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Appendix pain

Written by Ada’s Medical Knowledge Team

Updated on

What is appendix pain?

Appendix pain is typically described as pain or discomfort in the abdominal area (the belly), in the lower right side, where the appendix is located. Medically speaking, there is no such thing as “appendix pain”, even though the affected person may describe or experience it as such. The correct term is “abdominal pain”, which is a symptom of both serious and non-serious medical issues, such as gastroenteritis, gas, hepatitis, irritable bowel syndrome, gallstones, and indeed acute appendicitis.

Abdominal pain or "appendix pain" in the region of the appendix may be caused by acute appendicitis, an inflammation of the appendix that should be treated as a medical emergency.

Feeling unwell? Get a quick symptom assessment with the free Ada app.

The characteristic pain that results from acute appendicitis will typically begin in the vicinity of the stomach or belly button and then, as the abdominal wall and other organs begin to be affected by inflammation, the pain will move towards the lower right side of the abdomen and become more severe. However, pain from inflammation originating in the appendix may also be felt elsewhere in the abdominal area, though it is very common for it to be felt in the lower right region.

Other symptoms, such as nausea, vomiting, and fever may also occur. 1

Pain in the region of the abdomen is easily confused with pain from acute appendicitis, which specifically affects the appendix. A wide range of conditions can cause such abdominal pain, including non-serious buildups of gas or indigestion, as well as more serious conditions, such as ulcers, infection of the ovaries, diverticulitis, inflammatory bowel diseases, or kidney infection. People experiencing abdominal pain, whether or not localized to the lower right-hand side, that gradually gets worse, should seek medical attention urgently. 2 3

What is the appendix?

The appendix vermiformis (colloquially known as “the appendix”) is a small, narrow tube found at the end of the pouch-like cecum, which is found at the junction between the small and large intestine. In most people, the appendix is located in the lower right-hand side of the abdomen.

Although the exact function of the appendix is unknown – and for a time it was widely believed to have no function – some doctors believe that the appendix may serve as a storage unit for good bacteria and play a role in the development of the immune system. 4

Causes of abdominal pain in the region of the appendix

As pain specific to acute appendicitis and abdominal pain from other causes are easily confused, it’s important to be aware of all of the common conditions that can cause this pain.

Appendix pain is located in the abdomen. The abdomen can be divided into four quadrants, by imagining a vertical line running through the navel (belly button) and another running line through it horizontally. 5 The human abdomen is a large region of the human body, and it is the location of a number of organs and organ systems. 6

The left upper quadrant contains the stomach, spleen, left kidney, small intestine, descending colon and transverse colon. 7

The left lower quadrant contains the small intestine and the descending colon, sigmoid colon and rectum. 6

The lower right quadrant contains the small intestine, the cecum and the appendix, as well as the ascending colon.

The upper right quadrant contains the pancreas, gallbladder, liver, right kidney, small intestine, ascending colon and transverse colon.

The bladder lies roughly on the midline of the lower quadrants. The abdominal cavity is lined by the peritoneum, which is made up of connective tissue. 6 The peritoneum can become infected, a condition known as peritonitis (see below). The organs are held in a web of tissue known as the mesentery.

In men, the abdomen also contains the prostate, which is situated just below the bladder. In women, the abdomen also contains the uterus, cervix, ovaries and fallopian tubes. These differences between men and women mean that, in some cases, pain may be felt differently. This is partly because different organs and structures are involved. In acute appendicitis, men and women experience pain in the same regions.

Different disorders within the abdominal region may cause pain in different regions. For example, gastritis is usually felt in the left upper abdominal quadrant, while pain from an inflamed gallbladder or gallstones is felt in the right upper region. Pain which is experienced in the region of the appendix may be from acute appendicitis, but it may also result from other disorders and diseases of organs in the abdominal region.

Good to know: Pain from kidney problems is usually described as being in the back or side, rather than as pain in the abdomen.

Acute appendicitis

Acute appendicitis is a common condition that can affect people of all ages. It is an inflammation of the appendix, thought to be caused by a blockage of the appendix or by the appendix becoming infected. The main symptom of acute appendicitis is severe pain in the abdomen.

This will usually begin as a dull pain located around the stomach area or belly-button region, before gradually moving to the lower right side and becoming sharper and more severe. At this stage, the portion of the abdomen where the appendix is located may be painful or tender to touch.

Other symptoms of acute appendicitis may include: 8

  • Nausea
  • Vomiting
  • Fever
  • Constipation
  • Frequent urination, because of irritation of and around the ureter, which can imitate the symptoms of a urinary tract infection.

If the condition is left untreated, the appendix can burst. If this happens, an individual will typically experience severe pain across the entire abdominal region. This can cause peritonitis, a medically significant condition (see below).

If any symptoms of the condition occur and acute appendicitis is suspected, immediate medical attention should be sought. A person will be admitted to hospital and usually undergo surgery to remove the appendix. This common procedure is called an appendectomy and is considered routine by doctors. It will usually be carried out using laparoscopic surgery.

Other causes of abdominal pain

Although acute appendicitis is a common cause of severe pain in the region of the appendix, there are a variety of other possible causes. The source of pain in this location is often difficult to pinpoint, meaning that pain, which feels like the result of acute appendicitis, may in fact stem from a different source, such as a problem related to other parts of the intestines or the kidneys.

Other possible causes of abdominal pain include: 9 10 11 12

Women may additionally experience abdominal pain, usually in the lower abdomen, as a result of:

In rare cases, pain in the appendix area or abdomen can also be a symptom of a tumorous condition (benign or malignant). Nevertheless if a tumorous condition is suspected, urgent medical attention may be required. Treatment options include surgery, chemotherapy and radiation therapy. 13

Appendix pain location

What does appendix pain feel like? If acute appendicitis is the cause of the abdominal pain, the pain will generally begin as dull and be located around the stomach and/or belly button region. This pain can develop quickly or slowly, but will in most cases become severe over time.

As the pain intensifies, the lower right-hand side of the abdomen, where the appendix is typically located, will generally become particularly tender, and may be painful to the touch. If the appendix has burst, the pain will typically spread across the whole abdominal region and will be correspondingly severe.

Acute appendix pain location in adults

In adults, appendix pain – or rather, pain in the region of the appendix – can be the result of appendicitis or another disorder. The location of the pain can sometimes indicate whether the pain is the result of appendicitis or another disorder.

Is the pain on the left side or the right side?

In most cases, if the cause of the pain is acute appendicitis, the pain will begin around the belly button and then be felt in the right region of the stomach. If the pain is also felt on the left, the peritoneum may also be infected. This can cause something called rebound tenderness (see FAQs).

If you are concerned that you may have acute appendicitis or another problem that is causing you abdominal pain, try using the Ada app to find out what the problem is.

A number of other disorders of the abdomen typically cause pain only on the left or only on the right. Disorders which can cause pain on the right in men and women include: 14

Disorders which can typically cause pain on the left in men and women include: 14

Disorders which can typically cause pain on the left or the right or both in men and women include: 14 15

  • Inflammatory bowel disease
  • Pyelonephritis, a kidney infection
  • Nephrolithiasis, or kidney stones, which can cause pain in a number of locations throughout the abdomen
  • UTIs such as cystitis.

Disorders which can typically cause pain in the middle of the abdomen in men and women include: 14

If you are concerned that you may have acute appendicitis, a UTI, or another problem that is causing you abdominal pain, try using the Ada app to find out what the cause is.

Acute appendix pain location in men

The location of appendix pain in men and women is the same. However, there are a number of conditions that may cause appendix pain, or abdominal pain, only in males. These include: 14 15

If you are concerned that you may have acute appendicitis, prostatitis, or another problem that is causing you abdominal pain, try using the Ada app to find out what the cause is.

Acute appendix pain location in women

As stated above, men and women experience pain from acute appendicitis in the same locations.

However, there are a number of conditions that may cause abdominal pain only in females. These include: 14 15

All of the above can cause pain in the region of the appendix, mostly in the right lower abdomen and the left lower abdomen. 14

Good to know: Pain in the region of the appendix can also be a sign of pregnancy. During early pregnancy, mild stomach pain results from the expansion of tissue and the womb, as well as from hormones. The implantation of the fertilized egg in the lining of the uterus also commonly causes pain. Moderate period-like pain can also occur at the beginning of a pregnancy. 16 If severe pain and/or cramping occurs, medical advice should be sought as soon as possible (see below).

If you are concerned that you may have acute appendicitis, endometriosis or another problem that is causing you abdominal pain, you can do a free symptom assessment using the Ada app at any time.

Appendix pain location during pregnancy

The changes the body undergoes during pregnancy mean abdominal pain can be relatively normal, and it may be mistaken for pain from acute appendicitis. This pain can be a result of non-serious factors such as:

  • The expanding uterus: As the uterus grows during pregnancy, the bowel is displaced, potentially leading to pain in the abdominal area.
  • Round ligament pain: The round ligaments, located at the front of the uterus, can cause sharp and sometimes severe pain as the uterus expands. Typically, this pain is in the lower half of the abdomen. While the person experiencing the pain may confuse this with appendicitis, a physician will be able to tell the difference.
  • Constipation and gas: Common during pregnancy, due to changes in the location of the gastrointestinal tract, which is pushed out of the way and compressed by the expanding uterus. Constipation and gas can cause mild to moderate pain in the whole abdominal region.

At times, abdominal pain during pregnancy can be a result of more serious conditions.

Urinary tract infection: A treatable condition with symptoms including a sudden and/or frequent urge to urinate, pain when urinating and general abdominal pain.

Ectopic pregnancy: A condition that occurs when a fertilized egg implants itself somewhere other than the uterus, often causing severe abdominal pain. Pain from an ectopic pregnancy is usually felt in the lower abdomen.

Miscarriage: Miscarriage is the sudden loss of a pregnancy in the first 20 weeks. Symptoms can include pain and cramps on the right and left of the lower abdominal region. It is often accompanied by vaginal bleeding, as well as the loss of fluid or tissue from the vagina.

Abdominal pain during pregnancy may also be the result of acute appendicitis. Appendicitis during pregnancy can be difficult to diagnose due to the movement of the appendix from its usual position to a higher position near the liver or belly button. In pregnant women, pain from acute appendicitis may be felt in the right upper quadrant of the abdomen. 15 These symptoms should be reported to doctors as soon as they occur. To prevent complications, emergency surgical intervention is typically required. 17

If you are concerned that you may have acute appendicitis, or are experiencing an ectopic pregnancy, or another problem that is causing you abdominal pain, try using the Ada app to find out what the cause is.

Appendix pain location in children

Pain in the region of the appendix in children may be a result of a variety of conditions. These include relatively non-serious conditions such as: 18

If abdominal pain lasts for longer than a day or is particularly severe, it could be a sign of a range of conditions including:

  • Urinary tract infection
  • Hernia
  • Inflammatory bowel disease
  • Intussusception of the bowel, where a section of the intestine slides into the next, like a telescope folding up. This is rare and tends to affect the small intestine. However, it is a medical emergency.

In some cases, appendicitis may be the cause of abdominal pain. Children with appendicitis often present with similar pain or symptoms as adults with the condition. Other symptoms of appendicitis in children include:

  • Fever
  • Vomiting
  • Nausea
  • Lack of appetite

It is important to ensure children receive medical attention as soon as possible if appendicitis is suspected. Treatment will usually involve an appendectomy. This is considered a routine procedure, but will involve a hospital stay.

If you are concerned that your child may have acute appendicitis or another stomach problem, Ada is ready to check their symptoms.

Complications of untreated appendix pain

Acute appendicitis is a common disorder and is easily treated if it is diagnosed early. If it is not treated, the appendix may burst and this may lead to peritonitis.**

Peritonitis

Peritonitis is uncommon, but when it does occur, it is a medical emergency. Peritonitis is an infection of the peritoneum, the lining of the abdominal cavity. If it occurs without an underlying cause, it is known as primary peritonitis. However, peritonitis is usually caused by disorders including: 19

This list is not exhaustive. Many other abdominal disorders that involve inflammation can result in peritonitis if they are not treated. 15

Peritonitis is the result of an infection spreading from an organ to the peritoneal tissue. The regions in which pain is felt and how severe the pain is, change as the infection spreads. 19

Abdominal pain from peritonitis may be felt in several ways. Generally, an infection affecting an organ in the abdomen will be painful, and as the infection spreads to the peritoneum nearest the organ, the pain will also spread. If the infection then spreads to the entire peritoneum, the pain will then be felt as general belly pain and tenderness.

Pain from peritonitis feels worse when the affected person flexes their hips or coughs; it is also painful if pressure is applied. 20 It will usually be most intense over the site of the organ that originally began the infection.

Other symptoms of peritonitis may include:

  • Fever, with a body temperature of 38 C/ 100.4 F
  • Low blood pressure
  • Fast heartbeat
  • Low output of urine
  • Septic shock in severe cases

If you are concerned that you may have peritonitis, a burst appendix or another problem that is causing you abdominal pain and distress, share your symptoms with Ada.

Appendix pain relief

Relief from abdominal pain will generally depend on its underlying cause. When caused by acute appendicitis, the standard treatment option is surgery, which will usually take the form of an appendectomy. If a person experiencing moderate or severe abdominal pain is concerned and shows no improvement within a reasonable amount of time, they should seek medical help.

An appendectomy involves the complete removal of the appendix, sometimes following a course of antibiotics to reduce inflammation and make surgery easier. Keyhole surgery is generally used during this procedure, allowing for a shorter recovery time and less scarring. Generally, there are no long-term complications following an appendectomy.

It is more likely that abdominal pain is the result of gastroenteritis, gas, or food poisoning than acute appendicitis. It may be best to treat for these first, before seeking emergency medical help. About 179 million cases of acute gastroenteritis are reported every year in the USA, but only 7% of the population will have appendicitis in their lifetime, making gastroenteritis more common than appendicitis. 21 22 Gastroenteritis generally includes diarrhea and vomiting, with nausea and abdominal pain, and sometimes fever.

Treatment of gastroenteritis and food poisoning includes bed rest, oral rehydration, and medication to manage nausea, vomiting and diarrhea. 23 However, If there is no improvement in symptoms within a reasonable time with this treatment, then a physician should be consulted urgently.

If you are concerned that you may have acute appendicitis, gastroenteritis or another problem that is causing you abdominal pain, use Ada to check your symptoms.

Appendix pain FAQs

Q: In what location do you experience appendix pain?
A: In most cases of appendicitis, the pain will typically begin around the stomach or belly button area and move to the lower right side of the abdomen, while also becoming sharper and more severe.

Q: Why is appendix pain sometimes felt on the left?
A: In most cases, pain from acute appendicitis is felt on the right. However, some people experience it on the left. This occurs when the inflammation affecting the appendix spreads to the peritoneum, the lining of the abdominal cavity.

A common test that can distinguish possible appendicitis from other abdominal pain uses rebound tenderness to determine whether it is the appendix that is inflamed, or another structure. In this test, the doctor slowly presses their fingers on a part of the abdomen that does not hurt - in the case of suspected acute appendicitis, this would be the left-hand side - and then quickly lets go. The affected person feels pain in the lower right abdominal area. This sort of pain is known as “contralateral rebound tenderness”, as pain occurs on the side opposite to where the pressure is applied.

In very few cases, the reason for appendix pain being felt on the left may be because of a hereditary condition known as situs inversus, in which the organs of the chest and abdomen are in mirror-image positions – that is, they are on the opposite side to where they are in most people. 24 In people with situs inversus, for example, the liver and appendix are on the left of the abdomen. However, situs inversus only affects about one in 8000 people, and it is far more likely that, if you feel appendix pain on the left, it is because of rebound tenderness. 25