While stomachaches may be super common, they’re never any fun. It’s especially worse when you know it’s unlike any stomachache you’ve had before. If it feels like a sharp, stabbing pain in the lower right side of the abdomen, it could be appendicitis. Appendicitis is the inflammation of the appendix.

According to one estimate, appendicitis affects almost half (44.6%) of the population aged 11-20 years in India’s villages (reliable pan-India data are hard to come by). Often considered a vestigial organ, pain in the appendix can be extremely distressing, demanding urgent treatment or even surgical removal. The surgery is called an appendectomy.

However, recognising the pain of appendicitis is really important. If you wait too long to seek medical attention, the appendix could burst and make the situation much worse.

Vermiform appendix
The appendix is a small, pouched, fingerlike structure that projects out of the caecum (end part of the large intestine). It’s about 5-10 cm in size.

Most of us have learnt in school that the appendix is a vestigial organ – it no longer has a vital role to play. However, researchers at Midwestern University, US, have found that the appendix may be a reservoir for gut bacteria, boosting the process of digestion. Additionally, the researchers also found that people who hadn’t had their appendix removed had a number of lymphoid tissue or immune cells in the caecum. The lymphoid could also be the reason for the growth of good gut bacteria.

According to Darwin’s theory of evolution – the appendix in humans and other mammals was the evolutionary remains of the caecum. He claimed that our extinct ancestors used the appendix to digest food, especially cellulose-rich food.

Causes of appendicitis
Despite advancements in technology and medical research, the exact cause of appendicitis is still not known. Researchers believe it’s some kind of obstruction in the single-sided opening of the appendix that connects it to the caecum.

Once the only door to the large intestine gets blocked by either poop or an enlarged lymphoid tissue, inflammation or swelling sets in. In the absence of interventional treatment – the closed cavity starts showing symptoms of appendicitis.

Pain of appendicitis
Initially, the pain of appendicitis occurs in the centre of the abdomen. It occurs for a while and then disappears. Within the hour, the pain travels all the way from the centre to the lower right abdomen – where the appendix is.

The inflamed appendix starts to hurt severely and constantly. (Caution: Do not press the painful area as it makes the pain worse. Walking and coughing can exaggerate the condition as well.)

Having an inflamed appendix affects the process of digestion – one could experience either loose motion (diarrhoea) or tight motion (constipation) and loss of appetite. It could also cause fever, nausea and vomiting, especially in younger patients.

As the inflammation and swelling increases, the pressure on the appendix and the risk of rupturing also increases. Mark W. Jones et al wrote in his book “Appendicitis” that the risk of rupture is variable but about 2% in the initial 36 hours and increases about 5% every 12 hours after that.

If the pain is a constant, stabbing or piercing kind of pain on the lower right side of the tummy, it’s probably not a common stomachache. Please consult your doctor immediately.

Treatment and prevention
Since there is no known cause, there is no absolute prevention. Although, once a person develops appendicitis, there are two treatment methods: antibiotics and surgery.
Antibiotics are only preferred in very mild cases because, with antibiotics, the recurrence rate is high (39.1% within five years), according to published research in the Journal of the American Medical Association.

A news bulletin published by Stanford Medicine argues for surgical removal (appendectomy) to be the mainstay treatment for appendicitis either by laparotomy (open abdominal surgery) or laparoscopy (keyhole surgery).

Appendicitis should be addressed immediately. In the absence of prompt intervention, complications may arise. Rupture of the appendix can cause serious infection, leading to death in several cases.

This story is contributed by myUpchar, India’s first and biggest resource for verified medical information. At myUpchar, researchers and journalists work with doctors to bring you information on all things health. For more information, read our article on Appendicitis: Symptoms, Treatment, Prognosis.

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