Appendicitis Symptoms in Adults and Children: When to Go to the ER

It started as a vague discomfort around your belly button in the afternoon, and you put it down to something you ate. By evening you'd lost your appetite. Now, past midnight, the pain has moved low on the right side, and you feel it with every cough and every step to the bathroom. The question going round your head: is this appendicitis, or a stomach bug that will pass with sleep? This article helps you tell the difference, and tells you plainly when to stop waiting.

What is appendicitis?

The appendix is a small, finger-shaped pouch attached to the large intestine, low on the right side of the abdomen. When its opening becomes blocked, bacteria multiply inside it and it becomes inflamed and swollen. Left alone, it can burst and spread infection through the abdominal cavity, which is why appendicitis is treated as an emergency. It is most common in teenagers and young adults, but it can happen at any age, from small children to older adults.

Appendicitis symptoms in adults

• Pain that starts around the belly button, dull and vague, and may come and go at first.
• Over a few hours it moves to the lower right abdomen and becomes sharper and constant.
• It gets worse with moving, walking, coughing and sneezing, and when you press on the area. Many people notice that driving over speed bumps hurts noticeably.
• Loss of appetite, one of the most consistent signs.
• Nausea or vomiting that comes after the pain starts, not before.
• A mild fever that may rise over time.
• Sometimes constipation or diarrhoea, or a feeling that passing wind or opening your bowels would help, without relief.

You don't need all of these. Constant, worsening pain low on the right is reason enough to get checked on its own.

Appendicitis or just a stomach bug?

This is the question that confuses patients and parents most, because both can cause abdominal pain, vomiting and fever. The order and the trend matter more than any single symptom:

These are patterns, not rules: appendicitis can cause diarrhoea, especially in children, and a stomach bug can cause severe pain. If the picture is mostly vomiting and diarrhoea that is slowly settling, our guide to food poisoning and when to go to the ER covers the dehydration signs to watch for. If the pain is getting worse instead of better, don't settle for "it's just a stomach bug".

How appendicitis can look different in children, pregnancy and older adults

Young children

A child under about five may not be able to tell you where it hurts, and may not show the classic shift in pain. Appendicitis is harder to spot in young children, which is partly why a burst appendix is more common at this age. Watch for:

• Unusual irritability or crying, and refusing food, even favourites.
• Fever and vomiting, sometimes with diarrhoea that makes it look like a stomach bug.
• Not wanting to walk or jump, limping, or crying when picked up or when the car goes over a bump.
• Lying very still with knees drawn up to the tummy.
• A swollen or tender tummy.

Older children and teenagers often have the same pattern as adults. If fever is what worries you most, see our guide on child fever and when to worry. But fever with constant or worsening tummy pain in a child deserves a same-day check.

During pregnancy

Appendicitis is one of the more common reasons for abdominal pain needing surgery during pregnancy. As the womb grows, the appendix can be pushed upward, so the pain may sit higher on the right side, sometimes near the ribs. Nausea and vomiting are easy to blame on the pregnancy itself. Any new, constant or worsening abdominal pain in pregnancy, especially on the right or with a fever, needs urgent assessment.

Older adults

In older adults the pain can be milder than you'd expect and fever may be absent or slight, so many arrive late. The same applies to people on immune-suppressing medicines or regular strong painkillers. In an older person, abdominal pain that isn't improving deserves a check, even if it seems moderate.

Can appendicitis pain be on the left side or in the back?

The appendix usually sits low on the right, but its exact position varies from person to person. In some people it lies behind the bowel, so the pain shows up more in the right side or lower back than the front of the abdomen. In others it sits low near the pelvis and can cause pain when peeing or a frequent need to go, which can make it look like a urine infection. Pain on the left side alone is rarely the appendix, though it has other causes that also deserve assessment if it is severe or persistent. The practical rule: constant abdominal pain that is getting worse over several hours, wherever it is, needs an examination.

With the school year under way, many parents in Jordan hear "my tummy hurts" on school mornings. Most of it passes. But tummy pain that persists through the weekend, wakes a child from sleep, or makes them refuse food and walk carefully is not school nerves.

Why not to take laxatives or wait it out

• No laxatives or enemas: constipation alongside the pain can be a symptom of appendicitis rather than the cause, and laxatives can add pressure on an inflamed appendix.
• No hot water bottle on the abdomen: heat can mask the pain and delay diagnosis.
• Avoid eating or drinking much until you have been assessed, in case you need an operation.
• Ask before taking painkillers: they can ease the pain for a while so you think the danger has passed, while the inflammation carries on.
• Don't wait another day "to see": the longer an inflamed appendix goes untreated, the higher the chance it bursts.

Burst appendix warning signs: call 911

When an appendix bursts, infection spreads into the lining of the abdomen (peritonitis), which is serious. Call 911 or go to the ER immediately for:

• Pain that suddenly gets much worse and spreads across the whole abdomen.
• A hard or swollen abdomen, or severe pain at the lightest touch.
• A high fever with shivering or chills.
• A racing heartbeat, fast breathing, or pale, cold skin.
• Fainting, confusion or extreme drowsiness.
• Sudden relief after hours of severe pain, followed by worse pain and feeling very unwell: don't take the relief as a sign of recovery.

When to go to the ER, and what happens there

Suspected appendicitis belongs in the emergency department, not on a waiting list for a clinic appointment. The doctor starts with questions and an examination of your abdomen. Blood tests help look for signs of inflammation, a urine test helps rule out a urine infection or a kidney stone, and women of childbearing age will have a pregnancy test. Ultrasound is often used, especially in children and pregnancy, to help assess the appendix and rule out other causes. If your pain is in your side or back and spreads towards the groin, the cause may be a kidney stone rather than the appendix.

Appendicitis isn't always clear at the first examination, and the doctor may ask you to come back for a recheck if things change. If you are told it is probably not appendicitis, come straight back if the pain gets worse, settles low on the right, or you develop a fever or repeated vomiting.

Sources

• NHS — Appendicitis
• Mayo Clinic — Appendicitis: Symptoms and Causes
• Cleveland Clinic — Appendicitis
• MedlinePlus — Appendicitis