Our appendix is the finger-like pouch at the end of the colon, and appendicitis simply refers to the inflammation of the appendix. We often hear about people missing school or work to have their appendix removed, which is the most common cause for an emergency abdominal surgery.

Is it a cause for concern when we start experiencing pain in the lower side of our abdomen, and will it go away on its own? Read on to find out more.

What is appendicitis?

Appendicitis is the inflammation of the appendix. The appendix, sometimes called the vermiform appendix, is the finger-shaped pouch at the end of the colon, near the junction of the small intestine and the colon. Although the appendix is thought to serve no function, scientists of late believe it is involved in immune, endocrine, and digestive functions of the gut. 

Appendicitis can happen to anyone, but is typically seen in younger patients, from children to adults in their 30s. It often starts as a dull pain near your belly button, which further progresses into more palpable pain in the lower right side of your abdomen. 

If not treated immediately, the appendix can rupture, causing peritonitis, a medical emergency. Thankfully, the appendix can be removed via open surgery or a minimally invasive laparoscopy.

What does appendicitis feel like?

The symptoms of appendicitis include:

• Sudden intense pain on the lower right side of the abdomen
• Pain usually originates from the belly button to the lower right side of the abdomen
• Nausea and vomiting often follows the abdominal pain
• Low grade fever (typically between 37.5°C to 38°C)
• Constipation or diarrhoea
• Loss of appetite
• Abdominal bloating

Abdominal pain from appendicitis is experienced differently for each individual. Older people and pregnant women tend to have milder symptoms. Regardless of the cause, if you have persistent abdominal pain, a visit to your doctor is a recommended first step.

What causes appendicitis?

Appendicitis is commonly caused by an obstruction to the appendix, leading to inflammation.  Common causes of obstruction include:

• Faecoliths – Faecoliths are hardened masses of compacted faeces, which can clog up the lumen of the appendix.
  
• Tumours – Tumours that grow in the intestine or around the appendix can obstruct the appendix or compress against it.
  
• Intestinal parasites – Intestinal worms, such as Ascaris lumbricoides can get into the lumen of the appendix and cause an obstruction.
  
• Seeds – Small seeds from your foods that are not digested can get stuck in the appendix, leading to an obstruction.
  
• Lymph nodes – Hypertrophied lymph nodes can compress against the appendix, blocking the lumen of the appendix.

Experiencing Appendicitis vs. Stitches: Does it feel different?

A side stitch, or exercise-related transient abdominal pain can be mistaken as appendicitis pain.

Does appendicitis go away on its own?

In rare cases, mild appendicitis can resolve on its own. However, not seeking treatment puts you at risk for a ruptured appendix, this can lead to complications such as peritonitis, abscesses, and sepsis. This makes seeking a proper diagnosis and treatment paramount.

How is appendicitis diagnosed?

Appendicitis are typically diagnosed with the following tests:

• Clinical evaluation – Your doctor can typically diagnose you with appendicitis simply from your symptoms, they may also examine or palpate your lower right abdomen to look for signs of swelling tenderness.
  
• Abdominal ultrasound – Appendicitis diagnosis is confirmed through imaging tests such as an abdominal ultrasound. An ultrasound allows your doctor to observe your appendix and look for possible causes of pain.
  
• Computed tomography (CT) – CT scans are among the most common methods to diagnose acute appendicitis in adult patients. CT scans are also used prior to appendix removal surgery.
  
• Magnetic resonance imaging (MRI) – MRI scans are not typically used for appendix diagnosis due to their high cost and accessibility. Diagnosis using MRI scans are typically recommended for those who cannot be exposed to radiation, such as pregnant women.
  
• Blood test – A blood test can be helpful in looking for signs of infection, such as high white blood cell counts.

How is appendicitis treated?

Appendicitis is typically treated by removing the inflamed appendix. However, in milder cases, non-operative treatment can resolve the inflammation.

• Appendectomy – Appendectomy is the surgical procedure to remove the appendix. In emergency cases, such as acute appendicitis, delay or appendectomy can be life-threatening. 

• Open appendectomy — often recommended during cases where an appendix has ruptured or there is widespread infection.

• Laparoscopic appendectomy — a minimally invasive alternative that involves small incisions and the use of a miniature camera and surgical instruments to remove the appendix.
  

• Drainage – Abscess drainage is done in cases when an abscess forms in the appendix. Your doctor drains the pus by aspirating the fluid out with a catheter. After draining the abscess, appendectomy is done several weeks after the infection clears.
  
• Antibiotics – In cases where the appendix is not perforated or ruptured, treatment with antibiotics can resolve in the infection and inflammation. However, recurrences of appendicitis is very common in patients who did not undergo appendectomy. Hence, more often than not, your doctor will recommend you to get your appendix removed, especially if an obstruction was detected during diagnosis.

What happens if appendicitis is left untreated?

An inflamed appendix should not be left untreated as the condition can worsen, causing sepsis. Seeking medical attention is crucial to prevent potential complications.

• Rupture – An inflamed appendix is at risk of rupture or perforation, this condition is referred to as acute appendicitis. The ruptured appendix can release bacteria into your abdominal cavity, leading to peritonitis.
  
• Peritonitis – Peritonitis is caused by an infection to the inner lining of your abdomen from the perforated or ruptured appendix.
  
• Abscess formation – In some cases, a pus can form due to the infection, leading to abscesses. These abscesses are also at risk of rupturing and spreading the infection further.
  
• Gangrene – Gangrene of the appendix can be caused by a lack of blood supply to the appendix. This causes the tissues of the appendix to die off.
  
• Sepsis – Chronic infections from an appendix rupture, peritonitis, abscess rupture, and gangrene can lead to sepsis. Sepsis can be life threatening if not treated immediately. 

Summary

Appendicitis can cause life-threatening complications if not treated properly or promptly. In rare cases, and when caught early, you may not need surgery and antibiotics may suffice. However, waiting it out can be fatal, and it’s always best to consult your doctor when you start experiencing symptoms. Schedule a consultation with us today for a detailed diagnosis and personalised treatment plan.

Frequently Asked Questions

When should I see a doctor for appendicitis?

If you experience persistent abdominal pain, which can last hours at a time, it may be indicative of an inflamed appendix. In any case, if you experience abnormal, persistent abdominal pain that does not go away, a visit to your healthcare provider is always recommended.

How do I know if my stomach pain is caused by appendicitis?

Abdominal pain from appendicitis typically originates from the belly button, then travels down to the lower right side of the abdomen. The pain can also be intense, lasting for several hours. You may also feel intense pain when walking or coughing. Nausea and vomiting also commonly accompanies abdominal pain.

What is the appendix for?

Many believe that the appendix may be a vestigial organ and does not have any function. However, scientists now believe that the appendix may be a ‘reservoir’ for gut bacteria which can be beneficial for repopulating the gut microbiome after recovering from a gastrointestinal infection.