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Dr QM Leong

Can Appendicitis Pain Come And Go?

Can Appendicitis Pain Come And Go?

Usually, appendicitis starts with a pain in the middle of your stomach that comes and goes. Within hours, the pain moves to your lower right side abdomen, where your appendix is, stays there, and gets worse.

Appendicitis is a painful swelling of the appendix. The appendix is 5 to 10 cm (2 to 4 inches) length. It’s a tiny and thin pouch attached to the large intestine.

Appendicitis causes the appendix to become inflamed and swollen. Without treatment, the pressure will eventually cause the appendix to burst, which can occur within 48 to 72 hours of the onset of symptoms.

Symptoms Of Appendicitis

Symptoms Of Appendicitis

Abscesses loaded with pus may form around the appendix. Scar tissue and other abdominal structures will “wall off” the abscessed appendix and the drainage, preventing the spread of infection.

A ruptured appendix can be a life-threatening emergency, prompting the patient to seek immediate medical assistance.


  • Acute abdominal pain may originate in the upper or middle abdomen but settles typically in the lower right abdomen.
  • Abdominal pain worsens when you walk, stand, jump, cough, or sneeze.
  • A bloated or swollen belly tenderness when you press on your abdomen, which may worsen when you stop pressing it.
  • Incapacity to pass gas
  • Sudden abdominal pain when sleeping.

Other symptoms include:

  • Fever
  • Nausea
  • Vomiting
  • Loss of Appetite
  • Constipation
  • Diarrhoea



To aid in diagnosing appendicitis, your doctor will likely take your medical history and examine your abdomen.
The following tests and procedures help in diagnosing appendicitis:

  • Physical examination to evaluate your pain. Your physician might apply light pressure to the uncomfortable spot. Appendicitis discomfort typically worsens when the pressure is suddenly lifted, indicating that the neighbouring peritoneum is irritated.
  • In addition, your physician may check for abdominal tightness and a tendency to tense abdominal muscles in reaction to pressure over the inflamed appendix (guarding).
  • Your physician may insert a gloved, lubricated finger to inspect your lower rectum (digital rectal exam). Women of childbearing age may undergo a pelvic examination to check for gynaecological issues that could be causing the pain.
  • Blood test. Enables your physician to examine your white blood cell count, which may suggest an infection.
  • Urine test. Your doctor may request a urinalysis to rule out a urinary tract infection or kidney stone as the source of your pain.
  • Imaging testing. Your physician may also order an abdominal X-ray, an abdominal ultrasound, a computed tomography (CT) scan, or magnetic resonance imaging (MRI) to confirm appendicitis or identify alternative reasons for discomfort.

Complications Of A Ruptured Appendix

If appendicitis is left untreated, the appendix can rupture and lead to potentially fatal infections and serious complications, and you should have immediate medical care. Below are other complications resulting from a ruptured appendix:


  • If your appendix ruptures, bacteria will infect the lining of your abdomen (peritoneum). It is known as peritonitis.
  • It can potentially cause internal organ damage.
    Peritonitis symptoms can include:
    • Persistent severe abdomen pain
    • Exhibiting symptoms of illness or a high temperature
    • A fast heart rate, shortness of breath with rapid breathing, and abdominal puffiness.
  • Peritonitis may be fatal if not treated immediately; it can create long-term complications.
  • Peritonitis is treated with antibiotics and appendix removal surgery.


When there is an infection in the abdomen, surrounding tissues may attempt to separate the infection from the remainder of the abdomen. The wall develops an abscess — a sealed collection of pus and bacteria.

Abscess symptoms are identical to those of appendicitis except for the following:

  • The pain may be localised to one place (although not necessarily the lower right abdomen) or spread over the entire abdomen.
  • The pain may be a mild aching or acute and stabbing.
  • While taking antibiotics, the fever does not subside.
    You may also experience chills and weakness.


When left untreated, bacteria from a ruptured appendix can enter the circulation and cause sepsis, a life-threatening illness. Sepsis is an inflammation of the entire body.

Symptoms of sepsis include:

  • A high or low temperature
  • Rapid heartbeat and shivering breathing
  • Weakened mental state and low blood pressure

Appendicitis Can Be Confused With

Appendicitis can be confused with the following disorders:

  • Gastroenteritis – a stomach bug that causes diarrhoea and vomiting.
  • Severe irritable bowel syndrome (IBS) – common disorder that affects gastrointestinal tract.
  • Constipation – faeces passes too slowly through the digestive system or cannot be adequately removed from the rectum.
  • Bladder or urinary tract infections – infection of the urinary tract that occurs frequently when bacteria enter the urethra.
  • Crohn’s disease – causes inflammation of the digestive tract tissues, which can result in stomach pain, severe diarrhoea, exhaustion, and weight loss.
  • Pelvic infection – infection of the reproductive organs of women frequently caused by sexually transmitted disease (STD).

In women, appendicitis-like symptoms may have a gynaecological origin, such as:

  • Ectopic pregnancy
  • Menstrual pain
  • Pelvic inflammatory disease (PID)

Treating Appendicitis

If you have appendicitis, your appendix must be removed immediately. This surgical removal procedure is referred to as an appendectomy.

If there is a possibility that you have appendicitis, but it has not been possible to make a definitive diagnosis, surgery is indicated.

Here are other ways your doctor may treat appendicitis:


Laparoscopy is a surgical treatment that enables the surgeon to examine the interior of the abdomen (tummy) and pelvis using a laparoscope and without making extensive skin incisions. A laparoscope is a tiny tube with a light source and a camera that transmits images of the abdomen’s interior to a monitor.

This method is also referred to as keyhole surgery or minimally invasive surgery. Small surgical instruments are used for appendectomy. After the appendix has been removed, the incisions are often healed with stitches that dissolve over time.

Additionally, regular stitches may be used, which must be removed 7 to 10 days later at your doctor’s office.

Open Surgery

In certain situations, open surgery is preferred to keyhole surgery. Open appendectomy is recommended when the appendix has already ruptured and developed a lump known as an appendix mass.

In these instances, the appendix is removed by a single, bigger incision on the lower right side of the abdomen.

When peritonitis, an infection of the inner lining of the abdomen, is widespread, a laparotomy may be required. This involves making a long incision along the middle of the belly.

Like keyhole surgery, the wound is closed with either dissolvable or normal stitches that must be removed afterwards.

After both methods of appendectomy, the excised appendix is typically sent to a laboratory for cancer detection.

Conclusion On Can Appendicitis Symptoms Pain Come And Go

Appendix pain can come and go, but when the pain worsens, it’s best to see a colorectal specialist.

Schedule a consultation with Dr. QM Leong and learn more about appendicitis. He specialises in gallstone removal, anal fissures, hernia surgery, colorectal cancer, peptic ulcers, and treating other changes in bowel habits.

Frequently Asked Questions On Can Appendicitis Pain Come And Go

Should I Be Concerned About Pain On The Right Side?

Suppose you have significant abdominal discomfort, particularly on the right side. You should see a doctor to rule out causes that require emergency medical attention, such as appendicitis, an ectopic pregnancy, an ulcer, or kidney stones.

Before surgery, antibiotics are administered to patients suspected of having appendicitis. Some mild cases of appendicitis are treatable solely with antibiotics in undeveloped countries.

However, in a developed country like Singapore where modern medical facilities and surgeons and anaesthetists are available, treating appendicitis with antibiotics is not recommended. This is because appendicitis treated with antibiotics often recur and hence the definitive treatment should always be surgery.

Yes. You may feel discomfort in the middle of the belly that may come and go when you have appendicitis. Within hours, the pain spreads to your lower right side, where the appendix is, and intensifies. Pressing the region, coughing, or walking may aggravate the pain.

Yes, It’s possible that the initial symptoms of appendicitis are similar to those of a bad case of gas pains. However, appendicitis typically worsens and causes more discomfort over time.

Symptoms including a high temperature, bowel changes (such diarrhoea or constipation), or vomiting may also present themselves.

Yes, it’s possible. The body’s inflammatory response is triggered when your digestive tract is overworked by spicy food. When this inflammation combines with other health issues, it can cause the appendix to burst, causing a great deal of discomfort and even death.