Just a stomach bug - or could it be appendicitis?

Written by: Mr Nebil Behar
Edited by: Bronwen Griffiths

Tummy ache can be a fairly common annoyance, especially in children, but knowing the difference between pain caused by a stomach bug and pain caused by appendicitis can be potentially life-saving. Find out from top surgeon, Mr Nebil Behar, how to recognise appendicitis and what to do if you develop it.

Can anyone get appendicitis?

Appendicitis is generally considered a disease of childhood and early adulthood, but in fact, it can occur at any age and the lifetime risk of having it is 1 in 10. It affects men and women equally but the diagnosis can be harder to make in women who may present with similar symptoms due to gynaecological conditions. People who have had a previous attack of appendicitis treated without surgery (with antibiotics), for a variety of reasons, are at increased risk of having another attack. This can be up to 20% within one year. This group of patients are therefore usually advised to undergo a planned operation to remove their appendix a few months after the first attack.

What are the symptoms of appendicitis? How do I know it isn’t just a stomach bug?

Patients with appendicitis typically complain of a vague pain in the centre of their tummy; around the belly button first, but soon the pain moves to the lower right side of the tummy where the appendix is found. At this point, pain is particularly worse on moving, such as when walking or coughing. The patient often loses appetite, feels thirsty and gets a dry mouth.

Nausea and vomiting can occur and, indeed, even some loose bowel motions can happen as the disease progresses. This must not be mistaken for a tummy bug (gastroenteritis) where profuse diarrhoea often follows significant abdominal cramps.

Fever and sweats are also common, although the temperature is rarely above 38°C in adults. Touching the lower right side of the abdomen can be unbearably painful although this is not always the case if the appendix is hiding behind the bowel. Another confusing symptom can be pain on passing urine which can be mistaken for a urinary infection, but if this is accompanied by other symptoms, as described above, appendicitis should be suspected instead.

When should I see a doctor?

You should see the doctor as early as possible with the above symptoms and if you feel really unwell you should make your way to the accident and emergency department where you will be seen quickly by a surgeon who will make the diagnosis based on your symptoms, signs and investigations. The operation of laparoscopic appendectomy will be recommended and performed soon after that.

Why is it important to get treated quickly?

As with all conditions, appendicitis presents in a spectrum of severity. In addition, it is also time-dependent, in that the longer you ignore the symptoms and avoid seeking help, the worse the disease will get. A mildly inflamed appendix is easy to remove by the surgeon with a short operation and a quick recovery within few days. However, this can quickly turn into a gangrenous appendix with eventual perforation, leakage of its infected contents, and generalised peritonitis. This results in needing a longer operation, a higher likelihood of complications and a prolonged recovery of more than a couple of weeks. This can also be life-threatening if your appendicitis reaches this stage.

In other patients, if the disease progresses more slowly, an abscess and a swelling will form inside the tummy necessitating a delay to surgery with antibiotics to enable a safer operation at a later date. This will prolong the time you have to live with the condition and worry about it, unfortunately.


If you start to experience the symptoms described here, and you have not had your appendix removed already, seek medical attention for urgent treatment.

By Mr Nebil Behar

Mr Nebil Behar is a consultant general surgeon with a special interest in laparoscopic and emergency surgery. Practising at Chelsea & Westminster Hospital, Mr Behar specialises in the management of appendicitis, diverticulitis, and all types of hernias, and regularly manages serious complications after general surgery. He is well-regarded by patients for his personable manner through all stages of treatment and recovery.

Mr Behar originally qualified from the University of Leicester then pursued specialist surgical training in London, eventually specialising in lower-GI surgery. After becoming a fellow of the Royal College of Surgeons Mr Behar was appointed Consultant in Laparoscopic and Emergency Surgery at Chelsea & Westminster Hospital, where he is also the lead for infection control in surgery. Mr Behar has developed a particular interest in improving decision-making in emergency surgery, and co-authored a proposal for the establishment of emergency general surgery as a medical specialty. As Honorary Senior Lecturer at Imperial College London, Mr Behar is committed to the teaching of the next generation of emergency surgeons.

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