Appendix Pain

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 “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.

The appendix vermiformis is a small, narrow tube found at the end of the caecum, which is a pouch-like structure at the intersection between the small and large intestine . The biological function of the appendix is unknown. Abdominal 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. 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 caecum, 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.

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:[5]

  • 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.

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 (“keyhole”) 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 located in the abdomen include:[6][7][8][9]

  • Diarrhea
  • Food poisoning
  • Constipation
  • Vomiting
  • Crohn's disease
  • Irritable bowel syndrome (IBS)
  • Stomach ulcers
  • Infectious enterocolitis (inflammation of the digestive tract)
  • Diverticulitis, which is common in elderly patients
  • Gallstones
  • Kidney infections
  • Kidney stone diseases
  • Urinary tract infections
  • Dysmenorrhea
  • Conditions affecting the ovaries, such as infected or inflamed ovaries, ovarian cyst, ovarian torsion
  • Pelvic inflammatory disease
  • Stress

In rare cases, pain in the appendix area/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.[10]

What does pain from acute appendicitis 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.

Appendix pain 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:[11]

  • A buildup of gas
  • Constipation
  • Gastroenteritis
  • Mild food poisoning
  • A mild food allergy

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.

Appendix pain 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:[10][11]

  • 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 including:

  • 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.

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. These symptoms should be reported to doctors as soon as they occur. To prevent complications, emergency surgical intervention is typically required.[12]

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.

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.[13][14] 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.[15] Constipation may be relieved by laxatives or a fibre supplement. However, If there is no improvement in symptoms within a reasonable time after this treatment, then a physician should be consulted urgently.

Appendix pain FAQs

Q: In what location do you experience appendix pain?
A: In 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.

  1. Patient. “Appendicitis.” August 1, 2017. Accessed September 28, 2017.

  2. Cancer. “Appendix Cancer: Introduction.” April, 2016. Accessed September 28, 2017.

  3. Healthline. “Appendix.” August 21, 2017. Accessed September 28, 2017.

  4. Patient. “Appendicitis.” August 1, 2017. Accessed September 28, 2017.

  5. Patient. “Appendicitis.” August 1, 2017. Accessed September 28, 2017.

  6. RSNA. “Beyond Appendicitis: Common and Uncommon Gastrointestinal Causes of Right Lower Quadrant Abdominal Pain at Multidetector CT.” March 17, 2010. Accessed September 29, 2017.

  7. University of Maryland Medical Centre. “Conditions with Similar Symptoms as: Appendicitis.” August 11, 2015. Accessed September 29, 2017.

  8. NHS Inform. “Stomach ache and abdominal pain”. 6 March 2018. Accessed 28 March 2018.

  9. Netdoctor. “Lower abdominal pain in women”. 8 June 2016. Accessed 28 March 2018.

  10. Cancer.Net. “Appendix Cancer.” April, 2016. Accessed September 29, 2017.

  11. Everyday Health. “Appendicitis in Children.” February 6, 2017. Accessed September 29, 2017.

  12. ELSEVIER. “Appendicitis during pregnancy.” July, 2003. Accessed September 29, 2017.

  13. Centers for Disease Control and Prevention Journal of Emerging Infectious Diseases. “Incidence of Acute Gastroenteritis and Role of Norovirus, Georgia, USA, 2004–2005”. August 2011. Accessed 30 March 2018.

  14. American Family Physician. “Acute Appendicitis: Review and Update”. November 1999. Accessed 30 March 2018.

  15. AdaHealth. “Gastroenteritis”. Accessed 30 March 2018.