Appendicitis: symptoms, which side the appendix is on, and when to go to hospital

What is appendicitis?

The appendix (apendiks) is a small, finger-shaped pouch attached to the large intestine. Appendicitis means it has become inflamed, usually because it is blocked, for example by hardened stool, and then infected.

It is common: about 5 to 9 in every 100 people have appendicitis during their life. It can happen at any age, but is most common in children over 10, teenagers and young adults, and is slightly more common in males. It is rare in babies.

Which side is the appendix on?

The appendix is on the lower right side of the abdomen (bawah kanan perut), roughly between your belly button and the bony point at the front of your right hip. That is where appendicitis pain usually settles.

Pain on the lower left side is rarely appendicitis. It has other causes, which we cover in our guide to stomach pain by location. In pregnancy, the growing womb can push the appendix higher, so the pain may be felt higher up on the right.

Symptoms of appendicitis (tanda appendix)

The classic pattern:

1. Pain starts in the middle, around the belly button. It may come and go at first.
2. Within hours it moves to the lower right side, becomes constant and gets steadily worse.
3. Moving, coughing, walking or going over bumps in a car makes it hurt more.

Other common symptoms are loss of appetite, feeling sick or vomiting, a fever, constipation or diarrhoea, and needing to urinate more often.

Not everyone has the classic pattern. In young children, pregnant women and older people, pain can be milder, come on more slowly or be felt somewhere else. Older people may simply become confused. Children may be unusually quiet, refuse food or not want to walk.

Can the appendix burst?

Yes. If appendicitis isn’t treated, the inflamed appendix can burst (appendix pecah), often within 1 to 2 days of the first symptoms. This spills infection into the abdomen (peritonitis) and can lead to an abscess or sepsis, which are life-threatening and need more complex surgery and a longer hospital stay.

The pain may ease for a short while when the appendix bursts, as the pressure is released, before becoming severe and spreading. Don’t take an easing of pain as a sign you are getting better.

What to do if you think it’s appendicitis

• Go to a hospital emergency department if you have pain that has moved to the lower right side and is getting worse. A GP can assess milder or unclear tummy pain and refer you if needed, but for typical appendicitis symptoms go straight to hospital.
• Don’t wait it out overnight hoping it will settle.
• Avoid eating or drinking until you have been seen, in case you need an operation.
• Bring a list of any medicines you take, and tell the doctor if you could be pregnant.

Not sure where to go? See our guide on clinic or emergency department.

How appendicitis is diagnosed

There is no single test for appendicitis. A doctor will:

• ask about your symptoms and press on your abdomen to find where it is tender
• do blood tests (to look for signs of infection) and a urine test (to rule out a urine infection or kidney stone), plus a pregnancy test for women
• often arrange an ultrasound (commonly used for children and pregnant women) or a CT scan

Doctors may use a scoring system such as the Alvarado score, which adds points for symptoms, tenderness and blood results. A low score makes appendicitis unlikely, and a high score makes it probable. If the picture isn’t clear, you may be observed in hospital for a few hours, or up to a day, to see how symptoms change.

Treatment: surgery or antibiotics?

The standard treatment is an operation to remove the appendix, called an appendicectomy (appendectomy), usually done as soon as possible. Most are done by keyhole (laparoscopic) surgery through a few small cuts, and take about an hour. Open surgery through a larger cut may be needed if the appendix has burst.

Antibiotics instead of surgery? For some adults with uncomplicated appendicitis confirmed on a scan, antibiotics alone are an option. Large trials found that about 3 in 10 people treated with antibiotics needed their appendix removed within a year, rising to about 4 in 10 within five years, and the risk was higher when a hardened stool stone (appendicolith) was present. Your surgeon will explain whether this is suitable for you.

Recovery after appendix surgery

• After keyhole surgery, many people go home the next day. Recovery after a burst appendix or open surgery takes longer.
• Most people need 1 to 2 weeks off work or school, and should avoid heavy lifting and strenuous sport for a few weeks until fully healed.
• Get medical advice if you develop a fever, increasing pain or swelling, redness or discharge from a wound, or vomiting after going home.

Can you live without an appendix? Yes. Removing it doesn’t cause any long-term problems.

Where to get tummy pain checked

For pain that has moved to the lower right and is getting worse, go straight to a hospital emergency department. For milder or unclear tummy pain, a GP can examine you and refer you if needed. Our directory lists GP clinics across Kuala Lumpur, Selangor and other states, including clinics open late, at weekends and 24 hours.

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Frequently asked questions