Appendicitis usually unfolds over hours, not days. The first sign is often a vague pain around the belly button, followed by loss of appetite, nausea and vomiting, and then pain that moves to the lower right belly and keeps getting worse. Cleveland Clinic says an inflamed appendix can burst within 36 hours of the first symptoms, so the safest time to get checked is as soon as you notice this pattern.
Appendicitis is a medical emergency. Don’t wait to see if it passes. If you or your child has belly pain that keeps getting worse, moves to the lower right side, or comes with vomiting or fever, see a doctor or go to the emergency room right away. A burst appendix can cause a life-threatening infection. If you think it’s an emergency, call 911.
In the short video above, family physician Dr. Richard Honaker describes the typical order of appendicitis symptoms in a child. Pain starts first, right around the belly button. An hour or two later come nausea and vomiting, in that order. An hour or two after that, the pain moves down to the lower right side of the belly, where the appendix is. He calls that progression very suggestive of appendicitis, though appendicitis can show up in many different forms.
What are the first signs of appendicitis?
The earliest signs are easy to brush off as a stomach bug or gas:
- Pain around the belly button or in the upper middle belly. MedlinePlus says it may start minor. Cleveland Clinic says it may hover or come and go for several hours.
- Loss of appetite. MedlinePlus and Cleveland Clinic both list it among the early or common symptoms.
- Nausea and vomiting, which typically come after the pain starts.
- A low fever, which MedlinePlus lists as an early symptom.
NIDDK adds that the pain may start suddenly, may wake you from sleep, and may feel different from any pain you’ve had before.
The typical appendicitis timeline
No two cases follow the same clock, and the sources give different time frames for each stage. This table lists the typical order and only the timings the sources give.
| Stage | What happens | Timing the sources give |
|---|---|---|
| 1. Pain begins | Vague pain around the belly button or upper middle belly | Cleveland Clinic: may hover or come and go for several hours |
| 2. Stomach symptoms | Loss of appetite, nausea, vomiting | Dr. Honaker (in the video): an hour or two after the pain starts |
| 3. Pain moves | Pain shifts to the lower right belly, gets sharper and easier to point to, and worse with movement | Dr. Honaker: an hour or two after the nausea and vomiting. MedlinePlus: most often 12 to 24 hours after the illness starts. NHS: after a few hours |
| 4. Later symptoms | Fever, chills and shaking, diarrhea or constipation, a swollen belly | MedlinePlus lists these as later symptoms |
| 5. Risk of bursting | The inflamed appendix can burst | Cleveland Clinic: within 36 hours of the first symptoms. Merck Manual: less than 36 hours after symptoms begin |
Cleveland Clinic says only about half of people with appendicitis follow the classic pattern. Children, older adults and people who are pregnant are less likely to have typical symptoms. If the order is different, or the pain is somewhere else, it can still be appendicitis. For where the pain usually sits, see Where is your appendix?
How fast can an appendix burst?
There’s no exact deadline, but the risk rises the longer appendicitis goes untreated.
- Within about 36 hours. Cleveland Clinic and the Merck Manual both say an inflamed appendix can burst within 36 hours of the first symptoms.
- Delays raise the risk. A review in American Family Physician found that in children, a delay of more than 48 hours from the start of symptoms to diagnosis and surgery was linked to more ruptures than care within 24 hours.
- It’s common. The American College of Surgeons says a ruptured appendix occurs in up to 32% of people with acute appendicitis. The risk is higher in the very young, the very old and during pregnancy.
A burst appendix can cause peritonitis, an infection of the lining of the belly that can be life-threatening, or a pocket of pus called an abscess. It usually means a longer recovery.
Warning: pain that suddenly eases
Feeling better doesn’t always mean you are better. The Merck Manual says that after the appendix bursts, pain may lessen for several hours before peritonitis develops. NHS says the pain may briefly ease, then become severe and spread across the whole belly, with movement becoming very painful. If belly pain eases and then returns worse, get emergency care.
Can appendicitis pain come and go?
Early on, it can. Cleveland Clinic says the first pain around the belly button may hover or come and go for several hours. After that, the pain usually becomes steady and keeps getting worse. The American Academy of Pediatrics says a child’s appendicitis pain will continue and become worse over time.
familydoctor.org says appendicitis symptoms can start fast and get worse over time. NHS advises getting urgent advice for belly pain that is gradually getting worse or not going away.
Can appendicitis go away on its own?
Rarely. Cleveland Clinic says it’s possible but unlikely, for example if a blockage passes, and warns not to assume it has gone away even if the pain eases. The Merck Manual says that without surgery or antibiotics, appendicitis is fatal in many people.
Can antibiotics treat appendicitis without surgery?
Sometimes, for mild cases where the appendix hasn’t burst. NIDDK says some mild cases may be treated with antibiotics alone, but surgery to remove the appendix (appendectomy) is still the standard treatment. The catch is that appendicitis often comes back: the American College of Surgeons and American Family Physician both report that about 40% of people treated with antibiotics needed their appendix removed within a year. NHS says antibiotics alone may be used if the infection hasn’t spread and surgery is high-risk for you. This is a decision to make with a surgeon, not a reason to wait at home.
How to know if you have appendicitis
You can’t confirm it at home. Watch for:
- pain that started around the belly button and moved to the lower right side
- pain that keeps getting worse over hours
- pain that’s worse when you walk, cough, sneeze or ride over bumps
- loss of appetite, nausea or vomiting after the pain started
- fever
The jump test. In the video, Dr. Honaker suggests having a child jump off a step just 6 or 8 inches high. If their stomach hurts worse when they land, that’s what doctors call rebound, a sign of inflammation inside the belly; his advice is to get it checked out. Pain-free landing doesn’t rule appendicitis out, and a child who is already in a lot of pain shouldn’t be asked to jump. More on this: Appendicitis Jump Test: What Belly Pain When Landing Can Mean.
At the hospital, doctors combine your history, a physical exam, blood and urine tests, and often an ultrasound, CT or MRI. Tell them when the pain started, where it was at first, and whether nausea came before or after the pain. In women, appendicitis can look like other conditions; see Appendicitis symptoms in women. For the full guide, see Appendicitis Symptoms Explained.
Go to the ER if
Get emergency care, or call 911, for:
- belly pain that moved to the lower right side, or keeps getting worse
- sudden, sharp or severe belly pain
- a rigid, hard or very tender belly
- pain that eased and then came back worse and spread across the belly
- vomiting and being unable to pass stool, vomiting blood, or blood in the stool
- trouble breathing, confusion, or blotchy or unusually pale skin
- belly pain during pregnancy, or when you could be pregnant
While you wait: don’t take medicine for belly pain without checking with a health care provider, and don’t give a child food or drink if appendicitis is suspected. Don’t drive yourself if the pain is severe.
Frequently asked questions
What are the 1st signs of appendicitis?
Usually a vague pain around the belly button or upper middle belly, followed by loss of appetite, nausea and vomiting. A low fever may follow. Then the pain moves to the lower right belly.
How long can you have appendicitis before it bursts?
There’s no set time. Cleveland Clinic says it can burst within 36 hours of the first symptoms. The longer it goes untreated, the higher the risk, so don’t wait.
Can appendicitis pain come and go?
Early pain may come and go for several hours, according to Cleveland Clinic. Then it usually becomes constant and gets worse. Pain that suddenly eases can be a sign the appendix has burst.
Can you have appendicitis for days?
Some people go longer before getting care, but that raises the risk of a burst appendix. In children, delays of more than 48 hours were linked to more ruptures. Any belly pain that’s getting worse should be checked the same day.
Can appendicitis go away with antibiotics?
Some mild cases can be treated with antibiotics alone, but about 4 in 10 people treated this way needed surgery within a year. Surgery is still the standard treatment.
Find a doctor
For a child’s belly pain, call your pediatrician or family doctor, such as family physician Dr. Richard Honaker, or go to the emergency room if it could be appendicitis. An appendectomy is done by a general surgeon; general surgeons on Best Docs Network include Dr. Jason Harrison, Dr. Robert Santaella and Dr. Robert Pollard, all in Dallas-Fort Worth.
Sources
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK, NIH): Symptoms & Causes of Appendicitis
- NIDDK: Diagnosis of Appendicitis
- NIDDK: Treatment for Appendicitis
- MedlinePlus (National Library of Medicine, NIH): Appendicitis
- MedlinePlus: Abdominal pain
- Cleveland Clinic: Appendicitis
- Merck Manual Consumer Version: Appendicitis
- NHS: Appendicitis
- HealthyChildren.org (American Academy of Pediatrics): Appendicitis in Children and Teens
- familydoctor.org (American Academy of Family Physicians): Appendicitis
- American College of Surgeons: Appendectomy
- American Family Physician (American Academy of Family Physicians): Acute Appendicitis: Efficient Diagnosis and Management (2018)
This article is for general information only and is not medical advice. Talk with a qualified health professional about your own situation. If you think you may have a medical emergency, call 911.
