Symptoms of appendicitis


The symptoms of appendicitis are the same as those of appendicitis.
In the foreground is a sharp pain in the right lower abdomen. Other symptoms such as nausea, vomiting or fever can also occur. The distinction between the two clinical pictures can only be made by observing the clinical course and further diagnostics.

The typical symptoms of appendicitis

These are the typical symptoms of appendicitis:

  • Pain in the right lower abdomen
  • Loss of appetite
  • Nausea and vomiting
  • fever
  • chills
  • increased heart rate

More information can be found at: Symptoms, causes and therapy of appendix irritation

Symptoms of appendix irritation - early symptoms

If there are symptoms of appendicitis without evidence of infection, one speaks of appendicitis. It most commonly occurs in children between the ages of 9 and 14.

Irritation of the appendix is ​​not dangerous in itself, but since it occurs most frequently in children and these often have an atypical course of appendicitis, a doctor should always be examined. The symptoms of appendix irritation can vary greatly in intensity and severity.

The most common symptoms include abdominal pain and abdominal cramps, which can range from a slight feeling of pressure to extreme pain. Nausea, vomiting and loss of appetite are also common with appendicitis.

In rare cases, there is even a fever and chills, whereby an inflammation of the appendix is ​​usually already present.

Appendicitis can precede appendicitis as an early sign and should therefore be taken seriously, because appendicitis can often be treated with medication, whereas acute appendicitis always requires surgery.

Read more on the topic: Duration of visual bowel irritation

Appendicitis pain

Where is the pain from appendicitis?

In the early stages, the pain of appendicitis is distributed across the upper abdomen and around the navel.
Later, after about 4 to 24 hours, they migrate to the right lower abdomen. They then remain there. This migration of pain is very typical of appendicitis. In some cases there are variances in the position of the appendix. Then the pain can also be felt in the flanks or in the lower abdomen, depending on where the appendix is ​​in the body. In pregnant women, the localization of pain is higher than in non-pregnant women.

Read more on this topic at: Signs of appendicitis

Pain in the right lower abdomen

Pain in the right lower abdomen is typical of both appendix irritation and inflammation of the appendix.
The pain is specifically localized in the right lower abdomen, since this is where the appendix is ​​usually located. In the initial phase of appendix irritation, the pain can also be diffuse around the navel. Only after a few hours does the pain move to the right lower abdomen. Here they are then perceived as stinging or cramping.

Find out more about the topic here: Lower abdominal pain

Lower left abdomen pain

Pain in the left lower abdomen is not necessarily typical of appendicitis, but it can also occur, for which there are various causes.

Classically, the pain of appendicitis begins in the middle of the upper abdomen and then moves to the right lower abdomen. However, the spread of pain depends on the position of the appendix, usually the appendix is ​​located in the right lower abdomen and therefore causes pain here as well. In rare cases, however, the appendix can lie further in the middle or to the left in the lower abdomen, so that pain is expressed in the left lower abdomen.

Another very typical feature of appendicitis is the so-called letting go pain, here is pressed deep into the left lower abdomen and held for a few seconds, which also causes pain in a classic appendicitis, and then suddenly let go. In the case of appendicitis, this triggers an even stronger pain in the right lower abdomen, the pain of letting go.

However, pain in the left lower abdomen is far more often the cause of other diseases than appendicitis. The most common are diseases of the large intestine in the form of protuberances that can become inflamed, so-called diverticulitis, diseases of the urinary tract - ascending urinary tract infections or ureteral stones - and in women also diseases of the ovaries and fallopian tubes.

For a precise differentiation and diagnosis of the pain, a doctor should always be consulted as quickly as possible, as many of the clinical pictures described above can have an acute course.

Read more on the topic:

  • Pain in the left lower abdomen
  • Pain associated with diverticulitis

How is the pain from appendicitis?

At first, the pain is perceived as dull and diffuse. In this phase, the pain cannot be assigned a precise location.
Once the pain has migrated to the right lower abdomen, it is described as sharp and bright by the patient. If there are complications, such as a perforation, i.e. a tear in the appendix, the pain is temporarily perceived to be reduced. Then there is severe pain all over the abdomen. This condition is described in medical terminology as peritonitis.

Do you have any other questions about appendicitis pain? Read more about this at: Appendicitis pain

Colicky stomach pain

Colic-like abdominal pain is the most severe pain, with a cramping and labor-like pain character. These pains are rather untypical for appendicitis, but cannot be ruled out.

Colic abdominal pain is more often the cause of a disease of the pancreas, accompanied by belt-shaped pain in the upper abdomen, kidney or gallstones, with gallstones usually causing symptoms after high-fat meals.

Read more on the topic:

  • Pancreatitis - How Dangerous Is It?
  • Gallstones

How can you provoke the pain?

The provocation of the pain is part of the diagnostic work-up of appendicitis.
Initially, pain can be provoked solely by pressure on the right lower abdomen. The pain often lies on the line connecting the navel and the upper front edge of the pelvic bone or on the line between the two pelvic bones. Another option is to put pressure on your left lower abdomen and then quickly let go. The pain is then typically felt in the right lower abdomen. A shock can also provoke the pain well. A shock can be triggered, for example, by hopping on one leg. Finally, lifting the right leg against resistance can also provoke the pain.

Read more on this topic at: Tests to detect appendicitis

Is there also appendicitis without pain?

The typical symptoms of appendicitis can also be absent, especially in childhood and adolescence. One then speaks of an atypical symptomatology.
The children do not perceive any pain, which can then lead to a delayed diagnosis. This is especially the case with young children. In this case, attention should be paid to abnormal behavior on the part of the children, such as a stooped position or sparse movements on the examination couch.
Older patients do not necessarily have to suffer from appendicitis pain. The patients report a feeling of pressure rather than a sharp pain. The course of the pain is also different. Instead of the acute course, which can worsen within hours, older patients typically show a creeping course of pain.

Other symptoms of appendicitis


Flatulence is a nonspecific symptom and does not directly indicate appendectal irritation as it can have many other causes as well. It is known, however, that appendicitis can cause gas and bloating as well as constipation.
Thus, the assumption can be made that flatulence can also occur with irritation of the appendix. However, it is not a sure sign of irritation of the appendix.

Read more about the topic here: Causes of Flatulence

Hardening of the entire abdomen

In appendicitis, the abdomen usually remains soft and can be pressed in, but depending on the progression of the inflammation with pain-related defensive tension in the middle upper abdomen or right lower abdomen.

However, if the entire abdomen feels hard and any manipulation of the abdominal wall leads to severe pain and defensive tension, a doctor should be consulted as soon as possible, as there is probably an inflammation of the peritoneum and thus the entire abdominal cavity.
Peritonitis, too Peritonitis called, is a serious complication of appendicitis. The peritoneum is a double-layered skin that lines all organs in the abdomen. In the context of appendicitis, intestinal bacteria can escape into the abdominal cavity - the most common pathogen here is the intestinal bacterium Escherichia coli, which infect the peritoneum and thus lead to inflammation of the entire abdominal cavity. This is a life-threatening infection that requires therapy as soon as possible.

Read more on the topic: Acute abdomen

Back pain

Back pain is not one of the classic symptoms of appendicitis.
Because of the location of the appendix, pelvic pain is far more common. However, there are people in whom the appendix is ​​shifted further back in the abdomen. With such a position variance, flank or back pain is more often perceived instead of abdominal pain. Since back pain typically has other causes, it must be determined whether the back pain is related to the appendix irritation or whether it occurred as a separate symptom.

Find out more about the topic here: Causes of back pain


Nausea is one of the typical signs of appendicitis and is quite common. The nausea can also be accompanied by vomiting. In addition, it is classically linked to a lack of appetite.
It is often difficult to distinguish whether the nausea is due to appendicitis or a simple gastrointestinal flu. In both cases, nausea occurs early on in the disease.
In children and adolescents, it must be noted that they may have atypical symptoms and that appendicitis should still be considered.

Read more on this topic at: Abdominal pain and nausea

Loss of appetite

The classic symptoms of appendicitis include loss of appetite. Often this already sets in before any other symptoms such as pain, but is not always noticed.
Loss of appetite is our body's response to a disturbance in the digestive system in order to keep eating, which does not worsen possible complications such as diarrhea and vomiting. However, loss of appetite is a very common symptom also with many diseases, especially with diseases of the gastrointestinal tract and therefore not to be regarded specifically for appendicitis.

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Appendicitis is often associated with constipation and flatulence (wind retention).
Diarrhea, on the other hand, is rather atypical in appendicitis and suggests gastrointestinal inflammation. In small children, appendicitis can also be associated with diarrhea, so the differential diagnosis of appendicitis should always be kept in mind.

Read more on this topic at: Abdominal pain and constipation

Blood in the stool

Blood in the stool is unlikely to suggest appendicitis. If there is blood in the stool, other causes should be investigated as a matter of priority.
Inflammation of a Meckel's diverticulum, chronic inflammatory bowel disease or colon cancer must be considered.

Read more on this topic at: Causes of blood in the stool

Blood in the urine

Blood in the urine is not typical for appendicitis.
For blood to get into the urine, there must be damage to the kidneys or the urinary tract. In the case of appendicitis, it is possible that the right ureter becomes inflamed due to its proximity to the appendix. This could lead to blood staining in the urine. It is therefore important not to rule out appendicitis from the outset if there is blood in the urine.

Read more on this topic at: Causes of blood in the urine

The symptoms of appendicitis differ from those of visual bowel irritation

The difficulty in diagnosing appendicitis is that the symptoms hardly differ from those of appendicitis. In both clinical pictures, the main symptom is pain in the right lower abdomen. It is also known that symptoms such as loss of appetite, nausea or vomiting are equally present in both diseases of the appendix and therefore do not allow any differentiation.
The symptom of fever can be suspected that it is more pronounced in appendicitis due to the inflammatory processes in the body than in appendicitis. However, not every appendicitis is accompanied by a fever and a fever can also be present when the appendix is ​​irritated. In terms of symptoms, a distinction is only possible in a few cases. The clinical course of the symptoms and further diagnostics, such as blood sampling and sonography, are more important.

Read more about the topic here: Signs of appendicitis

How do I know the symptoms of appendicitis in children?

In children, distinguishing between irritation of the appendix and appendicitis based on the symptoms is even more difficult than in adults. Small children in particular do not show the typical symptoms of the two clinical pictures.
For example, diarrhea can also be a sign of appendix irritation in young children. On the other hand, in children, appendicitis is the most common cause of acute abdomen. Since an acute abdomen can lead to significant complications, ruling out appendicitis in children is essential.
Waiting for the course of the disease should only be carried out under medical supervision. In addition, a blood sample or sonography should be performed in children to rule out appendicitis.

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What are the symptoms of a ruptured appendix?

In the course of the inflammation, there is a strong swelling of the appendix. If the inflammation remains undetected or untreated for a long time, the massively swollen and inflamed tissue can rupture - burst.

Signs of a rupture of the appendix are mainly found in the course of the pain. Usually appendicitis begins with pain in the upper middle abdomen, along with malaise, nausea, and loss of appetite. Over time, the pain moves from the upper abdomen to the right lower abdomen and finds its highest intensity here. Even light touches in the right lower abdomen are often no longer tolerable, and straight standing or walking is usually no longer possible.

If the appendix bursts, the symptoms suddenly improve, and the feeling of pressure and pain in the lower abdomen is usually significantly reduced or no longer present. This is a critical point because at this moment many patients think that they have overcame the worst and are on the way to recovery.

Unfortunately, exactly the opposite is the case, the rupture initially relieves the inflamed tissue and thereby alleviates the pain, but now bacteria can enter the abdomen from the intestine and lead to severe inflammation of the entire abdomen. After the initial pain relief, severe pain and fever spread across the entire abdomen within a few hours. The stomach becomes as hard as a board and every touch and shock triggers the greatest pain.

Further information on this:

  • Ruptured appendix
  • Appendectomy