Appendicitis: symptoms, treatment and recovery

The NHS says symptoms usually start with pain in the middle of your tummy (abdomen), around your belly button. After a few hours the pain usually moves to the lower right side of the abdomen and gets worse. NHS inform adds that the pain may come and go at first, then becomes constant and severe.

The pain may feel worse when you move, cough or press on the area, and it may feel slightly better when you pull your knees up to your chest.

Other symptoms, listed by the NHS and NHS inform, are below.

• Feeling or being sick, or loss of appetite.

• A high temperature (fever), and sometimes a flushed face.

• Constipation or diarrhoea.

• Needing to pee more than usual.

• Sudden confusion in older people.

Yes. The NHS says some people with appendicitis do not have the usual pain symptoms. The pain might be less severe, develop more slowly or be in a different place. This is more likely if you are pregnant, and in young children and older people.

NHS inform says typical symptoms are present in only about half of all cases, and that the appendix can sit in a slightly different position, for example in the pelvis, behind the large intestine, around the small bowel or near the right lower part of the liver. That changes where the pain is felt.

The NHS gives two levels of advice, and the same applies if the person affected is your child.

Ask for an urgent GP appointment or get help from NHS 111 if you or your child have tummy pain that is gradually getting worse or does not go away, or that moves to the lower right side of the abdomen.

Call 999 or go to A&E if you or your child have severe tummy pain, or confusion, blotchy or paler than usual skin (on brown or black skin this may be easier to see on the palms of the hands or soles of the feet) or difficulty breathing. The NHS says these could be signs of sepsis.

The NHS says not to drive to A&E yourself. Ask someone to drive you or call 999 for an ambulance, and bring any medicines you take with you.

NHS inform describes the appendix as a small, thin pouch about 5 to 10cm (2 to 4 inches) long, connected to the large intestine. It says nobody knows exactly why we have one, but removing it is not harmful.

Appendicitis is a painful swelling of the appendix. The NHS describes it as swelling and infection in the appendix. If it is not treated quickly the appendix can burst, which the NHS says is a serious condition.

The NHS says appendicitis is usually treated with surgery to remove the appendix, called an appendectomy (or appendicectomy). If you need surgery it will be done as soon as possible, but you may need to wait a few hours. The operation usually takes about an hour.

NHS inform says surgery is usually also recommended if there is a chance you have appendicitis but a clear diagnosis has not been possible, because it is considered safer to remove the appendix than to risk it bursting. It notes that this means some people have an appendix removed that turns out to be normal.

You will have a general anaesthetic, so you will be asleep. Most operations are done as keyhole surgery, with several small cuts and a thin tube with a camera. Sometimes a larger cut in the lower right side of the abdomen (open surgery) is needed. NHS inform says open surgery is usually carried out if the appendix has burst or access is more difficult, and mentions it may also be used in people who have previously had open abdominal surgery.

The NHS says appendicitis can happen at any age but is most common in children over 10 years old and young adults, and that it is rare in babies under 12 months. NHS inform puts the most common age range at 10 to 20 years.

In young children the usual pattern may not be clear. The NHS says pain may be less severe, develop more slowly or be in a different place, which can be more likely in young children. Because many other conditions cause tummy pain, the NHS says not to try to diagnose the problem yourself and to get medical help if you are worried.

The urgent advice is the same for children: get help from NHS 111 or an urgent GP appointment if tummy pain is getting worse or does not go away or moves to the lower right side, and call 999 or go to A&E for severe pain, confusion, blotchy or paler than usual skin or difficulty breathing.

The NHS says appendicitis happens when the appendix becomes infected and swollen, often because something gets stuck in it, such as a small piece of undigested food or hard poo.

NHS inform says it is not exactly clear what causes it. Most cases are thought to occur when something blocks the entrance of the appendix, for example a small piece of faeces, or an upper respiratory tract infection leading to a swollen lymph node in the bowel wall. The blockage leads to inflammation and swelling, and the pressure can lead to the appendix bursting. NHS inform says that because the causes are not fully understood, there is no guaranteed way of preventing appendicitis.

The NHS says a GP or hospital doctor will feel your abdomen to check for pain and swelling, and you will need to go to hospital for tests and treatment. NHS inform says that if symptoms are typical this is normally enough for a GP to make a confident diagnosis and refer you straight to hospital.

The NHS says there is no test that can always show whether you have appendicitis, and it can be hard to diagnose because symptoms are similar to other conditions. Sometimes doctors wait a few hours in hospital to see how symptoms develop; NHS inform says this can be up to 24 hours when the diagnosis is uncertain. If it is very likely you have appendicitis, or the appendix may have burst, the NHS says doctors may recommend surgery instead of waiting for more tests.

The NHS says many other conditions can cause pain in the abdomen, and that you should not try to diagnose the problem yourself. NHS inform says appendicitis can easily be confused with other causes of tummy pain. In young women the symptoms can sometimes have a gynaecological cause.

The NHS says that if the appendix bursts, your pain may suddenly get better for a short time. You will then usually have severe pain that spreads to the whole of your abdomen, and it may be very painful to move.

A burst appendix (also called perforated or ruptured) is a serious condition. The NHS lists these possible complications: an infection of the inner lining of the abdomen (peritonitis), a life-threatening reaction to infection (sepsis), a painful build-up of pus (abscess), a blockage in the bowel and problems in pregnancy. These need to be treated urgently with surgery and antibiotics.

NHS inform says to phone 999 for an ambulance if you have sudden pain that continues to get worse and spreads across your abdomen.

The NHS says most people recover from appendicitis in 1 to 2 weeks, and it may take longer if you had complications such as a burst appendix.

In hospital, the NHS says how long you stay can vary. After keyhole surgery you may be able to go home the day after the operation; after open surgery or complications you may need to stay for a few days. Doctors will usually want to check that you are eating and drinking and are able to poo. NHS inform says that after prompt keyhole surgery most patients can go home within 24 hours, and that with open or complicated surgery it can take up to a week.

At home, the NHS says you may need 1 to 2 weeks off work or school, or sometimes longer depending on your type of work. It advises you to take painkillers if you need them, follow wound care advice, and be careful when washing or showering. If you have constipation it suggests eating plenty of fibre, drinking lots of fluids and asking a pharmacist about a mild laxative. NHS inform says that if you had keyhole surgery you may get pain at the tip of your shoulder for about a week, caused by the gas used in the operation.

The NHS says not to do strenuous activities such as sport until you have fully recovered and not to drive until you can use a car safely and comfortably, including doing an emergency stop. NHS inform says strenuous activities may need to be avoided for 4 to 6 weeks after open surgery.

The NHS says complications of surgery are rare. It lists the wound becoming infected, bleeding, scar tissue forming (adhesions) that can cause a bowel blockage, and, in rare cases, an abscess where the appendix was or stump appendicitis in the small part of the appendix that was not removed. NHS inform also lists scarring and hernia at the site of an incision.

The NHS says to ask for an urgent GP appointment or get help from NHS 111 if, after an appendectomy, you have soreness or redness around the wound that is getting worse, bleeding or pus from the wound, or a high temperature, as these could be signs of infection. NHS inform also mentions increasing pain and swelling and repeated vomiting.

The NHS says pain that is less severe, develops more slowly or is in a different place can be more likely if you are pregnant, so the usual pattern may not be clear. The NHS also lists a pregnancy test among the tests used when there is a chance you could be pregnant, and lists problems in pregnancy as a possible complication of a burst appendix.

Because many conditions can cause tummy pain, including ectopic pregnancy, the NHS advice is to get medical help if you are worried rather than trying to diagnose it yourself. Urgent advice is the same: 111 or an urgent GP appointment for worsening pain, and 999 or A&E for severe pain or signs of sepsis.

Suspected appendicitis is an emergency pathway. On the NHS it is managed through a GP referral, NHS 111, or A&E, and the NHS says it needs urgent treatment in hospital.

Private care can be relevant for planning and follow-up rather than for sudden severe pain, for example a surgical opinion after an appendix mass has been treated with antibiotics. If you have private medical insurance, check with your insurer what it covers, and in every case make sure your GP is told about any treatment you receive.