For a part of the body that, as far as we know, contributes nothing to our health and well-being, the appendix can be a real pain in the side. The right side, that is.
The appendix is a 4-inch long, finger-like tube located where the large and small intestine joins on the lower right side of the abdomen (belly). The tubular tissue is closed at one end. The other end attaches to the cecum, a pouch that connects the small intestine to the colon and is regarded as the beginning of the large intestine.
For most of most people’s lives, the appendix just hangs out, unnoticed and sidelined. But sometimes it becomes swollen and inflamed into the painful condition known as appendicitis. Severe and sudden abdominal pain is almost always the first sign of appendicitis.
The surgical operation to remove an inflamed appendix is called an appendectomy. It is reportedly the most common cause of abdominal surgery for children.
It’s not always clear why the mysterious appendix becomes inflamed but everyone agrees that immediate medical care is needed. Appendicitis can have multiple causes or none may be identified. Possible causes include:
- Blocked opening inside the appendix
- Enlarged tissue in the appendix wall due to infection in the gastrointestinal (GI) tract or elsewhere in the body
- Inflammatory bowel disease
- Stool, parasites or growths that can clog the appendiceal lumen (the interior of the tube of the appendix)
- Abdominal trauma
- Appendicoliths or fecaliths, which are calcified fecal deposits, also known as “appendix stones” (this is more common in children than adults)
- Intestinal worms or parasites, including pinworm
- Benign or malignant tumors
- Viral, bacterial or fungal infection that has spread to the appendix
Appendicitis often comes on suddenly and is the most common cause of acute abdominal pain requiring surgery to relieve the acute abdominal pain it causes. Over 5 percent of the U.S. population develops appendicitis at some point.
Appendicitis is usually diagnosed among youths in their teens and 20s but can strike anyone of any age. The symptoms vary between age groups and may be mistaken for signs of other maladies such as:
- Abdominal adhesions (scar-like tissue formed inside the abdomen)
- Constipation (inability to pass stool)
- Inflammatory bowel disease, including Crohn’s disease and ulcerative colitis, long-lasting disorders that cause irritation and ulcers in the GI tract
- Intestinal obstruction
- Pelvic inflammatory disease
The primary symptom of appendicitis is the extreme physical discomfort patients report:
- Pain when touched on the lower right side of the abdomen that gets worse in a matter of hours
- Severe pain that is often described as different from any pain ever felt before
- Abdominal pain or tenderness, usually in the center of the abdomen above or near the navel (belly button), that may shift to the lower right side of the abdomen and may increase when moving, taking deep breaths, coughing, or sneezing
- Sudden pain that can wake up a sleeping person
Other symptoms of appendicitis include:
- Loss of appetite
- Nausea and vomiting
- Fever, usually low-grade (under 100 degrees)
- Inability to pass gas
- Abdominal swelling
- The feeling that having a bowel movement will relieve discomfort
A person with appendicitis may not present all the signs. Anyone who suspects a troubled appendix is advised against taking laxatives or enemas to ease constipation because these treatments might cause the appendix to burst.
If treatment for gas doesn’t work, seek prompt medical assistance. If the symptoms are extremely acute – sudden – and excruciatingly painful, go directly to a hospital emergency room (ER).
Treating appendicitis early has a high success rate but, left untreated, appendicitis can be fatal.
Medical researchers have discovered that the appendix does serve some useful purposes. It helps encourage and protect the growth of beneficial gut bacteria by helping to recolonize the gut after infection from certain diseases destroys beneficial gut bacteria in the GI tract.
When the appendix is infected or obstructed, bacteria can multiply rapidly, causing the organ to swell and fill with pus (a thick liquid that contains bacteria, tissue cells, inflammatory debris, and dead infection-fighting white blood cells).
As fluid continues to back up, pressure inside the appendix increases, reducing the amount of oxygen-bearing blood that flows through the appendix walls, starving them and causing cell death.
Left untreated, the appendix will rupture and leak its contents throughout the abdomen. Complications of this serious health condition include:
- Abscesses (pockets of pus) may form on the ruptured appendix; if they tear, abscesses can infect the rest of the abdomen
- A ruptured appendix may cause the peritoneum (the silk-like membrane that lines the abdominal cavity) to become infected, a condition called peritonitis
- Untreated peritonitis can lead to sepsis (blood infection) which can be fatal
Higher rates of appendicitis have been linked to air pollution, especially high ozone levels. More cases of appendicitis occur during the summer months compared to other times of the year. A 2014 health sciences review concluded that more appendices get angry in warm weather due to a combination of increased exposure to air pollution and more GI infections during summer months.