Grumbling appendix: symptoms, what it could be and when to get help

People who say they have a "grumbling appendix" usually mean a dull, on-and-off ache in the lower right of the abdomen that comes and goes over days, weeks or longer. This guide uses that wording because it is how many people search, but it is worth knowing that the NHS and NHS inform describe appendicitis rather than a separate "grumbling" condition, and we have found no UK health service page that defines the term.

What the NHS does describe is how appendicitis can vary. The classic pattern is pain starting in the middle of the abdomen, around the belly button, then moving after a few hours to the lower right side, getting worse and feeling worse when you move, cough or press on the area. The NHS says it may feel slightly better when you pull your knees up to your chest.

It also says that some people do not have the usual pain. The pain may be less severe, develop more slowly or be in a different place, and this is more likely if you are pregnant, in young children and in older people. NHS inform adds that the classic symptoms are present in only about half of all cases, and that the appendix sits in a slightly different position in some people, such as in the pelvis or behind the large intestine.

• pain in the middle of the tummy that moves to the lower right

• feeling or being sick, or loss of appetite

• a high temperature

• constipation or diarrhoea

• peeing more often than usual

• sudden confusion in older people

Many conditions give lower abdominal pain, which is why you should not diagnose yourself. The NHS names urinary tract infections, kidney stones or gallstones, bowel problems such as irritable bowel syndrome or Crohn’s disease, conditions affecting the womb or ovaries such as pelvic inflammatory disease or a ruptured ovarian cyst, and ectopic pregnancy. NHS inform adds gastroenteritis, constipation and bladder or urine infections, and notes that in young women the cause can sometimes be gynaecological, such as menstrual pain.

Because the list is long, a doctor will usually examine the tummy and decide whether further tests are needed. A recurring pattern is a reason to see your GP rather than to wait and see.

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

Call 999 or go to A&E for severe tummy pain, or for 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, which could be signs of sepsis. Do not drive yourself to A&E.

A burst appendix can bring a sudden, short-lived improvement in pain, then severe pain across the whole tummy. The NHS says this is serious and can lead to peritonitis (infection of the inner lining of the abdomen) or sepsis. NHS inform advises phoning 999 for sudden pain that keeps getting worse and spreads across your abdomen.

A GP or hospital doctor will feel your abdomen for pain and swelling. The NHS says you will need to go to hospital for tests and treatment, which may include blood tests, a urine sample, scans such as an ultrasound or CT scan to check for swelling of the appendix, and a pregnancy test if there is a chance you could be pregnant.

The NHS is open about the limits of testing: there is no test that can always show appendicitis, and sometimes doctors will wait a few hours in hospital to see how symptoms develop. NHS inform adds that some people are advised to wait up to 24 hours, and that, if the diagnosis stays uncertain, a laparoscopy (keyhole look) may be suggested to inspect the appendix and pelvic organs.

NHS inform also explains that surgeons usually prefer to remove the appendix when appendicitis is suspected rather than risk it bursting, which means some people have an appendix removed that is later found to be normal.

The NHS says appendicitis is usually treated with surgery to remove the appendix, called an appendectomy. You do not need your appendix, so it is not harmful to remove it. It is done as soon as possible, under general anaesthetic, usually by keyhole surgery through small cuts, and sometimes by open surgery through a larger cut. The operation usually takes about an hour.

Sometimes appendicitis is treated with antibiotics rather than surgery. The NHS says this may be recommended if the infection has not spread and surgery is high risk for you. If an appendix mass has formed (a lump where the bowel sticks to the appendix), you will usually have antibiotics first and surgery a few weeks later if you still have symptoms.

There is no UK health-service guidance we found that sets out a separate treatment route for an unproven "grumbling" appendix. If pain keeps recurring, the sensible step is a GP assessment, which may lead to tests for the other causes listed above or to a surgical opinion.

The NHS says most people recover from appendicitis in 1 to 2 weeks, and it can take longer if there were complications such as a burst appendix. After keyhole surgery you may go home the day after the operation; after open surgery or complications you may need a few days in hospital.

At home the NHS suggests going back to usual activities when you feel ready (often 1 to 2 weeks off work or school, sometimes longer), taking painkillers if needed, looking after the wounds, eating plenty of fibre and drinking fluids if constipated, finishing any antibiotics, and avoiding strenuous activity such as sport and driving until you can comfortably do an emergency stop. NHS inform says strenuous activities may need to be avoided for up to 6 weeks after open surgery.

Contact the hospital ward or your GP, or call NHS 111, if after an operation the wound becomes more sore or red, bleeds or leaks pus, or you develop a high temperature, as these could be signs of infection.

NHS inform estimates that around 1 in 13 people develop appendicitis at some point in life. It can occur at any age but is most common between 10 and 20 years.

The exact cause is not fully understood. NHS inform says that most cases are thought to occur when something blocks the entrance to the appendix, such as a small piece of faeces or a swollen lymph node after an upper respiratory tract infection, leading to inflammation and swelling. Because the cause is unclear, there is no guaranteed way to prevent it.

On the NHS, sudden or worsening abdominal pain goes through NHS 111, an urgent GP appointment or A&E, with surgical assessment in hospital. Recurrent, milder pain is usually first assessed by your GP, who can examine you, arrange blood and urine tests and refer for imaging or a surgical opinion.

Some people choose a private consultation with a surgeon or gastroenterologist for recurrent pain. The same principle applies: persistent or worsening pain is never something to manage with a long wait for an appointment, and red-flag symptoms need urgent NHS care.