Where Exactly Does the Pain Occur During Appendicitis?
Appendicitis is the inflammation of the appendix, a disease that is mostly known as the rupture of the appendix. The human appendix is considered to be a vestigial structure. Vestigial means lacking meaningful work, or the evolving of a part of the body to take on a new shape, or an organ that has reduced its functional work. The vermiform appendix is a remnant of the cecum, which receives food from the small intestine and connects to the large intestines. In animals, the cecum is important in digesting the cellulose in plant materials. In humans, the cecum used to be important in digesting leaves from plants. Since humans have come to rely less on plants for food, dependency on the cecum to digest cellulose has been reduced, hence the vestigial part of the cecum that we today call the appendix.
Appendicitis and carcinoid tumors are the most commonly-known diseases associated with the appendix. When one has appendicitis, the first and classic symptom to be identified is pain. This pain often starts in the middle of the abdomen, close to the appendix's origin of growth as a portion of the embryo in which most of the intestines originate. The pain one experiences upon the breakage of the appendix starts with a dull ache in the tissue. It is hardly noticeable and can be mistaken for pain due to other reasons.
Other possible causes of abdominal pain apart from appendicitis are gallstones, an ectopic pregnancy, ovarian cysts that have ruptured or are too large, irritable bowel syndrome, any urinary tract infection, Crohn's disease, indigestion, stomach gas, peptic ulcers, and a kidney infection. Sometimes, too, abdominal pain could be due to a food allergy, constipation, or lactose intolerance.
As the breakage of the appendix continues, however, the pain becomes progressively more intense and more identifiable as appendicitis-related as it travels from the middle portion to the lower right part of the abdomen. The pain presents itself specifically at McBurney's point, the name given to the spot on the right side of the abdomen that is about a third of the way from the anterior superior iliac spine to the navel. The point is right over the part where the base of the appendix is usually located. If the parietal peritoneum breaks or bursts, the pain spreads to the lower portion of the body. This breakage of the peritoneum leads to tenderness, and pain that is experienced when pressure is released rather when pressure is exerted on the area. Feeling extremely cold or hot is also sometimes associated appendicitis.
The pain resulting from appendicitis is unique in that it starts at night so that one wakes up. This pain sharpens within hours and occurs prior to fever, nausea, and vomiting. Soon after, one’s appetite declines drastically in a condition known as anorexia. The pain the individual experiences later is worse when one breathes, walks, or coughs, and the pain spikes when the person is subjected to or performs any jarring motion.
Note that the classic symptoms and above-described pain of appendicitis may not be present in all cases. Only a doctor can tell for sure whether one has appendicitis by performing an examination. The possibility that one has appendicitis is indicated by hurt when the doctor releases pressure applied on the lower right area. Other indications of appendicitis that specifically relate to pain are when tenderness is felt when pressure is applied on the right side, and when the individual protects the lower right side of his or her abdomen even while unaware of the appendicitis. Sometimes pain can be felt when one experiences resistance of the right knee when trying to raise it when lying down. The abdomen too may ache when one bends the leg to the right and then left.
Why is it important to identify appendicitis symptoms early?
If the symptoms are not diagnosed and treated as soon as possible, there is a chance that the appendix might rupture and release bacteria into the abdomen. The resulting infection is called peritonitis, which is a medical emergency.
To have the appendix rupture is life-threatening. Although it rarely happens within 24 hours of the first symptoms, the risk increases drastically after 48 hours of the symptoms' first appearance. Hence, it is very important to identify the symptoms early and get treated right away.
Appendicitis usually causes fever that is between 99 degrees F to 100.5 degrees F. If the appendix bursts, the individual suffers a fever greater than 101 degrees F and an elevated heart rate.
Symptoms of appendicitis in children
It is difficult to diagnose appendicitis in children as they are not able to describe their pain and what they feel. They are often unable to specify the exact location of the pain and say that their entire abdomen hurts. This makes it difficult for the parent to determine whether the pain is due to appendicitis or some other infection. For this reason, it is always best to immediately take a child experiencing abdominal pain to the doctor to have the symptoms assessed and addressed. In case of any delay in treatment, the appendix might rupture and cause death. Deaths due to the rupture of the appendix are highest among infants and children.
Symptoms of appendicitis in infants and children less than two years old include:
- Swelling or bloating of the abdomen
- Tenderness in the abdomen
- Vomiting
Older children experience the same symptoms of pain, vomiting, and nausea that adults do.
Symptoms of appendicitis while pregnant
To diagnose appendicitis during pregnancy is most difficult even for doctors, since the symptoms mimic various discomforts of pregnancy such as stomach cramps, nausea, and vomiting. However, pregnant women, especially those in the later stages of pregnancy, do not have the classic pain-related symptoms of appendicitis. The pain occurs in higher up in abdomen because pregnancy pushes the appendix into the upper abdomen. The common symptoms of appendicitis during pregnancy are heartburn, constipation, gas, and diarrhea.
Diagnosis and treatment
Diagnosis in all cases of appendicitis in all the stages is done through physical examination, a blood test, a urine test, an ultrasound, and a CT scan of the abdomen. The diagnosis helps the doctor to determine what treatment is needed. Medications are given before surgery to avoid infection afterward. Depending on the severity of the appendicitis, the surgeon opts for either open surgery or laparoscopy.
While most people recover from the surgery without any complications, there are a few who can develop some. The pain may not ease, or the patient may develop abscesses. In such cases, doctors will order the patient to remain confined in the hospital for further treatment.
