Appendicitis: Types, Causes, Symptoms & Treatment

Appendicitis is the inflammation of the appendix. It can cause acute (sudden and intense) or chronic pain in your lower abdomen. As inflammation worsens, the pain typically increases and eventually becomes severe.

Acute appendicitis is common, especially between the ages of 10 and 30. Appendicitis in children is most common during the teen years, but younger children also get it. It’s the leading cause of abdominal pain leading to emergency abdominal surgery. The chronic one occurs in approximately 1% of the population.

What is the appendix

Your appendix is a small, tubular pouch, about the size of a finger, that protrudes from the lower right end of your large intestine. When your appendix becomes blocked, bacteria can multiply inside it. This can lead to the formation of pus and swelling, which can cause painful pressure in your abdomen.

When the appendix bursts, bacteria can spill into your abdominal cavity, which can be serious and sometimes fatal. Appendicitis can also lead to the blockage of blood flow.

Symptoms of appendicitis

Signs and symptoms may include:

• Sudden pain that begins around your navel and often shifts to your lower right abdomen
• Sudden pain that begins on the right side of the lower abdomen
• Pain that worsens if you cough, walk or make other jarring movements
• Low-grade fever that may worsen as the illness progresses
• Nausea and vomiting
• Constipation or diarrhea
• Abdominal bloating
• Flatulence
• Loss of appetite

The site of your pain may vary, depending on your age and the position of your appendix. When you’re pregnant, the pain may seem to come from your upper abdomen because your appendix is higher during pregnancy. Should make an appointment with your healthcare provider if you or your child has worrisome signs or symptoms. Severe abdominal pain requires immediate medical attention.

You can also read about symptoms and types of sciatica (nerve pain).

Type of appendicitis

There are two major classification which include:

• Acute appendicitis: This is a severe and sudden case. It’s most common in children and young adults between the ages 10 and 30 years old and occurs more frequently in males than females. Pain tends to develop and intensify quickly over the course of 24 hours. It requires immediate medical treatment. If left untreated, it can cause your appendix to rupture. This can be a serious and even fatal complication. This type is more common than the chronic one.
• Chronic appendicitis: This is less common than the acute one. It occurs in only about 1.5 percent of all people who have already had a case of acute appendicitis. In chronic cases, the symptoms may be relatively mild and are thought to usually occur following a case of the acute one. Symptoms may disappear before reappearing again over a period of weeks, months, or even years. This type can be so challenging to diagnose. Sometimes it’s not diagnosed until it develops into acute one.

Causes of appendicitis

The size and location of your appendix make it easy for it to become clogged and infected. Your large intestine is home to many bacteria, and if too many become trapped in your appendix, they overgrow and cause an infection.

Sometimes, the appendicitis begins with an infection, and sometimes, the infection is secondary. Swelling in your appendix can reduce or close the opening and trap more bacteria inside. Common causes of inflammation, swelling, obstruction and infection in your appendix include:

• Hardened poop (appendix stones). Hard, calcified fecal deposits known as fecaliths, appendicoliths or appendix stones can get stuck in the opening to your appendix. They carry bacteria and can also trap bacteria that was already there inside your appendix.
• Colitis. Inflammation in your colon from an infection or inflammatory bowel disease can affect your appendix. The infection may spread, or the inflammation itself may irritate it.
• Lymphoid hyperplasia. Your lymphatic system, which is part of your immune system, helps fight infections by producing and releasing white blood cells into your tissues. This can cause the lymphoid tissue in your appendix to swell, even when the original infection is elsewhere in your body. The swollen tissue in your appendix can obstruct it and lead to infection inside.

Other factors that could block the opening to your appendix include:

• Cystic fibrosis.
• Parasites.
• Tumors.

The theory of chronic appendicitis is that something causes mild inflammation on and off for a long time. It might be a chronic condition like inflammatory bowel disease or mild bacterial overgrowth. Or it might be an obstruction that moves in and out of the opening to your appendix. Chronic inflammation can lead to lymphoid hyperplasia or even scar tissue in your appendix if it lasts a very long time.

You can also read about causes and complications of kidney stones.

Complications of appendicitis

It can cause serious and severe complications if your appendix ruptures, which can cause fecal matter and bacteria to spill into your abdominal cavity. A ruptured appendix can lead to painful and potentially life threatening infections, including:

• abscesses
• peritonitis
• sepsis
• Ischemia and necrosis
• Gangrene/perforation

Abscesses. An abscess is a painful pocket of pus that forms around a burst appendix. These white blood cells are your body’s way of attempting to fight the infection. The infection must be treated with antibiotics, and the abscess will need to be drained.

Peritonitis. When the appendix bursts and bacteria spill into your abdominal cavity, the lining of your abdominal cavity, or peritoneum, can become infected and inflamed. This is known as peritonitis. It can be very serious and even fatal. Symptoms of peritonitis may include:

• high fever
• fast heartbeat
• severe and continuous abdominal pain
• shortness of breath or rapid breathing

Sepsis. In rare cases, bacteria from a ruptured abscess may travel through your bloodstream to other parts of your body. This extremely serious condition is known as sepsis. Symptoms of sepsis include:

• confusion
• high or low temperature
• shortness of breath 
• severe sleepiness

Ischemia and necrosis. Severe swelling in your appendix cuts off the blood supply (ischemia,) which increases inflammation and eventually causes the tissues to start to decay (necrosis).

Gangrene/perforation. Once necrosis sets in, infection can spread. It may spread slowly through internal gangrene or quickly when your appendix tears or bursts (perforation).

Prevention of appendicitis

There’s no sure way to prevent your risk of appendicitis. But you can lower your risk of developing it by eating a fiber-rich diet. Although more research is needed on the potential role of diet, appendix problem is less common in countries where people eat high-fiber diets.

Foods that are high in fiber include:

• vegetables
• fruits
• oatmeal, brown rice, whole wheat, and other whole grains
• lentils, split peas, beans, and other legumes

You can also read about the complications and prevention of high blood pressure.

Diagnosis of appendicitis

To help diagnose appendicitis, your doctor will likely take a history of your signs and symptoms and examine your abdomen. Tests used in the diagnosis include:

• Physical exam to assess your pain. Your doctor may apply gentle pressure on the painful area. When the pressure is suddenly released, appendicitis pain will often feel worse, signaling that the adjacent peritoneum is inflamed. Your doctor may also look for abdominal rigidity and a tendency for you to stiffen your abdominal muscles in response to pressure over the inflamed appendix (guarding). Your doctor may use a lubricated, gloved finger to examine your lower rectum (digital rectal exam). Women of childbearing age may be given a pelvic exam to check for possible gynecological problems that could be causing the pain.
• Imaging tests. Your doctor may also recommend an abdominal X-ray, an abdominal ultrasound, computerized tomography (CT) scan or magnetic resonance imaging (MRI) to help confirm appendicitis or find other causes for your pain.
• Blood test. This allows your doctor to check for a high white blood cell count, which may indicate an infection.
• Urine test. Your doctor may want you to have a urinalysis to make sure that a urinary tract infection or a kidney stone isn’t causing your pain.

You can also read about the diagnosis and symptoms of deep vein thrombosis.

Treatment of appendicitis

It’s possible but not likely. It may spontaneously resolve if the cause suddenly goes away on its own. This might happen if an obstruction in your appendix gets unstuck and passes on through your intestine, or if an infection that was causing lymphoid hyperplasia in your appendix suddenly improves. But you shouldn’t assume this will happen or that it has happened, even if your pain has reduced.

Appendicitis treatment usually involves medications and surgery to remove the inflamed appendix. Before surgery you may be given a dose of antibiotics to treat infection.

Medication treatment

Almost everyone will need antibiotics for appendicitis treatment. Even if you didn’t have an infection to start with, it usually leads to one. Antibiotics are also a standard preventive treatment before surgery.

If you have a very early and mild case, your healthcare provider might take a wait-and-watch approach to see if your condition improves with antibiotics alone. You might prefer this approach if you have risk factors that make surgery less safe for you. However, healthcare providers rarely recommend it because appendix problem often returns when you don’t have your appendix removed.

You may also need medication for pain relief. You can have this through your IV. If you’re having surgery, you’ll have general anesthesia, so you won’t be conscious (awake) during the procedure.

Medical procedure

Once you’ve been diagnosed with appendicitis, time is of the essence. Your appendix can rupture within 36 hours of your first symptoms. Surgeons will usually schedule your appendectomy within 24 hours of your diagnosis. Appendectomy is one of the most common surgical procedures performed worldwide. Surgeons can often perform it using minimally invasive methods, such as laparoscopic surgery.

Your surgeon will also treat any complications you have during your surgery. Complications may require open abdominal surgery to manage. After surgery, they’ll rinse your abdomen with a sterile solution.

There aren’t any side effects of having your appendix removed. Healthcare providers aren’t sure if your appendix has any function. If it does, it’s a small one. It may help make antibodies during childhood.

If you had a simple laparoscopic appendectomy, you might be able to go home the same day. If you had complications or open surgery, you might need to stay in the hospital a little longer. Before you leave the hospital, your healthcare provider can help you learn how to care for your incision sites. They may prescribe antibiotics or pain relievers to support your recovery process. They may also advise you to adjust your diet, avoid strenuous activity, or make other changes to your daily habits while you heal.

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