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Symptoms

Many of the symptoms of appendicitis can occur in a variety of illnesses making diagnosis difficult. Typical symptoms and signs of acute appendicitis appear in less than 50% of patients. 

The most prevalent symptom is abdominal pain, which begins as vague discomfort around the navel.  The pain is at first diffuse and poorly localized. This pain usually increases over a period of 6 to 12 hours and may become very severe.

As inflammation increases, it extends through the appendix to its outer covering and then to the lining of the abdomen, a thin membrane called the peritoneum. Once the peritoneum becomes inflamed, the pain changes and then can be localized clearly to one small area. Generally, this area is between the front of the right hip bone and the navel. The exact point is named after Dr. Charles McBurney--McBurney's point. If the appendix perforates (ruptures) and infection spreads throughout the abdomen, the pain becomes diffuse again as the entire lining of the abdomen becomes inflamed.

Symptoms of appendicitis may include:

  • pain in the abdomen, first around the navel, then moving to the lower right area
  • anorexia (loss of appetite)
  • nausea
  • vomiting
  • constipation or diarrhea
  • inability to pass gas
  • low-grade fever that begins after other symptoms
  • abdominal swelling

Not everyone with appendicitis has all the symptoms. The pain intensifies and worsens when moving, taking deep breaths, coughing, or sneezing. The area becomes very tender. People may have a sensation called "downward urge," also known as "tenesmus," which is the feeling that a bowel movement will relieve their discomfort. Laxatives and pain medications should not be taken in this situation.

The fact that abdominal pain begins before nausea and vomiting, rather than after, is one clue that the problem might be appendicitis rather than a gastrointestinal infection. Another clue is that the pain associated with appendicitis doesn't come and go; it continues to get steadily worse.

If appendicitis isn't treated promptly, the infected appendix may perforate (rupture) and the infection may spread to other areas of the abdomen. In this case, the abdominal pain may involve the whole abdomen, and a person's fever can become very high.

Pregnant women, infants and young children, and the elderly have particular issues.

Abdominal pain, nausea, and vomiting are more common during pregnancy and may or may not be the signs of appendicitis. Many women who develop appendicitis during pregnancy do not experience the classic symptoms. Pregnant women who experience pain on the right side of the abdomen need to contact a doctor. Women in their third trimester are most at risk.

Infants and young children cannot communicate their pain history to parents or doctors. Without a clear history, doctors must rely on a physical exam and less specific symptoms, such as vomiting and fatigue. Toddlers with appendicitis sometimes have trouble eating and may seem unusually sleepy. Children may have constipation, but may also have small stools that contain mucus.

Older patients tend to have more medical problems than young patients. The elderly often experience less fever and less severe abdominal pain than other patients do. Many older adults do not know that they have a serious problem until the appendix is close to rupturing.

Many variations in symptoms and signs can occur. Pain may not be localized, particularly in infants and children. Tenderness may be diffuse or noted only on rectal or pelvic examination; in rare instances, tenderness is absent and abdominal pain, persistent fever, and leukocytosis (elevated white blood count) are the only signs. Bowel movements are usually less frequent or are absent; if diarrhea is a sign, a retrocecal appendix should be suspected.