix can be life threatening and doctors must remove it immediately to avoid toxicity. The most obvious sign of an appendicitis attack is pain in the lower right side of the abdomen, but these 13 symptoms may also accompany the telltale abdominal pain…

1. Intensifying Pain

Most people know that appendicitis causes pain, but they aren’t necessarily familiar with the pain’s typical pathology. While appendicitis pain will become severe, in about 50-percent of cases, it starts out as a dull ache that seems to originate around your belly button area. The definitive characteristic of appendicitis pain is that it will increase in intensity very quickly, moving from slightly bothersome to debilitating and severe within the space of a few hours.

There’s no mistaking this type of pain. Mothers often liken it to the kind of pain they experience during labor. If left untreated, this pain will quickly become so severe that you won’t be able to participate in normal activities. If the appendicitis flares up while you’re asleep, the pain will be severe enough that will wake you up and prevent you from falling back asleep. You should consider this situation a medical emergency and seek immediate treatment.

2. Abdominal Pain

As mentioned, appendicitis pain is usually localized around your navel when it begins, but as it intensifies, the pain seems to migrate from around your belly button to the lower right abdomen. This is where your appendix is located, and the pain is caused by the organ swelling and enlargement as the infection worsens.

In some cases, the pain of appendicitis will present itself in an entirely different manner. Some patients complain of pain that isn’t localized around the appendix, but rather seems to affect the entire lower abdomen or rectal area. This pain might also occur in your lower back. It can be a dangerous situation because you might not immediately associate the pain with an internal infection (of your appendix). When pain develops as a result of this pathology, it may not be sharp or overwhelming; it might just be dull (but constant), and it may or may not increase in intensity.

3. Nausea

Nausea is another telltale symptom of appendicitis. It can even precede the appearance of abdominal pain. Vomiting may also occur spontaneously, and it also can happen before any kind of stomach discomfort. In the vast majority of appendicitis cases, sharp and sudden abdominal pain will appear shortly after nausea and vomiting, but this doesn’t always happen.

If nausea and vomiting are accompanied by generalized or localized pain that increases in intensity and seems to be centered in the lower right abdominal area, you should suspect appendicitis as the probable cause and seek immediate medical attention. Otherwise, give your symptoms some time to see if they clear up on their own. If you’re still feeling ill or vomiting 24 hours after symptoms first appear, then go to your local emergency room. If these symptoms subside, they were likely caused by something other than appendicitis.

4. Fever and Chills

In the initial stages, the symptoms of appendicitis can mimic a simple stomach flu. You will likely feel generally unwell and probably have a mild or a sharp stomach ache and experience chills. Most times these chills will soon be joined by a low-grade fever that leaves you sweating, or alternating between feeling too hot or too cold.

Over the course of a few hours, your body temperature will likely rise past 100-degrees Fahrenheit (37.8-degrees Celsius). As your fever intensifies, so too will your other symptoms. Fever and chills that are accompanied by sharp or worsening abdominal pain, lower back pain, or rectal pain may indicate appendicitis. You should never underestimate or dismiss a fever and should certainly treat it as a potentially serious problem anytime it comes on suddenly, particularly if it’s accompanied by other symptoms.

5. Gas and Bloating

Gas and bloating are fairly common occurrences after you’ve eaten a big meal or ingested a large volume of water. However, in these cases, the excess gas will usually clear from your stomach fairly quickly, and you’ll look and feel normal within a short period of time. In the days leading up to an acute case of appendicitis, you may notice gas and bloating that does not go away. You’ll also notice that you’re not able to clear gas from your abdomen as efficiently or easily as usual, if you’re able to at all.

These symptoms generally intensify over the course of a few days, culminating in difficult bowel movements and constipation. Most people aren’t even aware that there’s a problem with their appendix when these symptoms first develop. It’s only once nausea, vomiting and abdominal pain set in that they put two and two together and realize their appendix might be inflamed/infected.

6. Painful Movement

Sooner rather than later, the pain associated with appendicitis will become so severe that it will inhibit your movements and make everyday occurrences such as sneezing or coughing excruciatingly painful. If you’ve ever suffered an injury to your rib cage, you know how painful it can be to suddenly sneeze or cough. This is exactly what happens with appendicitis.

Pain can also occur with kinetic movement. For example, you may find walking or turning your torso causes a sudden, sharp pain in your abdomen, which is likely on the lower right side. Over the course of about a day or so, this type of pain will also become more intense, and it may spread from your abdomen down into your legs. By this point, you’re almost certain to be experiencing other symptoms, which will probably be severe enough to warrant a trip to the emergency room.

7. Abdominal Tenderness

In a small minority of cases, the abdominal pain caused by appendicitis isn’t terribly severe. However, even in these cases, you’re likely to experience a phenomenon known as “rebound tenderness.” To test to see if you have rebound tenderness, press down on your lower right abdomen as firmly as you can tolerate and hold the pressure for a few seconds before releasing your hand.

Once you take the pressure off, you’ll notice an intensification of your pain – it will move from being a dull ache to a stabbing type of pain before the sharpness subsides back into a dull ache. Rebound tenderness is usually seen in the early stages of appendicitis, before any other worrisome symptoms develop. From there, the pain will usually follow the typical pathology of increasing severity, along with migration to the lower right side of the abdomen.

8. Diarrhea

Appendicitis is one of those tricky conditions that sometimes presents with contradictory symptoms. Some individuals get a terrible case of diarrhea. Like other symptoms, the diarrhea usually starts out mildly before getting worse and worse, even to the point where you may risk becoming dangerously dehydrated. You shouldn’t worry too much if you occasionally have loose bowel movements or bowel movements with an unusually high liquid content. However, if the condition worsens and/or persists for more than 24 hours and doesn’t improve with front-line over-the-counter treatments, it could signal something more serious.

You should be especially suspicious if you notice the presence of mucus in your bowel movements. When this symptom occurs in people with appendicitis, bowel movements typically increase in frequency until the patient feels the urge to use the washroom hourly or even more frequently. Because you can lose a lot of water through diarrhea, you should take care to stay hydrated while you get yourself to a doctor.

9. Relief with Bowel Movements

There’s a medical term for the relief you feel after passing a bowel movement. This phenomenon is known as “tenesmus,” and it’s a perfectly normal part of the process. However, there are a couple of unusual things about the tenesmus you feel after a bowel movement if you are suffering from a case of appendicitis.

First, the tenesmus is likely to be noticeably intensified from what you would normally feel, in part because the urgency of the bowel movements themselves is also amplified. Second, you will feel tenesmus even if you know you haven’t completely evacuated your bowels – something that often happens given the nature of the abdominal disruption caused by appendicitis. If you find yourself needing to pass a bowel movement with unusual frequency, even though you felt fully relieved after your last one, it may be a sign that something is wrong. You should go on heightened alert for other symptoms. The next symptoms to come along are likely stomach gas, bloating, nausea and abdominal pain.

10. Abdominal Swelling

Abdominal swelling is different from bloating. When you have a buildup of gas in your stomach, it will be accompanied by an uncomfortable feeling of fullness. In other words, you’ll feel that the gas is there, and you’ll likely pass gas bit by bit without being fully able to get rid of it.

The abdominal swelling caused by appendicitis is not accompanied by a feeling of pressure or buildup inside your stomach. Instead, it results from the actual physical enlargement of your appendicitis, which puts increased pressure on the surrounding tissues. The lower right side of your abdomen will appear inflated, and it will be extremely sensitive to touch. The pain you will feel at this point will also be extremely intense, and it will remain present even if you do not put any pressure on the affected area. This is a serious symptom and constitutes a medical emergency.

11. Loss of Appetite

Loss of appetite is another symptom that often occurs with appendicitis. In fact, Prevention says it “is present in about 74 to 78-percent of patients.” So if you’re normally a consistent eater and suddenly can’t be bothered with food, appendicitis may be the culprit.

Loss of appetite is rarely the only symptom of appendicitis, however, it is often coupled with other symptoms mentioned on this list, such as intense pain and abdominal tenderness. Experiencing these symptoms tends to divert attention away from things that might potentially worsen these symptoms, which feelings of fullness can very well do.

12. Painful Urination

Pain and difficulty when urinating are telltale signs of a bladder infection, but that’s not the only condition that can cause these symptoms to occur. In some cases, these changes in urination may be the result of appendicitis.

Difficulty urinating, for instance, may be due to a blockage caused by the infection or inflammation associated with appendicitis, which makes it difficult to excrete waste from the body, while painful urination may result from a spreading infection or the body straining to move urine around a blockage. If you experience any of these urinary symptoms, be sure to make an appointment with your doctor, as he/she can conduct tests to confirm the underlying cause.

13. Fatigue

A condition like appendicitis is hard on the body, and it can cause you to feel a great deal of fatigue as you battle the disease. Fatigue can also occur as a symptom of appendicitis. For example, because of the pain and discomfort in the abdomen, you may not sleep well at night, which causes you to experience fatigue throughout the day.

Also, as mentioned earlier, appendicitis often causes loss of appetite, and not consuming enough nutritious food can lead to lack of energy and fatigue. Even if you do happen to get some food and water down, it may not stay in your system long enough for your body to absorb what it needs due to vomiting and diarrhea.

MD, Family Medicine, Internal Medicine

Gerald Morris, MD is a family medicine/internal medicine physician with over 20 years expertise in the medical arena. Dr. Morris has spent time as a clinician, clinical research coordinator/manager, medical writer, and instructor. He is a proponent of patient education as a tool in the diagnosis and treatment of acute and chronic medical conditions.

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