Appendix pain is any extreme discomfort or tenderness associated with some disease of the appendix, the small outpouching from the cenum of the large intestine. Anatomically, it is more correctly known as the cecal appendix or vermiform appendix. Tenderness or pain associated with the appendix is a symptom due to a disease. It is difficult for any person to conclusively in a specific region of the abdomen as being appendix pain. Other symptoms accompanying the pain must be noted and diagnostic investigations need to be conducted in order to confirm that the pain is really originating from the appendix. Remember that the abdomen is packed with various organs and tissues, all of which lie closely to each other.
Where is the appendix located?
Location of Appendix
The appendix is located in the right lower quadrant (RLQ) of the abdomen and more specifically within the right iliac (inguinal) region. As a long pouch with an average length of 11 centimeters (about 4.5 inches), the location of the entire appendix cannot be isolated to a specific spot. Sometimes the appendix can sit behind the cecum or even extend down into the pelvis. However, with pain due to the appendix, it can be confirmed by tenderness at a very specific anatomical spot known as McBurney’s point.
McBurney’s Point in Appendix Pain
When right lower quadrant pain is suspected to be due to the appendix, this can be confirmed by applying pressure at McBurney’s point. Any worsening of the pain or tenderness at McBurney’s point is indicative of pain emanating from the appendix. In order to find McBurney’s point, one has to imagine a line running between highest front portion of the pelvic bone (anterior iliac spine) and the navel (belly button / umbilicus). McBurney’s point lies two-thirds down (or one-third) up this imaginary line.
What causes appendix pain?
Appendix Pain Causes
It is important to remember that the appendix is part of the gut. Therefore any disease of the gut, specifically those affecting the end of the small intestine or the beginning of the large intestine has the potential to involve the appendix as well. This can include diseases such as inflammatory bowel disease (IBD – Crohn’s disease or ulcerative colitis), enterocolitis, diverticulitis among others. However, the two main causes of appendix paid is appendicitis and a ruptured (burst) appendix.
- Appendicitis is inflammation of the vermiform appendix. It is usually acute and arises as a result of an infection of the appendix usually secondary to a blockage of the opening of the appendix. Acute appendicitis is extremely painful. Very rarely can appendicitis become a chronic condition.
- Ruptured appendix is where the pouch bursts following severe inflammation and infection. It can occur as a complication of untreated acute appendicitis or even with appendix injury.
- Appendix injury is where there is trauma to the area of the appendix. Very rarely can the appendix be injured on its own without involving the surrounding intestines or overlying abdominal lining (peritoneum). This can occur as blunt force trauma or penetrating injuries.
What are the symptoms with appendix pain?
Appendix Pain Other Symptoms
Pain on its own is non-specific, especially abdominal pain, since there are so many organs lying within the cavity. The same applies to appendix pain. Although tenderness or exacerbation of pain at McBurney’s point is confirmatory for appendix pain, other symptoms should be noted. With regards to appendix pain, concomitant symptoms are primarily the clinical features of acute appendicitis or a burst appendix.
- Nausea with or without vomiting.
- Constipation but diarrhea may also occur.
- Difficulty or inability to pass gas (flatus ~ ‘fart’) although gas may be expelled with diarrhea.
- Swollen abdomen.
- Low-grade fever.
- Loss of appetite with patients reporting worsening of pain and nausea after eating.
What does appendix pain feel like?
Severity, Duration and Referred Pain
At first, appendix pain is felt more like s dull ache around the umbilicus. It does not often raise the concern of appendicitis or other appendix problems until it becomes localized to the right side of the abdomen. The pain usually becomes worse rather suddenly (over hours) and appendicitis is one of the main causes of an acute abdomen. The severity of the pain may reach levels where a person curls up in the fetal position, writing in pain and even crying. Fainting from the pain is even possible.
The duration of the pain depends on the cause. Appendicitis pain worsens over hours and does not ease without medical treatment. Sometimes there is episodes of severe pain followed by a milder pain or an ache in between. Although the pain is described as sharp, sometimes the nature of the pain is not obvious until a person moves or coughs. This is when the sharpest pain is felt.
Appendix pain can be referred to other parts of the body. A person may report pain as high up as the upper abdomen, pain that extends across the lower abdomen, to the lower back or even the rectum. Due to the nature and distribution, sometimes women mistaken appendix pain for gynecological conditions.
How is appendix pain diagnosed?
Diagnosis of Appendix Pain
Ultimately the treatment of appendix pain depends on the cause. Tenderness at McBurney’s point should compel the doctor to undertake the relevant diagnostic tests to confirm the cause. Blood and urine tests may be helpful to indicate inflammation and infection but it is imaging studies that provide a more definitive diagnosis for appendix pain. A simple abdominal x-ray may suffice but a CT (computed tomography) scan is preferable. When no abnormality can be found but the severity of the pain is not easing, doctors may consider an investigative surgical procedure known as a laparotomy. The advantage of this rather diagnostic investigation is that the necessary surgery can be undertaken immediately once the problem is identified. However, it is not common where this is necessary without first confirming the diagnosis of appendix pain on an x-ray, CT scan or in rare instances with an abdominal ultrasound.