Can Stress Cause Appendicitis? Gastroenterologist Explains.

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Summary: can stress cause appendicitis?

There is no scientific evidence that suggests that stress or emotions are a direct cause of appendicitis. The inflammation of the appendix is primarily caused by an obstruction and bacterial infection.

Few studies found that acute stressors are associated with acute appendicitis. However, the link is controversial and not well established until now (reference).

Stress is known to influence your digestive system. Many functional Gastrointestinal diseases such as Irritable bowel syndrome and functional dyspepsia are linked to psychological factors such as stress.

Another theory is that stress, anxiety, and depression may affect your immune system. a weakened immune system can trigger inflammation and infections such as appendicitis (reference).

What we know about the causes of appendicitis.

The established causes of appendicitis are its obstruction and subsequent infection. Obstruction of the appendix can be due to a hard stool mass (fecalith), swollen lymphatics, appendix stone, or severe inflammation and swelling.

Appendix obstruction is often the trigger of appendicitis. Obstruction allows for bacteria and mucus to build up inside the appendix lumen. A rapid inflammation occurs which can lead to abscess formation and rupture of the appendix.


The link between stress and appendicitis (Research evidence).

In 1992, Dr. Beaurepaire and his research team published a research article in the (Journal of Psychosomatic Research). The team studied the link between psychological stressors and appendicitis.

Here are their most important findings:

  • Severe short-term stressors (as goal frustration) are associated with the development of acute appendicitis.
  • However, the link between the two conditions was very weak and debatable.
  • Acute rather than chronic stress was more associated with acute appendicitis.
  • Psychological stressors such as depression can cause non-inflammatory appendicitis-like pain (without actual appendix inflammation).

Interestingly, Stress and other psychological diseases are known to affect your digestive system.

One interesting study found that people with functional bowel diseases are two times more likely to undergo appendectomy operations! (Reference).

Functional Gut diseases such as irritable bowel syndrome are linked to psychological stressors such as anxiety and depression.

Stress and anxiety can result in (functional) or (non-organic) abdominal pain. The abdominal pain from stress can simulate appendicitis without actual inflammation of the appendix.

How does stress affect your immunity?

The alternation of your immune system is another explanation of the relationship between stress and appendicitis.

Acute stress can initially stimulate your immune system. However, as stress continues, the released stress hormones weaken the immune system. A week immune system will raise the odds of infection (reference). 

Appendicitis is a bacterial infection. So, it can occur as a result of a weakened immune system.

How can stress affect your gut health?

Your gut has billion of nerve cells that acts to regulation your digestive processes independently of the brain. This massive collection of nerve cells inside your digestive system is called the enteric nervous system.

The enteric nervous system and your central nervous system interact and affect each other (the brain-gut axis). Chronic stress has profound effects on your digestive system through the affection of the brain-gut axis.

The digestive system has the longest list of the functional diseases that are all linked to stress such as:

  • Irritable bowel syndrome.
  • Functional dyspepsia.
  • Functional bloating.
  • Functional bloating and functional abdominal pain.

Moreover, chronic stress can affect the immunity of your digestive system. Chronic stress can alter the bacterial microenvironment (the gut microbiome). A decreased gut immunity will make your digestive system more vulnerable to inflammatory diseases (such as inflammatory bowel diseases) and infection.

Although there is no direct link between stress and appendicitis. But the long-term effects of stress on gut health and immunity may play a role in appendicitis. More research is needed in this area.

MORE: What Does Anxiety Stomach Pain Feel Like? 5 Pain Types Explained.

Can stress cause appendicitis to rupture (burst appendix)?

No scientific evidence suggests a direct link between emotional stress and the rupture of the appendix. A burst appendix is primarily caused by a combination of infection, obstruction and pressure build-up inside the inflamed appendix.

Stress can affect your overall health and immunity. Theoretically, stress can aggravate inflammation and complications of appendicitis (such as perforation). But there are no strong well-designed studies that tested that theory.