Which is indicative of rebound tenderness in the abdomen?

Your appendix is a small, finger-like pouch that’s located at the lower right side of your abdomen at the junction of your large intestine and small intestine.

Appendicitis occurs when your appendix becomes inflamed and filled with pus, a fluid made up of dead cells and inflammatory debris that often results from an infection. If appendicitis is left untreated, the appendix will swell and eventually burst, leaking its infected contents throughout your abdomen and leading to a potentially life-threatening infection.

There is no way to predict who will get appendicitis, so spotting the signs of appendicitis is vital for early diagnosis. If you have appendicitis, the first symptom you will likely experience is a pain around your belly button.

Over a matter of hours — typically 12 to 24 hours after onset — this pain slowly moves to the lower right part of your belly and tends to settle at a spot called McBurney’s point, which lies directly above the base of your appendix. (1)

Is This Abdominal Pain Related to My Appendix, or Did I Eat Too Many Spices?

Other Causes of Stomach Pain

What Is Irritable Bowel Syndrome?

Abdominal pain is common in a lot of illnesses, such as irritable bowel syndrome, gastroenteritis, urinary tract infections (UTI), and pelvic inflammatory disease, an infection of a woman’s reproductive organs. (2)

You could also experience stomach pain if you’re constipated or have food poisoning, kidney stones, or some kind of intestinal obstruction, so it’s important to look for other signs of appendicitis if you’re experiencing abdominal pain.

Common Signs and Symptoms of Appendicitis

At the onset of appendicitis, people typically experience several other symptoms along with the pain. These include:

• Loss of appetite
• Nausea
• Vomiting
• Low-grade fever
• Inability to pass gas or have a bowel movement
• Abdominal swelling
• Constipation or diarrhea

It’s also important to note that if you have appendicitis, your abdominal pain will likely spike whenever you move around, take deep breaths, cough, or sneeze. Your lower right abdomen will be tender, and you will experience pain if you put pressure on the area and quickly release it (a symptom called “rebound tenderness”). (2)

How Appendicitis Affects Children: Signs and Symptoms

Though most people who have appendicitis have the same symptoms, some people may display atypical symptoms of appendicitis, or a lack of certain symptoms. This is especially true for children and pregnant women.

Most often, appendicitis affects teens and those in their twenties. In children, appendicitis is usually marked by:

• Fever
• Rebound tenderness
• Abdominal pain that starts around the navel and migrates to McBurney’s point (above the appendix)
• Loss of appetite
• Diarrhea
• Bloating or swollen stomach, especially in infants 
  
• Elevated white blood cell count, which is indicative of an infection (3)

In children, the symptoms of appendicitis can be similar to gastroenteritis (a “stomach bug,” which is a viral or bacterial infection causing abdominal pain, vomiting, and diarrhea), food poisoning, or a respiratory illness. (4)

If you suspect you or your child has appendicitis, seek immediate care. (2)

Appendicitis Symptoms in Pregnancy: Be Aware of These Signs

Pregnant women with appendicitis most often experience appendicitis symptoms that include:

• Lack of appetite
• Nausea
• Vomiting
• Pain in the lower right abdomen

Fever and diarrhea are less common in appendicitis during pregnancy.

Pregnant women may also experience other symptoms not often seen in nonpregnant adults with appendicitis, including urination that’s painful or difficult, uterine contractions, and pain in the upper right belly, possibly as a result of the appendix changing its position during pregnancy. (5) Appendicitis can be challenging to recognize during pregnancy because of the abdominal and gastrointestinal discomfort pregnancy already causes in some women, and because of changes in the body shape due to an enlarged uterus. (6)

How Appendicitis Is Diagnosed — and Sometimes Misdiagnosed

To diagnose appendicitis, your doctor will begin with your medical history and ask more detailed questions about your abdominal pain, other symptoms you’ve experienced, medical conditions you may have, and your alcohol and drug (both legal and illegal) use.

Your doctor will then perform a physical exam and look for signs of an inflamed appendix, including: (2)

• Rebound tenderness
• Rovsing’s sign, in which you experience pain in the lower right side of your abdomen when pressure is applied and released on the lower left side of your abdomen
• Psoas sign, in which flexing your psoas muscles near your appendix causes abdominal pain
• Obturator sign, in which pain is felt during flexion and internal rotation of the hip
• Guarding, in which you subconsciously tense your abdominal muscles before your doctor touches your belly

It may also be necessary to examine your rectum, which may be tender from appendicitis.

But these signs don’t necessarily mean you have appendicitis; they can occur with other conditions, too. Your doctor will likely order a number of laboratory tests that will point toward a diagnosis of appendicitis. These can include a blood test to look for signs of infection, a urine test to rule out urinary tract infections and kidney stones, and a pregnancy test if you’re a woman.

Additionally, your doctor may conduct imaging tests, including abdominal ultrasounds and magnetic resonance imaging (MRI) scans. These tests can reveal inflammation and rupturing of the appendix, appendix obstructions that can cause appendicitis, and other sources of abdominal pain. Computerized tomography (CT) scans are also typically used to diagnose appendicitis, but the radiation from CT scans can be harmful to a developing fetus, so CT is usually avoided in pregnant women. (2)

Because the symptoms of appendicitis are similar to so many other conditions, it is sometimes misdiagnosed. One study found that almost 12 percent of all appendectomies performed in the United States between 1998 and 2007 occurred in people who did not in fact have appendicitis, but had some other condition. (7)

Additional reporting by Deborah Shapiro.

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Editorial Sources and Fact-Checking

1. Appendicitis. MedlinePlus. April 4, 2021.
2. Symptoms and Causes of Appendicitis. National Institute of Diabetes and Digestive and Kidney Diseases. July 2021.
3. Appendicitis. KidsHealth. May 2015.
4. Appendicitis in Children Stanford Medicine Children’s Health.
5. Pastore P, Loomis D, Sauret J. Appendicitis in Pregnancy. Journal of the American Board of Family Medicine. November–December 2006.
6. Rebarber A, Jacob B. Acute Appendicitis in Pregnancy. UpToDate.com. August 2022.
7. Seetahal S, Bolorunduro O, Sookdeo T, et al. Negative Appendectomy: A 10-Year Review of a Nationally Representative Sample. American Journal of Surgery. April 2011.

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