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Appendicitis symptoms: What are the early signs of appendicitis?

Medically reviewed by Chad Shaffer, MD
Physician
Updated Oct. 27, 2023  •  Published Feb. 28, 2023
Fact Checked
Appendicitis symptoms

Overview: What does appendicitis feel like?

Appendicitis is inflammation of the appendix, a small, thin tube attached to the large intestine in the right lower corner of the abdomen. Appendicitis typically comes on suddenly and rapidly worsens into a medical emergency. The swelling may eventually tear a hole in the appendix within one or two days after the first symptoms. The bacteria filling the appendix then spill out into the abdominal cavity and cause a wider infection. What does appendicitis feel like? It hurts. In fact, it eventually hurts a lot. The pain classically starts around the belly button, but within one or two hours, becomes focused at the bottom right area of the abdomen. The pain gets worse and worse as the appendix swells. If the appendix ruptures, the pain can be severe. 

Key takeaways:

  • Appendicitis is a relatively common health condition that can affect anyone regardless of age, sex, race, or ethnicity, though it is slightly more common among men. 

  • Early signs of appendicitis include generalized pain around the belly button area that migrates to the lower right abdomen within a few hours.

  • Serious symptoms of appendicitis, such as lower right abdomen pain, may require immediate medical attention.

  • The cause of appendicitis is obstruction of the appendix opening, usually by a fecal mass, stone, or swelling within the appendix wall. You may be at greater risk for developing appendicitis symptoms if you are a young male, ages 10 to 30, or if you have a family history of appendicitis.

  • Appendicitis requires a medical diagnosis.

  • Symptoms of appendicitis generally require treatment. They typically resolve only with abdominal surgery, although intravenous antibiotics are sometimes tried.

  • Treatment of appendicitis may include surgical removal. Read more about appendicitis treatments here.

  • Untreated appendicitis could result in life-threatening complications. Some complications include perforation of the appendix, infection of the abdominal cavity (peritonitis), and sepsis.

  • Save on prescriptions for appendicitis with a SingleCare prescription discount card.

What are the early signs of appendicitis?

The most common symptom and earliest sign of appendicitis is generalized pain centered around the navel. In the first hour or two, the pain may come and go a few times. As the appendix swells over the next couple of hours, the pain will move to the bottom right area of the abdomen and become constant. The migratory pain sequence occurs in about half of patients with appendicitis, so if absent, it does not rule out appendicitis. Also of note, the appendix can be located more toward the back or pelvis, and in these individuals, the pain location can be different. As the appendix swelling continues, coughing, a bumpy car ride, or walking may worsen the pain. 

What are the early signs of appendicitis?

Other appendicitis symptoms

Other common symptoms of appendicitis include:

  • Fever

  • Nausea

  • Vomiting

  • Loss of appetite

  • Diarrhea

  • Feeling ill

  • Increased urination or an increased need to urinate

Appendicitis vs. ovarian cyst vs. kidney stone symptoms

Like appendicitis, ovarian cysts or kidney stones can cause abdominal pain. However, appendicitis requires emergency medical treatment, so it’s important to know how to recognize an inflamed appendix. Pain is the best sign. Although all three cause abdominal pain, 

  • Appendicitis starts with pain around the belly button that soon moves to the lower right abdomen. At first, the pain comes and goes, but soon it becomes constant and unbearable. Other intestinal causes of pain include diverticulitis, infection, and Crohn’s disease. 

  • Kidney stone pain starts near the upper abdomen or back, near the ribs, and can move down the abdomen. The pain is very sharp but usually comes in waves. Unlike appendicitis, moving does not usually affect the pain. Urinating is typically painful only when the stone is farther along in passage. Other urologic conditions can mimic appendicitis too.

  • Pain due to a ruptured ovarian cyst can be in the lower right or left abdomen, but it does not start mid-abdomen. The pain may be sharp or dull and does not usually last. Ovarian abscess and torsion are two of the other gynecologic conditions that can present with signs that are similar to appendicitis.

Appendicitis Ovarian cyst Kidney stone
Shared symptoms
  • Abdominal pain
  • Nausea
  • Vomiting
  • Frequent urination (less common)
Unique symptoms
  • Pain that first appears in the middle of the abdomen and rapidly migrates to the lower right side of the abdomen
  • Constant pain that worsens over time
  • Pain worsens when coughing or walking
  • Loss of appetite
  • Diarrhea
  • Pain in the pelvic area, usually on one side of the body
  • Pain can come and go or be constant
  • Pain during sex
  • Difficulty passing stools
  • Difficulty urinating
  • Changes in menstruation
  • Abdominal bloating
  • Sharp pain in the side and back near the ribs
  • Pain radiates to the lower abdomen
  • Pain comes in waves
  • Pain or burning while urinating
  • Blood in the urine
  • Bad-smelling urine if also infected

Types of appendicitis: How can I tell which one I have?

There are three types of appendicitis: acute, recurrent, and chronic.

Acute appendicitis is what most people think of as appendicitis. It comes on suddenly and progresses rapidly. It’s usually divided into two stages: uncomplicated and complicated. When the only problem is an inflamed appendix, the situation is uncomplicated and can be resolved by removing the appendix. When the appendix ruptures or has an abscess, the situation is complicated and requires additional surgical work and treatment besides removal. At all stages, appendicitis is an emergency medical condition that typically requires surgical removal of the appendix as soon as possible. 

Recurrent appendicitis is an uncommon condition in which appendicitis symptoms resolve on their own and then come back later. The cause is unknown, but healthcare professionals believe it’s due to a temporary blockage of the appendix opening. 

Chronic appendicitis is also a rare condition marked by continuous but milder abdominal pain for weeks, months, or years. Again, the cause is unknown, but it is believed to happen when the appendix opening is only partially blocked.

When to see a doctor for appendicitis symptoms

See a doctor immediately when appendicitis symptoms are noticed. If the abdominal pain migrates from the area around the navel to the right lower abdomen, go to an emergency department, or if any abdominal pain. As time passes and the symptoms worsen, the situation gets more critical.

A doctor will diagnose appendicitis through the symptoms, particularly the migration of the pain, rebound pain, tenderness, nausea, loss of appetite, and fever. The doctor will also perform a physical exam, paying particular attention to tenderness and pain. A blood test will also be performed to measure white blood cell counts. That’s sometimes enough to make a diagnosis in an emergency, but the doctor will usually ask for a CT scan, abdominal ultrasound, or MRI.

Complications of appendicitis

The appendix will form an abscess and eventually rupture if it is not removed soon after the appearance of symptoms. The swollen appendix is full of bacteria, so there’s a danger of a bacterial infection spreading throughout the abdominal cavity if the appendix breaks open. Serious complications of appendicitis include:

  • Abscess

  • Perforation of the appendix

  • Bacterial infection of the abdominal lining (peritoneum) due to a ruptured appendix

  • Sepsis

Complications due to the surgical removal of the appendix (appendectomy) include:

  • Abscesses

  • Blood pooling in the abdomen (hematoma)

  • Surgical wound problems

How to treat appendicitis symptoms

Appendicitis always requires immediate medical treatment and usually surgical removal. The appendix is usually removed by inserting a camera tube and small surgical instruments into the abdomen through small incisions. Called a laparoscopic or robot-assisted appendectomy, the wounds are minimal, and people typically go home the same day or the next day. For complicated appendicitis, the surgeon may need to open the abdomen to remove the appendix and do other surgical work, which is called an open appendectomy.

Once the appendix has been removed, healthcare providers will prescribe pain medications. All that’s typically required for laparoscopy are NSAIDs such as naproxen or ibuprofen. For open surgery, opioids are typically prescribed for a few days. If the infection spreads to the abdominal cavity, patients will also be prescribed a course of antibiotics. Constipation may be a problem after surgery, so over-the-counter fiber supplements or laxatives may be recommended by the treating provider.

Living with appendicitis 

After the appendix is removed, recovery time will take a few weeks, typically two weeks for laparoscopic surgery and up to six weeks for an open appendectomy. Here are a few tips to help aid in recovery after surgery:

  • Keep all follow-up appointments

  • Take the medications as instructed

  • Do not take other medications unless approved by the doctor

  • Rest when tired

  • Avoid any strenuous lifting or activity

  • Walk a little each day, following the activity directions given by the surgeon

  • Do not strain when having a bowel movement

  • Do not take a bath until instructed to

  • Follow the recommended diet

  • Drink plenty of fluids unless instructed not to

  • For an open appendectomy, wash the wound as instructed

  • Keep the wound clean and dry

  • Change the bandage every day if instructed

  • Watch for signs of infection

  • Follow all instructions about changing any wound packing or managing a drain

RELATED: Your guide to appendectomy recovery

Most importantly, go to an emergency department

Appendicitis worsens very rapidly. Within days, an inflamed appendix could lead to life-threatening complications if the appendix ruptures. Go to an emergency room for severe, worsening, or persisting abdominal pain, or if abdominal pain starts near the belly button, moves down to the lower right abdomen, and gets worse. Don’t wait. The longer you wait, the more likely that recovery will be long and painful or that life-threatening complications will occur. Only a doctor can diagnose and treat appendicitis, so don’t try to guess.

FAQs about appendicitis symptoms

How can you check yourself for appendicitis at home?

The definitive symptom of appendicitis is abdominal pain that starts around the navel and moves to the lower right quarter of the abdomen. The pain will worsen as time goes on. Do not waste time checking yourself for appendicitis. Only a doctor can diagnose appendicitis.

What are unusual appendicitis symptoms?

Less common symptoms of appendicitis include difficulty urinating, cramps, constipation, or diarrhea. Some people have their appendix on the left side of their body, not the right. In rare cases of appendicitis, people will experience appendicitis as a sharp pain in the left lower quadrant of their body. The appendix can sometimes be near the top of the abdomen, underneath the liver, near the stomach, touching a kidney, at the back of the colon, by the rectum, or even in the scrotum. Anyone with these variants will feel appendicitis pain at the top of their abdomen, their back, or some other unusual place.

Where is appendicitis pain located?

Appendix pain usually starts around the middle of the abdomen. It may come and go, but in a few hours, the pain will move to the lower right corner of the abdomen.

What’s next? Additional resources for people with appendicitis symptoms

Test and diagnostics

  • Diagnosis of appendicitis, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) at the National Institutes of Health (NIH)

Treatments

Scientific studies and clinical trials

Medically reviewed by Chad Shaffer, MD
Physician

Chad Shaffer, MD, earned his medical doctorate from Penn State University and completed a combined Internal Medicine and Pediatrics residency at the University of Pittsburgh Medical Center and Children’s Hospital of Pittsburgh. He is board certified by the American Board of Internal Medicine and the American Board of Pediatrics. He has provided full-service primary care to all ages for over 15 years, building a practice from start up to over 3,000 patients. His passion is educating patients on their health and treatment, so they can make well-informed decisions.

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