Appendicitis

What is appendicitis?

The appendix is a small, finger-shaped pouch connected to the large intestine on the lower right-hand side of your abdomen. Appendicitis is painful swelling and inflammation of the appendix.

Appendicitis symptoms

Appendicitis pain often starts in the middle of your tummy with the pain coming and going. After a few hours, the pain moves to the lower right-hand side of the abdomen, where the appendix is located. Appendicitis pain can be intense and constant.

Other signs of appendicitis are:

• Pain that gets worse if you press on the sore area or if you cough or walk

• Feeling sick and vomiting

• Loss of appetite

• High temperature

• Constipation or diarrhoea

• Abdominal bloating

What causes appendicitis?

A blockage in the lining of the appendix is likely to be the cause of appendicitis. Bacteria then multiplies quickly, causing the appendix to become inflamed, swollen and filled with pus. For example, it could become blocked by a small piece of poo, or an upper respiratory tract infection could cause the lymph node within the wall of the bowel to become swollen.

If the obstruction causes inflammation and swelling, it could lead to increased pressure within the appendix, which may then burst. This is known as acute appendicitis and is considered a medical emergency.

As the causes of appendicitis are not fully understood, there's no guaranteed way of preventing it.

How to know if you have appendicitis

Appendicitis can be difficult to diagnose because the symptoms are similar to other conditions like gastroenteritis, irritable bowel syndrome, constipation and urine infections.

To diagnose appendicitis, the doctor will ask questions about your symptoms and examine your abdomen by gently pressing on the area around your appendix. If the doctor thinks you have appendicitis, they will refer you to the hospital for immediate treatment.

Further tests may be needed to confirm the diagnosis and rule out other conditions. These may include:

• Blood test - to check for signs of an infection

• Urine test – to rule out a urine infection or other conditions like kidney stones

• Ultrasound scan - to check if the appendix is swollen

• Computerised tomography (CT) scan or magnetic resonance imaging (MRI) - to help confirm appendicitis or find other causes for the pain

How is appendicitis treated?

If you've got appendicitis, doctors will want to remove your appendix as soon as possible. Appendicitis surgery is called an appendicectomy or appendectomy.

The doctor may recommend surgery even if they are not sure you've got appendicitis because it's safer to remove your appendix rather than risk it bursting.

The appendix is not important for your health, so removing it does not cause any long-term problems.

Surgery for appendicitis (appendectomy)

There are two types of surgery to remove the appendix:

• Keyhole surgery (laparoscopy) – a few minor cuts (incisions) are made in the abdomen. This is usually the preferred option because it has a faster recovery time, and most people can go home within 24 hours.

• Open surgery - one larger cut is made in the lower right-hand side of the abdomen. If your appendix has ruptured, it may be necessary to cut along the middle of the stomach. This procedure is called a laparotomy. Open surgery has a longer recovery time. Some people may have to stay in the hospital for up to a week until they're well enough to go home.

After your surgery, you'll likely have some pain and bruising. This gets better over time, but you may need painkillers as you recover. It's normal to have some constipation for a short time after the appendectomy.

Drinking plenty of fluids and eating lots of fibre will help. But the GP can prescribe medication if the constipation isn't improving or you are in a lot of discomfort.

Before you leave the hospital, you'll be advised how to look after your surgical wound and what activities you should avoid. In a couple of weeks, you should be able to return to normal activities, but you may need to avoid more strenuous activities for up to six weeks after open surgery.

Appendicitis complications

Appendicitis can cause severe complications, including:

• A ruptured appendix – if the appendix bursts, it can spread infection throughout your abdomen. This is called peritonitis, and it can be life-threatening. If this happens, you need emergency surgery to remove your appendix and clean the abdomen.

• Abscess – this is a pocket of pus that forms in the abdomen. In most cases, a surgeon will drain the abscess by placing a tube through your abdominal wall into the abscess. The tube is left in place for about two weeks, and you'll be given antibiotics to clear the infection. Once the infection is clear, you'll have surgery to remove the appendix or, depending on the situation, your appendix may be removed immediately.

When to get medical help

You should get medical help if you have pain in your abdomen that's gradually getting worse.

Severe abdominal pain that suddenly worsens and spreads across your abdomen, or pain that gets better before getting worse again needs urgent medical attention. There is a risk your appendix may have ruptured (burst), which can be life-threatening.