How Do You Know if Your IBS Pain Isn't Appendicitis?

Doctor assisting patient with severe abdominal pain
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As you probably well know, pain from irritable bowel syndrome (IBS) can be quite severe. You may have even worried if your pain was coming from something more serious than IBS — like how you would know if you were having an attack of appendicitis instead? Your concerns are certainly understandable. As you will see as you learn about any relationship between IBS and appendicitis, even doctors sometimes have a hard time knowing the difference!

What Is Appendicitis

Appendicitis is a serious health condition in which the appendix becomes inflamed and filled with pus. This may happen due to a blockage caused by fecal matter, a swollen lymph node, a foreign object, or in rare cases, a tumor. When appendicitis occurs, the appendix needs to removed immediately to prevent it from bursting, as that can lead to life-threatening complications.

When an appendix ruptures, its contents can spill into your abdominal cavity, leaving you at high risk for a severe, and potentially lethal, infection known as peritonitis. Although the ultimate treatment for a ruptured appendix is an appendectomy (surgical removal), your doctor may first start you on a course of antibiotics to reduce the infection before performing the surgery.

Symptoms of Acute Appendicitis

The following are the symptoms of acute appendicitis. If you are having these symptoms, you need to seek immediate medical attention.

Do not try self-treatment, as your efforts may make things worse.

  • Initial pain is located around your belly button
  • Pain worsens and moves to the lower right part of your abdomen
  • Pain may worsen with movement or coughing
  • Loss of appetite
  • Nausea
  • Vomiting
  • Low fever
  • Chills and shaking

Note: Appendicitis can present with different symptoms for different people and the severity of symptoms can be quite varied.

If you have any suspicion of a problem with your appendix, call your doctor immediately.

Your symptom picture may change if your appendix were actually to rupture:

  • Pain may ease up temporarily, but then worsen
  • Your abdomen may become very tender to touch
  • Worsening of all of the above symptoms

Are You at Risk for Unnecessary Surgery?

Because the complications of acute appendicitis are so serious, surgeons typically err on the side of caution and choose to remove the appendix of anyone whose symptoms indicate a problem with the appendix. This leads to a high rate of what is called a "negative appendectomy," which is the removal of a non-inflamed appendix. The rate of negative appendectomies is approximately 15 percent, even with the use of modern diagnostic technology.

Unfortunately, IBS patients appear to be at a higher risk for unnecessary surgeries in general, including unnecessary appendectomies. Research suggests that this higher risk appears to be due to several factors: IBS patients are more likely to seek treatment and they tend to be more anxious.

However, this higher rate is also related to doctors who do perform CAT scans prior to surgery.

Is There Such a Thing as Chronic Appendicitis?

To further muddy the waters, there is a small group of researchers and doctors who argue that there is a condition known as chronic appendicitis, otherwise known as recurrent appendicitis, appendicopathy syndrome or neurogenic appendicopathy. This notion is not widely accepted and even in those who attest to the presence of such a syndrome, they acknowledge that it is quite rare. It is theorized that the condition is related to some type of partial or intermittent obstruction of the appendix.

If there is such a thing as chronic appendicitis, how would one tell the difference between it and IBS? Both syndromes would involve recurrent abdominal pain, often worsened by a large meal, and symptoms of chronic diarrhea, constipation or both. Those who argue for the existence of chronic appendicitis would consider the diagnosis when the recurring pain is manifested in the lower right corner of the abdomen.

Can an Appendectomy Relieve Chronic Pain?

Those who argue for the existence of chronic appendicitis also propose surgery as a treatment. There are several case reports of patients who experienced chronic lower right side abdominal pain achieving significant or total pain relief after having their appendix removed, even though the appendix showed no sign of inflammation. It is important to note that these are only case reports — no randomized, control group studies have yet to be conducted.

However, given the fact that many IBS patients undergo unnecessary surgery, as of now, most experts would strongly advise against an appendectomy for a person who has IBS — unless, of course, there are signs of acute appendicitis. For this opinion to change, evidence would have to be provided, through randomized, control group studies, to show that such an invasive intervention would actually provide ongoing symptom relief to a person who has a functional gastrointestinal disorder such as IBS.

The Bottom Line

If you are experiencing any of the symptoms of acute appendicitis, you need to get yourself to the emergency room as soon as possible. If you have any questions about your IBS diagnosis, talk to your doctor. They are in the best position to assess whether your symptoms fit the criteria for IBS as opposed to the more unlikely possibility that the problem really lies within your appendix.

Sources:

"Appendicitis" Medline Plus Accessed April 12, 2016.

de Kok, H. "Is there an overlap between irritable bowel syndrome and appendicopathy syndrome? A new theory." Medical Hypotheses 2010 75:501-504.

Longstreth, G. "Avoiding unnecessary surgery in irritable bowel syndrome" Gut 2007 56:608–610.

Lu, C., et. al. "Irritable bowel syndrome and negative appendectomy: a prospective multivariable investigation" Gut 2007 56:655–660.

Machado, N. & Machado, N. "Neurogenic Appendicopathy: A Historical And Contemporary Review" World Journal of Colorectal Surgery 2014 4:

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