Appendicitis: Symptoms, Pain Location and When It’s an Emergency

Appendicitis is inflammation and infection of the appendix, a small pouch connected to the beginning of the large bowel. It often causes pain that begins near the middle of the abdomen and then moves towards the lower right-hand side. However, the symptoms are not always typical, especially in young children, pregnant people and older adults.

Appendicitis needs urgent medical assessment. An inflamed appendix can sometimes burst, allowing infection to spread inside the abdomen. Getting medical help promptly reduces the risk of serious complications.

What is appendicitis?

The appendix is a narrow, finger-shaped pouch attached to the caecum, the first part of the large bowel. It is usually located in the lower right side of the abdomen, although its exact position varies from person to person.

Appendicitis develops when the appendix becomes inflamed. This may happen after its opening becomes blocked by swelling, hardened stool or, less commonly, another obstruction. Bacteria can then multiply inside the appendix, causing further swelling and infection.

As pressure increases, the blood supply to the appendix may be affected. Without treatment, part of the appendix wall can become damaged and develop a hole. This is commonly described as a burst or ruptured appendix.

Appendicitis can happen at any age. It is particularly common in children, teenagers and younger adults, but it should not be dismissed in babies, older adults or anyone whose symptoms seem unusual.

You do not need your appendix to live normally. If it has to be removed, its absence should not affect everyday digestion or require a special long-term diet.

What does appendicitis pain feel like?

The classic pattern begins with a vague discomfort or ache around the belly button or in the middle of the abdomen. During the following hours, the pain often moves towards the lower right-hand side and becomes more persistent and intense.

This change happens because early inflammation irritates nerves that are felt more generally around the middle of the abdomen. As the inflammation reaches the lining of the abdominal cavity near the appendix, the pain becomes more precisely located.

Typical appendicitis pain may:

• start around the belly button before moving down and to the right;
• become steadily worse rather than coming and going completely;
• feel worse when walking, coughing, taking a deep breath or travelling over bumps;
• make it uncomfortable to stand upright or move normally;
• cause tenderness when the lower right abdomen is touched;
• feel slightly easier when lying still or drawing the knees towards the chest.

Not everyone develops this textbook pattern. The appendix can sit in different positions, so pain may be felt more centrally, in the pelvis, towards the back, higher in the abdomen or occasionally on the left.

The intensity of pain also varies. Early appendicitis may begin with moderate discomfort rather than sudden, unbearable pain. It is the direction in which the illness is progressing—pain becoming more localised, persistent or severe—that often matters more than a single pain score.

For a broader explanation of how the position of pain can point towards different conditions, see our guide to abdominal pain and its common causes by location.

Other symptoms of appendicitis

Abdominal pain is usually the main symptom, but appendicitis can also affect appetite, digestion and general wellbeing.

Possible accompanying symptoms include:

• loss of appetite;
• feeling sick or vomiting;
• a raised temperature;
• feeling generally unwell;
• constipation or diarrhoea;
• abdominal bloating;
• difficulty passing wind;
• needing to urinate more often;
• pain or discomfort when urinating.

Symptoms often develop over several hours, although the pace is unpredictable. Some people deteriorate quickly, while others have less obvious symptoms for longer.

Vomiting does not have to occur for appendicitis to be present. When it does occur, the abdominal pain often begins before the vomiting. This can help doctors distinguish appendicitis from some stomach infections, although no single symptom can confirm or rule it out.

A fever may be mild or absent, particularly early in the illness. Waiting for a high temperature before seeking help can therefore delay assessment.

Can you still eat with appendicitis?

Many people lose their appetite and do not want to eat. Being able to eat, however, does not prove that the appendix is healthy. Likewise, appetite loss has many other causes and is not diagnostic by itself.

Can appendicitis cause diarrhoea?

Yes. Although constipation is often associated with appendicitis, some people develop loose stools or diarrhoea. This is more likely when an inflamed appendix irritates the lower bowel or sits close to the pelvis.

Diarrhoea can make appendicitis look like gastroenteritis. The possibility of appendicitis should be considered when diarrhoea occurs alongside localised or progressively worsening abdominal pain.

When is appendicitis an emergency?

Suspected appendicitis is always urgent because it cannot be safely diagnosed at home and may worsen without treatment.

According to NHS guidance on appendicitis, you should seek urgent medical advice if abdominal pain:

• is gradually getting worse;
• does not go away;
• moves towards the lower right side of the abdomen.

Contact NHS 111, use NHS 111 online where appropriate, or request an urgent GP appointment. A clinician may direct you straight to an emergency department or surgical assessment unit.

Signs that an appendix may have burst

If the appendix develops a hole, infected material can escape into the abdomen. In some cases, severe localised pain may briefly improve as pressure inside the appendix is released. This apparent improvement can be misleading. The pain may then return and spread across the abdomen as the lining of the abdominal cavity becomes inflamed.

Possible warning signs include:

• severe pain that spreads across more of the abdomen;
• a rigid, very tender or swollen abdomen;
• high temperature or shivering;
• rapid breathing or a racing heartbeat;
• persistent vomiting;
• difficulty standing, walking or moving because of pain;
• confusion, faintness, unusual drowsiness or reduced responsiveness;
• pale, blotchy or clammy skin;
• breathlessness or a sense that something is seriously wrong.

A burst appendix can lead to peritonitis, an infection and inflammation of the abdominal lining, or to an abscess containing pus. Severe infection can also contribute to sepsis.

Call 999 or go to A&E immediately if someone has severe abdominal pain and appears seriously unwell. Information about recognising a medical emergency is available through the NHS sepsis guidance.

What should you do while waiting for help?

Follow the instructions given by NHS 111, the GP or emergency services. Avoid eating a large meal because surgery or an anaesthetic may be needed. Do not delay seeking care while trying home remedies, laxatives or repeated doses of pain medicine.

Reasonable pain relief does not prevent doctors from assessing appendicitis, but taking medication should never be used as a reason to postpone medical advice. Tell the clinical team what you have taken, the dose and the time.

Appendicitis in children, pregnancy and older adults

Appendicitis can be harder to recognise when a person cannot describe the pain clearly or when the appendix has been displaced from its usual position.

Appendicitis in babies and young children

Young children may not describe pain moving from the belly button to the lower right abdomen. Their symptoms may instead include:

• being unusually irritable, quiet or sleepy;
• refusing food or drink;
• vomiting;
• fever;
• walking bent over or not wanting to move;
• crying when the abdomen is touched;
• drawing the knees towards the chest;
• diarrhoea or a swollen abdomen.

A child with worsening abdominal pain, repeated vomiting, marked sleepiness or reduced responsiveness needs urgent assessment. Parents and carers should trust their instincts when a child is much less well than expected.

Appendicitis during pregnancy

As the uterus enlarges, the appendix can be pushed upwards. Pain may therefore be felt higher on the right side than expected, particularly later in pregnancy.

Nausea, vomiting and abdominal discomfort can be mistaken for pregnancy-related symptoms. Any new, persistent or worsening abdominal pain in pregnancy should be medically assessed rather than assumed to be normal.

Doctors can use examinations, blood tests and pregnancy-appropriate imaging to investigate the cause while balancing the health of the pregnant person and the baby.

Appendicitis in older adults

Older adults may have less intense pain, little fever and fewer obvious signs of abdominal tenderness. The condition may therefore be diagnosed later, increasing the risk of complications.

A new change in appetite, mobility, alertness or general wellbeing alongside abdominal discomfort should be taken seriously, even when the pain is not severe.

How doctors diagnose appendicitis

There is no single home check or symptom that proves someone has appendicitis. Diagnosis is based on the overall pattern of symptoms, physical examination, laboratory tests, imaging and how the condition changes over time.

A doctor may ask:

• where the pain began and where it is now;
• whether it is becoming worse;
• when nausea, vomiting or appetite loss started;
• whether there has been diarrhoea or constipation;
• about urinary symptoms;
• about periods, pregnancy possibility or vaginal symptoms;
• about previous abdominal conditions or surgery.

The abdomen will usually be examined for tenderness, guarding and signs that movement makes the pain worse. The clinician may also check temperature, pulse, blood pressure and hydration.

Blood and urine tests

Blood tests may show signs of inflammation or infection, such as a raised white blood cell count or C-reactive protein. Normal blood results do not always exclude early appendicitis.

A urine test can help identify a urine infection or kidney stone. It is possible for appendicitis to irritate the urinary tract and cause minor abnormalities in urine, so the results must be interpreted alongside the other findings.

A pregnancy test may be offered where pregnancy is possible because ectopic pregnancy and other gynaecological conditions can cause similar symptoms and require urgent treatment.

Ultrasound, CT and MRI scans

An ultrasound scan is often considered in children, younger people and during pregnancy because it does not use ionising radiation. However, the appendix cannot always be seen clearly.

A CT scan provides more detailed images and can help identify an inflamed appendix, an abscess or another cause of pain. MRI may be used in selected situations, including pregnancy, depending on local facilities and clinical judgement.

You can read more about the strengths and limitations of these tests in our comparison of ultrasound, CT and MRI scans.

Observation in hospital

Sometimes the diagnosis is uncertain. A person may be observed for several hours, with repeat examinations and possibly further blood tests or imaging. This is not necessarily a sign that the symptoms are being dismissed. Early appendicitis can become clearer as the pattern develops.

In some cases, surgeons recommend an operation based on the clinical findings even when a scan has not provided a completely certain answer.

What else can cause pain in the lower right abdomen?

Several conditions can resemble appendicitis. Some are mild, while others are emergencies in their own right.

Possible alternatives include:

• gastroenteritis or food poisoning;
• constipation;
• irritable bowel syndrome;
• Crohn’s disease or another form of bowel inflammation;
• swollen lymph nodes in the abdomen following an infection;
• a urine infection;
• a kidney or ureteric stone;
• an ovarian cyst;
• ovarian torsion;
• pelvic inflammatory disease;
• ectopic pregnancy;
• testicular torsion or another testicular condition;
• a groin hernia.

The location of pain is not enough to distinguish these conditions safely. For example, an ovarian problem, ectopic pregnancy or kidney stone can produce severe right-sided pain that looks very similar to appendicitis.

People with ovaries may be asked about menstrual cycles, contraception, pregnancy possibility, bleeding and vaginal discharge. This is an important part of identifying urgent gynaecological causes, not an assumption that the symptoms are unrelated to the appendix.

Similarly, boys and men should mention testicular pain or swelling. Testicular torsion requires immediate treatment and can occasionally present with lower abdominal pain before obvious scrotal symptoms develop.

How appendicitis is treated

Most people with suspected or confirmed appendicitis are admitted to hospital. Treatment may include pain relief, fluids through a vein and antibiotics.

Surgery to remove the appendix

The standard treatment is usually an appendicectomy, also called an appendectomy: an operation to remove the appendix under general anaesthetic.

Most operations are performed using keyhole surgery. The surgeon makes several small cuts and uses a camera and fine instruments to remove the appendix. Keyhole surgery usually allows smaller wounds and a quicker recovery than open surgery.

An open operation, involving a larger incision, may be needed when:

• the appendix has burst;
• infection has spread widely;
• there is a large abscess;
• keyhole surgery is not technically suitable;
• the surgeon needs better access to examine or clean the abdomen.

The appendix may occasionally look normal during surgery. The surgical team will then look for another explanation for the symptoms and decide whether removing the appendix is appropriate.

The Guy’s and St Thomas’ NHS Foundation Trust appendicectomy guide explains the main surgical approaches and what patients can expect.

Can appendicitis be treated with antibiotics alone?

Some carefully selected cases of uncomplicated appendicitis can be treated initially with antibiotics. This may be considered when imaging suggests that the appendix has not burst and there is no widespread infection.

Antibiotic treatment does not suit everyone. Symptoms can fail to settle or appendicitis can return later, meaning surgery may still be required. The decision depends on scan findings, severity, age, general health, pregnancy status, local protocols and the person’s preferences.

Antibiotics are also used around surgery and are especially important when the appendix has perforated or infection has spread.

Treating an abscess or burst appendix

A localised abscess may sometimes be treated with intravenous antibiotics and drainage through the skin, guided by imaging. Surgery may be performed immediately or delayed until the infection has settled, depending on the circumstances.

Peritonitis caused by a burst appendix generally requires urgent surgery, antibiotics and careful hospital monitoring. Recovery is often longer than after uncomplicated appendicitis.

Recovery after appendix surgery

Recovery depends on whether the operation was straightforward, whether the appendix had burst and whether keyhole or open surgery was used.

After an uncomplicated keyhole operation, some people can go home the same day or within a day or two. A longer stay may be necessary after open surgery, significant infection or complications.

During the early recovery period, it is common to experience:

• tenderness around the wounds;
• tiredness;
• temporary bloating;
• reduced appetite;
• constipation, particularly after opioid pain medicines;
• shoulder-tip discomfort after keyhole surgery because of the gas used during the procedure.

Follow the hospital’s advice about wound care, bathing, driving, lifting, exercise, school and work. Recovery instructions vary, so the discharge plan given by the surgical team should take priority over general online advice.

When to seek help after an appendicectomy

Contact the hospital team, NHS 111 or a GP promptly if you develop:

• pain that is becoming worse rather than gradually improving;
• persistent fever or shivering;
• increasing redness, heat, swelling or pus around a wound;
• repeated vomiting or inability to keep fluids down;
• increasing abdominal swelling;
• difficulty passing urine;
• new shortness of breath or chest pain;
• a painful swelling near a surgical wound.

Call 999 for severe breathing difficulty, collapse, confusion or other signs of a life-threatening emergency.

Most people recover fully and experience no long-term digestive problems after their appendix is removed.

Common myths about appendicitis

“If I can jump, it cannot be appendicitis”

Movement often worsens appendicitis pain, but jumping, coughing or pressing the abdomen is not a reliable diagnostic test. Some people with appendicitis can still walk, jump or tolerate examination, particularly early in the illness.

“Severe pain would start immediately”

Appendicitis often begins with vague or moderate discomfort. The pain may become more recognisable only after several hours. A steadily worsening pattern deserves attention even before the pain becomes severe.

“No fever means it is not appendicitis”

Fever may be absent early and can remain mild. Appendicitis cannot be excluded solely because someone has a normal temperature.

“Diarrhoea means it is a stomach bug”

Appendicitis can cause diarrhoea, especially when the appendix lies close to the rectum or pelvis. Localised or worsening pain should not be dismissed as gastroenteritis simply because stools are loose.

“Pain relief hides appendicitis”

Appropriate pain relief can be given while someone is assessed. Modern clinical evaluation does not depend on leaving a person in unnecessary pain. The important point is not to delay urgent medical assessment while repeatedly treating the symptoms at home.

“A burst appendix always causes instant unbearable pain”

Symptoms vary. Some people experience a temporary reduction in localised pain before widespread pain and illness develop. Any sudden change in a worsening abdominal illness requires urgent reassessment.

Frequently asked questions about appendicitis

How quickly does appendicitis develop?

Symptoms often progress over hours and may become substantially worse within one or two days. There is no safe timetable for waiting at home because some cases progress faster than others. Worsening or persistent abdominal pain should be assessed urgently.

Where exactly is appendix pain?

It is most commonly felt in the lower right abdomen. It often begins near the belly button before moving down and to the right. The appendix can sit in different positions, however, so pain may occasionally be felt in the pelvis, back, centre or higher on the right side.

Can appendicitis pain come and go?

Early discomfort may fluctuate, but appendicitis pain usually becomes increasingly persistent. Pain that briefly improves does not always mean the problem has resolved, particularly if the person remains unwell or the pain later spreads.

Can you have appendicitis without vomiting?

Yes. Vomiting is common but not universal. Some people mainly experience worsening abdominal pain and appetite loss.

Can you have appendicitis without a fever?

Yes. A normal temperature does not rule it out, especially during the early stages or in older adults.

Does pressing on the abdomen confirm appendicitis?

No. Tenderness may increase suspicion, but pressing the abdomen at home cannot diagnose appendicitis and may cause unnecessary pain. Diagnosis requires professional assessment and sometimes blood tests or imaging.

Can constipation cause pain similar to appendicitis?

Yes. Constipation can cause lower abdominal pain and bloating. However, it should not be assumed to be the cause when pain is becoming steadily worse, moving to the lower right side, or accompanied by fever, vomiting or marked tenderness.

Can appendicitis go away by itself?

Occasionally inflammation may settle, but it is impossible to predict safely at home. Untreated appendicitis can also rupture. Anyone with symptoms suggestive of appendicitis should receive urgent medical assessment rather than waiting for the pain to disappear.

Can appendicitis return after antibiotic treatment?

Yes. Antibiotics can successfully treat selected uncomplicated cases, but recurrence is possible because the appendix remains in place. A surgical team should explain the likely benefits, risks and follow-up plan.

Can you get appendicitis after your appendix has been removed?

True appendicitis cannot normally occur once the appendix has been completely removed. Very rarely, inflammation can develop in a small portion left behind, known as stump appendicitis. Anyone with serious abdominal symptoms still needs assessment regardless of previous surgery.

How long does recovery take after appendix removal?

Many people begin returning to normal light activities within a few weeks after uncomplicated keyhole surgery. Recovery may take longer after open surgery, a burst appendix or a significant abdominal infection. Follow the individual advice provided by the surgical team.

When should I call NHS 111?

Contact NHS 111 if abdominal pain is gradually getting worse, does not go away or moves towards the lower right side. Call 999 or attend A&E for severe pain, widespread abdominal pain, collapse, confusion, breathing difficulty or signs that the person is seriously unwell.