Learn more about this common condition, including appendicitis symptoms & treatment
What is appendicitis?
Appendicitis is a painful swelling and inflammation of your appendix, a small and thin finger-like pouch around 5cm to 10cm in length, which is attached to your large intestine where poo forms.
It’s usually treated by having an operation, as soon as possible, to remove your appendix and avoid the risk of it bursting. Your appendix doesn’t perform any important bodily functions, so there’s no long-term risk of having it removed.
How common is appendicitis?
Appendicitis is a common condition which can happen to anyone of any age, but most often affects people aged 10 to 30.
Around 50,000 people are admitted to hospital with appendicitis each year in England, and surgery to remove the appendix is one of the most common operations in the UK.
What causes appendicitis?
It’s not fully known what causes appendicitis, meaning there’s no way to prevent it from happening.
It’s thought to occur when something blocks the entrance to the appendix which can lead to inflammation and swelling. This could be something like a small piece of poo from the large intestine, or a swollen lymph node (pea-sized lump of tissue) in the bowel which can be caused by an upper respiratory tract infection (infections in parts of the body involved in breathing).
What are the signs & symptoms of appendicitis?
When you have appendicitis, pain usually starts in the middle of your tummy (abdomen) and may come and go.
Within a few hours, the pain becomes constant and severe and often travels to the lower right-hand side of your tummy where the appendix is usually located. You may find that the pain gets worse when coughing, walking or pressing on the area.
You might also experience other symptoms including:
• Feeling sick (nausea) or being sick
• Constipation
• Diarrhoea
• Experiencing a loss of appetite
• A flushed face and a high temperature
When to seek medical attention for appendicitis
Appendicitis is a surgical emergency. You should contact your GP or local out of hours service immediately if you have tummy pain that’s gradually getting worse.
Alternatively, you should call NHS 111 for advice if either of these options are unavailable.
You should call 999 and ask for an ambulance if your pain suddenly gets worse and spreads across your tummy, or if your pain eases for a while but then gets worse which could be a sign that your appendix has burst. A burst appendix can cause a serious infection of the inner lining of your abdomen which is called peritonitis.
How is appendicitis diagnosed?
A GP can usually diagnose appendicitis if you have typical appendicitis symptoms. In this case, you’ll be referred immediately to hospital for an operation. However, typical appendicitis symptoms are only present in around half of cases, meaning it can be difficult to diagnose.
Some people may have pain or symptoms that are similar to appendicitis but are actually caused by other conditions such as:
• Gastroenteritis – a stomach bug that causes sickness and diarrhoea
• Severe irritable bowel syndrome (IBS)
• Crohn's disease
• A bladder or urinary tract infection such as cystitis
• A pelvic infection
Other causes of similar symptoms may be gynaecological, such as menstrual pain, an ectopic pregnancy (when a fertilised egg implants itself outside of the womb) or pelvic inflammatory disease (PID) which is an infection in the womb, fallopian tubes or ovaries.
A GP will usually ask about what symptoms you have as well as examining your tummy and seeing if the pain gets worse when they press around your appendix. In most people, the appendix is usually located in the lower right-hand side of the abdomen, but in others it can be found:
• In the pelvis
• Behind the large intestine
• Around the small bowel
• Near the right lower part of the liver
If your symptoms aren’t typical of appendicitis, you may need further tests to confirm the diagnosis or rule out other causes.
How is appendicitis treated?
If you’ve been diagnosed with appendicitis, you’ll usually be referred to hospital as soon as possible for an operation to remove your appendix (known as an appendicectomy or appendectomy).
Surgery is also recommended in cases where it’s suspected you have appendicitis to avoid the risk of your appendix bursting.
Sometimes, if the appendix has tried to heal itself, a lump may form called an appendix mass. In this case, you may be given a course of antibiotics to take before having surgery a few weeks later.
An operation takes place under general anaesthetic either by keyhole surgery (laparoscopy) or open surgery.
Keyhole surgery
Keyhole surgery is the most common way to remove the appendix and it involves making three or four small cuts in your tummy. Special instruments are then inserted into your tummy to carry out the surgery and remove your appendix.
Recovery time is usually short and you can often leave hospital within a few days. You may need to go to your GP seven to 10 days later to have stitches removed, or your surgeon may have used dissolvable stitches which disappear by themselves.
Open surgery
In some cases, open surgery is required instead, such as for people who’ve previously had abdominal open surgery or for people whose appendix has already burst and formed a lump called an appendix mass.
Open surgery involves making a larger cut in the lower right-hand side of your tummy to remove your appendix. Recovery time is longer, you may need to stay in hospital for up to a week and it could be two weeks or longer before you feel up to doing normal activities. You will need to avoid anything strenuous for four to six weeks. As with keyhole surgery, you may need to have stitches removed afterwards.
In both types of surgery, your surgeon will be able to provide advice for your recovery. It’s important to keep an eye out for signs of any problems whilst you recover. Although having an appendix removed is very common and complications are rare, you should see your GP if you’re concerned about anything or if you experience any of the following, which could be signs of an infection:
• Increased pain and swelling
• Repeated vomiting
• A high temperature
• Discharge coming from the wound
• The wound is hot to touch
What are the complications of appendicitis?
If not treated, appendicitis can cause serious life-threatening infections, so you should see your GP or local out of hours clinic, or call NHS 111 if you have any of the symptoms listed earlier.
You should call 999 and ask for an ambulance if you have abdominal pain that suddenly gets much worse and spreads across your abdomen. This is a sign that your appendix could have burst which can cause peritonitis, an infection of the inner lining of your abdomen. If not treated immediately, peritonitis can cause damage to your internal organs and in some cases can be fatal. Treatment usually involves having antibiotics and emergency surgery to remove your appendix.
A burst appendix can also cause an abscess, a painful collection of pus that forms around the site as the body fights the infection. Abscesses usually need to be drained to get rid of the pus.
