Can Appendicitis Pain Come and Go for Day or Week? Doctor Explains.

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What is the typical scenario in appendicitis?

Appendicitis passes through a rapidly progressive course. Appendicitis pain increases quickly and becomes severe in less than 24 hours in most cases.

The following is the typical scenario in appendicitis:

  • It starts with mild abdominal pain around the umbilicus (belly button).
  • Within hours, the inflammation of the umbilicus irritates the peritoneum over it (the peritoneum is a thin layer that envelopes most of the abdominal organs). When the peritoneum becomes irritated, the pain localizes in the lower right abdomen.
  • The pain starts mild and may come and go. Soon, it becomes more severe, constant, and localizes.
  • Nausea and anorexia follow the onset of pain (pain is the first sign).
  • The pain doesn’t improve with defecation (unlike the pain from IBS and gastroenteritis).
  • Severe tenderness and gardening over the area of pain.
  • Fever (in 40% of the cases).
  • Diarrhea or constipation.
  • Generalized fatigue (malaise).
  • Sometimes, urinary frequency or urgency.

Note that classical appendicitis picture doesn’t occur in 100% of patients. The severity of pain depends on many factors such as:

  • The severity of inflammation.
  • The site of the tip of the appendix inside your abdomen.
  • The use of medications (as analgesics) may mask the symptoms.

For example, The classical shift and localization of pain from the umbilicus to the right-lower abdomen occurs only in 50% to 60% of the cases (reference)

Moreover, Chronic presentation with mild acute attacks of pain that comes and goes was also reported (reference).

Can appendicitis pain come and go in the first hours or days?

Appendicitis pain is the first symptom. It may start as a mild pain that comes and goes for few hours. However, it soon becomes more constant and severe. Abdominal pain that comes and goes for days in the form of colics is unlikely to be appendicitis.

The pain from appendicitis is classically constant. It may only come and go in the first few hours. It is unlikely for appendicitis pain to be intermittent for days.

Here are some tips that will help you suspect appendicitis:

  • Appendicitis pain classically starts around the umbilicus.
  • As the inflammation progresses, the pain shifts to the right lower abdomen.
  • The pain from appendicitis markedly increased with movements, straining, coughing, or bending your thigh.
  • The pain from appendicitis rises over time. It is not typical for appendicitis pain to remain mild or intermittent.
  • The pain is sharp and constant, unlike gastroenteritis or IBS, which is in the form of colics that comes and goes.

MORE:

Can appendicitis pain come and go for weeks?

Appendicitis pain can turn chronic if misdiagnosed or not treated. Chronic appendicitis is a rare possibility but exists. In such cases, appendicitis pain can come and go for weeks or months in the lower right abdomen.

In one study on 269 Italian patients, 14.2% of them were found to have evidence of chronic inflammation of their appendices.

These patients reported appendicitis pain that continued to come and go for weeks or months before the appendectomy operation (reference).

Another 2002 german study found evidence of chronic inflammation of the appendix in a group of patients operated for appendicitis (reference).

This group of patients suffered from significantly more extended periods of pain (more than a week) than other patients with acute appendicitis.

However, These studies are still small and not enough to validate the issue of chronic appendicitis (reference). Therefore, we need more research in this area.

What are the mimics of appendicitis pain that come and go?

Several conditions can mimic appendicitis pain. For example, the below condition can cause lower right abdominal pain that comes and goes:

  • Acute gastroenteritis (stomach flu and food poisoning): in such case, nausea, and diarrhea often proceeds the pain. After that, diarrhea and vomiting are more prominent. And the pain can occur where and it is partially relieved by defecation.
  • Irritable bowel syndrome.
  • Mesenteric adenitis.
  • Right renal colics.
  • Inflammatory bowel diseases (Crohn’s commonly affect the right lower abdomen).
  • Familial Mediterranean fever.
  • Cecal diverticulitis.
  • Right ovary pain or right pelvic inflammatory disease.
  • Right ectopic pregnancy, and others.

An organism called yersinia can cause a form of gastroenteritis that leads to right lower abdominal pain (especially in children). In addition, the organism causes inflammation of the lymph nodes in the right lower abdomen that produces a picture that mimics appendicitis.

The following are the main differences (reference):

 
Appendicitis (early stage)
Enteritis
1. Abdominal pain Location
Around umbilicus then shifts to the right.Anywhere, mainly in the lower central abdomen
2. Improvement of pain after defecation
NoYes (partial or complete)
3. Nausea onset
After the onset of pain.Before the onset of pain
Fever
None or slightNone or slight
Pain on touching the abdomen (tenderness)
May not present around the umbilicus in the early stages.Mild or none.
Vomiting
in <50% of cases (children)in >50% of patients (children)
The course of pain
-Increases over time-becomes more localized (lower right)starts severe and often decreases over time.
White blood cell count
often > 10000Often < 10000